Cherry Tree Lodge Nursing Home

Updated 28 December 2017

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 registered persons continued to meet 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.

We used information the registered persons 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 examined other information we held about the service. This included notifications of incidents that the registered persons had sent us since our last inspection. These are events that happened in the service that the registered persons are required to tell us about. We also invited feedback from the commissioning bodies who contributed to purchasing some of the care provided in the service. We did this so that they could tell us their views about how well the service was meeting people’s needs and wishes.

The inspection site visit took place on 24 November 2017 and was announced. We gave the registered persons three working days’ notice. This was because some of the people living in the service could not consent to a home visit from an inspector, which meant that we had to arrange for a ‘best interests’ decision about this. The inspection team consisted of an inspector and an expert by experience. An expert by experience is a person who has personal experience of using this type of service.

During the inspection site visit we spoke and spent time with eight people who lived in the service. We also spoke with a nurse, five members of care staff and with the chef. In addition, we met with the registered manager and with the operations manager. We observed care that was provided in communal areas and looked at the care records for four people who lived in the service. We also looked at records that related to how the service was managed including staffing, training and quality assurance.

In addition, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us.

After our inspection site visit we spoke by telephone with three relatives.

Updated 28 December 2017

We inspected the service on 24 November 2017. The inspection was announced. Cherry Tree Lodge Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cherry Tree Lodge accommodates 19 younger adults who have a learning disability in one adapted building. There were 17 people living in the service at the time of our inspection. Most of them had special communication needs and expressed themselves using single words, vocal tones and sign assisted language. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection on 18 February 2015 the service was rated, ‘Good’. However, we found that improvements were needed to ensure that people were fully supported to express their individuality by pursing their hobbies and interests. As a result of this shortfall we rated our domain ‘responsive’ as, ‘Requires Improvement’.

At the present inspection we found that sufficient progress had been made to address the concerns we previously raised in relation to the provision of responsive care. In addition, our overall rating for the service remained as, ’Good’.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service and background checks had been completed before new nurses and care staff had been appointed. People had benefited from most of the necessary steps being taken to prevent and control infection and lessons had been learnt when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. This included supporting people when they became distressed. People received most of the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services.

People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Most areas of the accommodation were adapted, designed and decorated in a way that met people’s needs and expectations.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that was responsive to their needs. As part of this people had been offered opportunities to pursue most of their hobbies and interests. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a robust management framework that helped nurses and care staff to understand their responsibilities so that risks and regulatory requirements were met. In addition, the registered persons had taken various steps to ensure the financial sustainability of the service.

The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put most problems right and to innovate so that people could consistently receive safe care.

Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.