Archived: Cherry Tree Care Centre

Updated 28 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 9 October 2018 and the first day was unannounced.

The inspection team consisted of an adult social care inspector, an assistant inspector, a medicines inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

We reviewed information we held about the service, including the notifications we had received from the registered provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We also contacted the local authority commissioners for the service and the local Healthwatch to gain their views of the service provided. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the feedback received when planning our inspection.

During the inspection we spoke with eight people who lived at the service and three relatives. We looked at six care plans and medicine administration records (MARs) along with other aspects of medicine management across the home. We spoke with eleven members of staff, including the manager, deputy manager, care staff, activities staff and kitchen staff. We looked at four staff files, including recruitment records.

Updated 28 November 2018

This inspection took place on 4 and 9 October 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming.

When we completed our previous inspection in February 2016 the service was rated good. At this inspection we found the service was no longer meeting all the required standards to retain this rating.

This is the first time the service has been rated requires improvement.

Cherry Tree Care Centre 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 service can accommodate a maximum of 42 people across two floors, each of which have separate adapted facilities. The first floor specialises in providing care to people living with dementia. At the time of this inspection there were 38 people using the service.

The previous registered manager of the service formally de-registered with CQC in January 2017. There had been no registered manager in place since that time. This has been dealt with outside of the inspection process. A new manager has now been appointed and begun the registration process. 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.

The systems in place for medicines management did not keep people safe.

When we arrived at the service on the first day of inspection the rear of the property was not secure. This meant people could leave the building when it was not safe for them to do so and also left people vulnerable to the risk of intruders. There were a number of environmental hazards around the service. Unattended kettles, bottles of alcohol and cleaning items were all easily accessible.

Accidents and incidents were recorded but there was no evidence that lessons had been learned as a result of this monitoring. The service did not always accurately monitor risks to people or ensure staff had the information necessary to minimise those risks.

There was currently no system in place to determine the number of staff or skill mix required to safely meet people’s needs. There was evidence of safe recruitment practices. Appropriate checks had been done before staff started work to reduce the risk of unsuitable people being employed. Where agency staff were used inductions were not always carried out.

Staff had received safeguarding training and they were able to explain what they would do if they had any concerns.

Maintenance and health and safety checks of equipment were regularly conducted. Records showed that when an issue was identified this was quickly rectified. Tests of fire equipment was undertaken but there had not been a recent evacuation drill.

There was a training matrix for mandatory training but the manager had no oversight of what additional training staff had undertaken. Specialist training had not been delivered to cover all aspects of people’s care needs, for example in behaviours that challenge or stoma care.

Staff did not always have time to read people’s care plans and therefore did not always have access to up to date information about their needs.

Staff had not all had regular supervision in line with the provider’s policy. Some staff had not had a supervision meeting since January 2018.

Kitchen staff had a good knowledge of people's dietary requirements and were able to tell us the adjustments they would make to support people’s diets. Mealtimes were calm and relaxed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, some best interest decisions did not clearly indicate who had been involved in the decision-making process.

People were supported to maintain their health and wellbeing. People's care records contained evidence of visits and advice from a variety of health professionals.

The use of dementia friendly signage was not consistent throughout the building.

Prior to admission a full assessment of people’s care needs was undertaken. This was a comprehensive document that looked at all aspects of people’s needs including any religious beliefs or cultural requirements

People who used the service and their relatives were very happy with the care their loved ones received. Staff treated people with dignity and respect and promoted independence.

People told us they felt staff did treat them as individuals. However, care plans were not written in a personalised way, instead they listed the general tasks necessary to provide basic support to the person. Activities were not tailored to meet people’s personal preferences.

There was a complaints procedure in place and people were aware of how to make a complaint if necessary.

Care plans were not up to date or accurate. Audits were not picking up on the issues we found and there was no evidence that feedback was being used to improve standards at the service.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.