We carried out a review of the data available to us about Cherwood House Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cherwood House Care Centre, you can give feedback on this service.
People’s experience of using this service:
People living at Cherwood House received safe care from skilled and knowledgeable staff. People told us they felt safe receiving care from the service. Staff understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.
Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely and people received their medicines as prescribed.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. However, recording of mental capacity assessments needed improving. People were supported to maintain good health and to meet their nutritional needs.
People told us staff were caring. Staff consistence enabled people to receive good care from staff who knew them well. People had access to a variety of activities to prevent social isolation.
Cherwood House was well-led which resulted in provision of good care. The service had a clear management and staffing structure in place. Staff worked well as a team and had a sense of pride working at the service. The provider had quality assurance systems in place to monitor the quality and safety of the service.
The service was an integral part of the local community. The team facilitated various community links that reflected the needs and preferences of the people who used the service.
We have made a recommendation about recording of MCA.
Rating at last inspection:
At our last inspection we rated the service requires improvement. Our last report was published on 25 May 2018.
Why we inspected:
This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.
Follow up:
We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Cherwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care home accommodates up to 119 people. At the time of the inspection there were 87 people living at the service.
There were two registered managers in place, one for each unit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our last inspection on 19 September 2017, we found the provider was in breach of five legal requirements. We asked the provider to take action and make sure people were safe and were treated with dignity and respect. We also asked the provider to make sure make sure people were supported in line with the principles of the Mental Capacity Act (2005). We asked the provider to take action to make sure people’s records were completed and maintained. We further asked the provider to take action and ensure they had effective quality assurance systems in place.
Following our inspection in September 2017, we imposed conditions on the provider's registration to restrict any new people being admitted to the service and to require monthly reports of actions they were taking to improve. At this inspection, we found some significant improvements had been made. However, more improvements were still required in some areas.
The provider did not have any systems in place to identify and manage any potential risks related to legionella disease.
We saw evidence that arrangements were in place to formally assess, review and monitor the quality of care provided at the home. However, these systems were not always effective. Some people’s records were not always updated to reflect changes. The provider had systems to record and manage accidents and incidents. However, trends were not always identified.
People told us they were safe living at Cherwood House. Staff demonstrated they understood how to keep people safe and we noted that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed.
We observed people's needs were met in a timely way by sufficient numbers of skilled and experienced staff. Staff told us they were well supported by the management team. Staff support was through regular supervisions (one to one meetings with their line manager) and appraisals to help them meet the needs of the people they cared for.
People had their needs assessed prior to living at Cherwood House to ensure staff were able to meet people’s needs. Staff worked closely with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible.
People were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, best interest decisions had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety. However, recording around specific decisions needed further improvement.
People’s care plans gave details of support required. The provider had a complaints policy and people knew how to complain. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements.
People, their relatives, staff and healthcare professionals told us they felt Cherwood House was well run. The registered managers and management team promoted a positive, transparent and open culture.
When we completed our previous inspection on 19 September 2017 we found concerns relating to people's care records not updated. At this time this topic area was included under the key question of Responsive. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of Well-Led. Therefore, for this inspection, we have inspected this key question and also the previous key question of Responsive to make sure all areas are inspected to validate the ratings.
We have made a recommendation about recording of the MCA.
We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.
Cherwood House Care Centre provides nursing and residential care for people over the age of 65. The home offers a service for up to 119 people. At the time of the inspection there were 97 people living at the service. Some of the people at Cherwood House were living with dementia.
There were two registered managers in post, one for the residential unit and another one who was a Matron for the nursing unit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Cherwood House did not have enough staff to meet people’s needs and keep them safe. Staff told us they often worked short staffed and records confirmed planned staffing levels were not always met. We observed the shortage of staff to have a negative impact on the promptness of support people received and the interaction they received with staff.
Staff at Cherwood House did not always manage risks to people. Where people’s needs had changed, risk assessments and risk management plans were not always updated. People did not have any personal emergency evacuation plans (PEEPS) in place. People were exposed to the risk of harm in the event of an emergency evacuation. The provider took action to address this concern.
People’s medicines were not always managed safely. Where people were prescribed when necessary medicines (PRN), there were no PRN protocols in place to guide staff. Medicine administration records were not always complete. There was no system in place to monitor boxed medicines. Where people’s medicines were being administered covertly, this was not done safely.
The registered manager and staff did not understand the Mental Capacity Act 2005 (MCA) and understand their responsibilities under the Deprivation of Liberty Safeguards (DoLS). As a result people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.
People's nutritional needs were met and they were given choices. However, some people did not receive their meals in a timely and dignified manner. Staff sometimes used in appropriate language to refer to people which did not respect their dignity. Support with personal care was not always delivered in a way which met people’s individual needs or respected their privacy.
People’s care plans were not always person centred and often had conflicting information to that recorded in daily records. People’s care records were not up to date and did not reflect current care.
The provider’s systems and processes to monitor and improve the quality and safety of the service were ineffective in identifying areas for improvement and ensuring that changes were made to improve the quality and safety of the service. Accidents and incidents were not always recorded and followed up.
People who were supported by the service told us felt safe living at Cherwood House. Staff had a clear understanding of how to safeguard people and protect their health and well-being. The provider followed safe recruitment practices.
Staff worked closely with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner. Staff knew the people they cared for. People's choices and wishes were respected and recorded in their care records. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.
People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements.
The registered managers informed us of all notifiable incidents. People and staff spoke positively about the management and leadership they had from the registered managers.
We identified five breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
We inspected Cherwood House Care Centre on 15 June 2015. It was an unannounced inspection. We previously inspected the service in January 2014, when we identified People did not always have records that were accurate or contain information about how they should be supported. This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to send us a plan outlining what actions they would take to bring the service up to the required standard. At this inspection we found these actions had been completed but identified some further improvements were still required. This was because people's changing needs were not always documented in people’s records in a timely way.
The service provides nursing, residential and extra care housing for people over the age of 65. Some people at the service were living with dementia. The home offers a service for up to 116 people.
There were two registered managers at the service, one for the residential care and extra care housing services and one for the nursing wing. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. People and staff felt the service was well led and the management team were open and approachable. There were a range of quality monitoring systems in place that were used to monitor and improve the quality of the service.
There were enough staff to meet people’s needs. People felt safe and supported by competent staff. Staff felt motivated and supported to improve the quality of care provided to people and benefitted from regular supervision and appraisal. Staff were encouraged and supported to gain further skills and knowledge to be able to meet people’s specific needs.
People described the service as a community and valued their relationships with staff and each other. People felt they mattered and spoke highly of the staff and of the quality of care they received. People were cared for in a caring and respectful way. Staff demonstrated an appreciation of people’s individual needs around privacy and dignity.
People were provided with person-centred care which encouraged choice and independence. Staff knew people well, understood their individual preferences and unique ways of communicating. Risks to people’s health were identified and plans were in place to minimise the risks. People were supported to maintain their health and were referred for specialist advice as required.
People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable. People who had lost weight had a plan in place to manage their weight loss. People were supported with specialist diets and nutritional supplements as prescribed.
Where people were receiving end of life care they and their families were supported in a caring and compassionate way. Other professionals were involved and the service strived to ensure people experienced a comfortable and dignified death.
People knew how to make a complaint if required. People’s views about the quality of the service were sought through residents’ meetings and surveys. However, people told us their views were not always acted on because they had asked for an art board to be put back up on the wall but it had not been done.
Medicines were stored and administered safely.
The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions or who may be deprived of their liberty for their own safety.
We found that people were asked for their consent and the provider acted in accordance with their wishes. People we spoke with and people acting on their behalf felt that staff ensured they were asking for consent before giving support. One person told us, 'yes, they always ask me first, listen to what I say and tell me what is happening'. We also saw that people were signing to consent to care plans. We spoke with the relative of one person living with dementia, they told us, 'I am spoken to with regard to decisions, we discuss best interests and they consult me on even minor details'.
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We saw that some people had complex needs and in one file we reviewed we saw that one person required support with all their mobility and was also at high risk of pressure sores. We saw a care plan in place to prevent pressure sores occurring and risk assessments in place to ensure the person and care staff were safe when mobilising and their needs were met. We saw during our SOFI observation that care staff were patient and respectful when supporting people to move around freely.
We saw that the design, layout and security of the premises safely met the needs of everyone who received care and treatment including those with dementia We saw that the risks to people's safety had been identified and were being managed. For example we saw that appropriate fire checks and equipment checks were completed on a regular basis. We saw that the design of the premises promoted people's dignity, independence and wellbeing.
Staff we spoke with felt supported and felt if they had concerns managers would listen. All staff confirmed they received regular supervision and could also go to their supervisor for support in between if necessary. The registered manager on the residential wing told us, 'We do have regular meetings, and we conduct responsive meetings when we identify concerns'. All staff had the opportunity to obtain further qualifications and training.
We found that both wings had an effective system in place to audit quality and manage risk. We found that issues identified through these audits were acted upon. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw satisfaction surveys for both the residential and nursing wings.
We found that people were not always fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. For example, we observed one person on the nursing wing drinking squash that had been thickened to double cream consistency, staff we spoke with confirmed this was correct and had 'been doing it for a couple of weeks', but did not know where the recommendation had come from. The 'lead carer' confirmed that the thickening of the fluid was the latest recommendation which we saw in the person's notes, but was not recorded in this person's care plan.