We carried out a review of the data available to us about Cherry Tree House 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 Cherry Tree House, you can give feedback on this service.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Cherry Tree House is a residential care home providing personal care and accommodation to up to 11 people. At the time of the inspection, nine people were living at the service. The service supports people with a learning disability, autistic people and people with mental health needs.
People’s experience of using this service and what we found
Right Support:
The service gave people care and support in a safe, clean and well maintained environment that met their needs. People personalised their rooms and had input into other areas of the home. The manager had plans in place to review the living environment to better meet people’s wellbeing, sensory and physical needs in line with best practice.
People and their families or representatives were involved in discussions about how they received support. Staff supported people to make decisions in their best interests. People were supported to access specialist health and social care support to maintain their independence, health and wellbeing.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.
Staff avoided restricting people whenever possible. When there was no alternative, restrictions were documented, and staff learned from these incidents to avoid or reduce them in the future.
Right Care:
Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
Staff, people and families worked together to assess and manage the risks people might face. Where appropriate, staff enabled people to take positive risks. People’s support plans reflected their range of needs and this promoted their wellbeing and quality of life.
With the support of regular agency staff, there were enough appropriately skilled staff to meet people’s needs and keep them safe. Staff knew people and had the skills to understand and communicate with them in a way which met their individual needs.
Right Culture:
People received safe care and support because trained staff could meet their needs and wishes. Staff understood the strengths, needs or sensitivities people with a learning disability and/or autistic people may have. This meant people received support which was tailored to their needs.
Although there had been staff changes, a core team of staff knew people well and provided consistent support. The culture was positive, and people’s wishes, needs and rights were at the heart of staff actions and service developments.
Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The manager was keen to develop a culture of improvement and transparency.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 21 April 2021).
Why we inspected
We received concerns in relation to the safety of people who lived at the service, restrictive practices and staff skills and training. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We found no evidence during this inspection that people were at risk of harm from the concerns which had been raised. Please see the safe and well led sections of this full report.
The overall rating for the service has remained good based on the findings of this inspection.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Tree House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information we may inspect sooner.
About the service
Cherry Tree House is a care home which provides accommodation and support for people who have learning disabilities, autistic spectrum conditions or additional needs. At the time of our inspection, nine people were living there.
People’s experience of using this service and what we found
We found people were protected from the risk of harm, and that staff understood their responsibilities in protecting people and reducing the risk of harm. Improvements had been made and health and safety checks and individual risk assessments were documented and provided guidance to keep people safe.
We were assured that people were protected by the prevention and control of infection.
It was acknowledged that there was a high turnover of staff at the service. Agency staff provided support to ensure people were supported safely. Relatives and staff told us it could be difficult when agency did not know the people they supported or the service.
The management team understood their responsibilities, and the service appeared organised and well run. Up to date policies and procedures were in place to provide guidance and support to staff. A system of audits and monitoring was in place to monitor performance and the quality and safety of people’s care. Checks were completed daily, weekly and monthly, and senior staff and managers reviewed these. This meant there was clear oversight and the service complied with legislation and best practice. The management team were clear about their priorities for service improvement and had plans in place to develop the service further.
Staff we spoke with reflected the provider’s vision and aimed to provide person centred care which empowered people and gave them a good quality of life.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. For example, the model of care and support provided maximised people’s choice and control where possible. People's support usually focused on them having as many opportunities as possible to gain new skills and become more independent. There had been some restrictions on this during the coronavirus pandemic, but staff were making efforts to resume meaningful activities and contacts as the most recent period of lockdown eased.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published November 2019), and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns in relation to people’s safety and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry tree House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Cherry Tree House is a care home located in a purpose-built detached property. Communal areas include spacious living and dining areas, kitchens and secure gardens. The property is on two floors with access by lift and stairs. Two self-contained bungalows are within the secure garden.
The service can provide support and accommodation for up to 11 people who have learning disabilities, autistic spectrum conditions or additional needs. At the time of our inspection, eight people were living there.
People’s experience of using this service and what we found
Risks to people’s safety had not always been assessed or reviewed as required. This could place people or staff at risk of harm.
Systems for monitoring, reviewing and improving quality and standards were not always effective. Some checks were not in place, and others did not identify shortfalls or highlight action when required.
The provider had not displayed the latest CQC inspection rating on their website. This meant people did not have easy access to information about the service.
Some care plan reviews had not taken place as scheduled. Care plans were personalised and helped identify what was important to people.
There had been improvements at the service since the last inspection. We received positive feedback about the new manager, and changes had been made to improve the culture and the quality of care provided.
People's medicines were administered and managed safely. Staff received training and the provider regularly checked staff’s competency in the management of medicines.
Staff felt supported and received training and appraisals. Some staff had not had supervision as frequently as the provider required, but a plan was in place to address this. People were supported by enough staff and regular agency staff were used when needed. Staff were safely recruited.
We received positive feedback overall from relatives. They said their loved ones generally seemed happy living at Cherry Tree House. Staff were kind and caring and treated people with dignity and respect.
People were supported to maintain social relationships and participate in some activities. A plan was in place to develop activities further.
Staff had contact with other professionals to ensure people’s needs could be met. People accessed routine and specialist healthcare services and were supported to eat and drink enough to remain healthy.
People were supported to have some choice and control in their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service applied the principles and values of Registering the Right Support and other best practice guidance where possible. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The service was registered for the support of up to 11 people and was not a domestic property. This is not in line with current best practice guidance. However, the building was well established in the residential area, and steps had been taken to ensure it fitted in to the local community. Staff did not wear anything that suggested they were care staff when coming and going with people.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support was now focusing on them having opportunities for them to gain new skills and become more independent, although this was a change which had only been in place for a few months.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of the thematic review, we carried out a survey with the management team during this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. Restraint was used occasionally, and staff had received training in current practice and principles. Review processes including a debrief after the use of restraint were in place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (report published January 2019). There were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found some improvements had been made, however the provider was still in breach of some regulations. The service met the characteristics for a rating of good in caring, effective and responsive. The other areas were rated as requires improvement. The overall rating for the service remained requires improvement. This is the second consecutive time the service has been rated requires improvement.
Please see the action we have told the provider to take at the end of this report.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the previous inspection carried out on 17 September 2016 we rated the service as good and did not identify any breaches in regulation. At our inspection on 30 and 31 October 2018 we found that the registered provider was in breach of multiple regulations 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.
There was not a registered manager in post. A new manager had started and was in the process of completing their induction. They planned to apply to CQC to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
Why we have rated this service as Requires Improvement?
Medicines were not managed safely. We identified discrepancies and recording errors with the medicines system.
Risks had not always been assessed and the appropriate action was not always taken to minimise the risk of harm to people and staff.
Staff were not being supported within their role. Staff did not receive supervision and guidance within their role.
When restraint had been used debriefs were not carried out by staff. Documented debrief information, and detailed clear recording and support are used to learn from the incident and to ensure that restraint has been used legally, appropriately and safely.
The home was not always caring which had affected the wellbeing of people. They did not receive continuity of care which was important to their needs. There was a lack of respect and regard of the person’s needs.
There was a lack of effective leadership in the home and the staff did not feel supported. The provider did not have insight into what was going on in the home and this led to multiple breaches of regulations.
Quality assurance systems were not effective to assess and monitor the quality of service people received and identify any areas that required improvement.
People were protected from the risk of infection. Staff understood the importance of infection control and prevention.
We received mixed feedback about staffing levels at the home. Appropriate checks were made before staff started to work to make sure they were suitable to work in a care setting.
Staff received training to develop the skills needed to care for people effectively. People told us they enjoyed the meals and we saw staff offered people hot and cold drinks throughout the day.
People's care was provided in line with the Mental Capacity Act and staff understood the importance of seeking appropriate consent for care and treatment.
People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.
The service is registered to provide accommodation for up to 11 people and cares for people who predominantly have learning disabilities needs. At the time of this inspection, there were nine people using the service.
There was a registered manager in post. 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 service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. The administration, recording and storage of medication was safe. The registered manager took appropriate steps to ensure suitable people were employed to support the people using the service.
People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).
The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which promoted this.
The service was responsive. Care plans were person centred and provided sufficient detail to provide safe, high quality care to people. Care plans were reviewed and people were involved in the planning of their care. There was a robust complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.
The service was well-led. Quality assurance checks and audits were occurring regularly and identified actions required to improve the service. Staff, people and their relatives spoke positively about the registered manager.
Below is a summary of what we found which describes what we observed, what the staff told us, and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
There were enough staff on duty to meet the needs of the people who used the service and they had all received relevant training in order to carry out their roles. We saw that staff ensured people's personal safety was maintained whilst parts of the building were being refurbished by ensuring some areas were not accessible to people. We also saw that these areas were only out of bounds for limited periods of time and as soon as it was safe to do so, people were able to access the whole building again. We saw that people's care plans detailed where their safety might be at risk, and what staff should do to prevent this.
Is the service effective?
Due to communication difficulties and because some people were out for part of our inspection, we were unable to speak directly with people who used the service. However, the people we saw and met, appeared smart, comfortable and calm and were interacting well with the staff. The atmosphere was friendly and calm and people appeared well cared for. Staff we spoke with confirmed that they had received service specific training such as positive behaviour management to help them in their role.
Is the service caring?
We spoke with four members of staff; one support worker, one senior support worker, one team leader and the registered responsible person. The staff told us "I love my job, helping people with supported living and making a difference to people's lives" and another told us "it's a lovely home, with lovely people" and "I really love working with people with learning difficulties". We observed staff talking and sitting with people. We also saw that people were encouraged with activities.
Is the service responsive?
Records contained people's individual preferences and personal care needs and behaviour assessments and people were supported to access activities. We were told that one person who used the service enjoyed cooking and so they were assisted and encouraged to make some of their own meals with staff help.
Is the service well led?
There was no registered manager available at the time of our inspection. We were told that a new manager had been appointed, but we had not received an application at the time of the inspection.