About the service:

Cherry Lodge is a care home that provides personal care for people, some of whom are living with dementia. At the time of the inspection 43 people were living there. The home was established over three floors with communal areas that included a dining area, three lounge spaces and a large garden. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or into residential/nursing care.

People’s experience of using this service:

¿ At the last inspection, we found the provider to be in breach of Regulations 11, 17 and 19 of the Health and Social Care Act 2008 (Regulations0 2014. We asked the provider to complete an action plan and send us monthly updates to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. At this inspection, we found that although some improvements had been made, some aspects of the service required further improvement.

¿ Since the last inspection, the registered manager and operations director had started to implement new processes to bring a clear and consistent oversight of operations. During the last 12 months, the service has experienced some challenges which has resulted in the loss of a number of care and senior care staff. The changes in staffing have meant that planned improvements have not always happened or have not been sustained.

¿ The provider’s governance systems to monitor and check the quality of the service provided for people were not consistently effective and still required further improvement. The management team and provider were extremely open and transparent with us about the current improvements required to the service and were enthusiastic and committed to turning the service around. Although we saw new systems and processes were being put in place to support the necessary improvements, it was too soon to comment on their effectiveness.

¿ People and relatives told us they felt the service was safe and there were sufficient numbers of staff to support people. New staff members had completed their induction training. However, there were gaps in staff training, supervisions and observations of staff practice. The registered manager had recognised these gaps and plans were in place to make the required improvements.

¿ Risk assessments and care plans were not always up to date and reflective of people's support needs and in some cases, staff were supporting people in different ways. The registered manager explained as part of the ongoing improvement plan to develop the service, the system for revising care plans was under review to ensure people were included in the process and that care reflected people’s individual needs.

¿ Staff had access to equipment and clothing that protected people from cross infection.

¿ People were assisted to have enough to eat and drink and told us the food was good.

¿ People accessed healthcare services to ensure they received ongoing healthcare support.

¿ People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way. Staff demonstrated an understanding of how to support people to make choices. There had been an improvement in the completion of mental capacity assessments and appropriate deprivation of liberty safeguard applications had been completed which meant the provider was compliant with the law.

¿ People were supported by kind and caring staff that knew them well. Staff encouraged people’s independence, protected their privacy and treated them with dignity. People were supported by staff that knew their preferences.

¿ There was a complaints procedure in place and people and relatives told us their concerns were dealt with positively.

¿ There were mixed views from people and their relatives’ conce

This inspection took place on 15, 17 and 22 August 2017 and was unannounced on the first and second days but the manager knew we would be returning on the 22 August. At the last inspection on 30 and 31 August 2016, we found that the provider required improvement in four of the five domains we looked at, but was meeting the legal requirements of the Regulations we inspected.

Cherry Lodge is a residential care home providing accommodation and residential care for up to 46 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home. At the time of our inspection 45 people were living at the home.

It is a legal requirement that the home has a registered manager in post. There was no 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. A new manager had started at the home in July 2017 and gave us their assurances; they would submit an application to become the registered manager. At the time of writing this report, no application has yet been received from the new manager, should an application not be received, we will consider our regulatory response.

At our previous inspection in August 2016, we found that for the questions is the service safe, effective, responsive and well-led, improvement was required. At this recent inspection, although we found there had been some improvement, overall the service still required improvement.

Systems in place to monitor and improve the quality of the service were ineffective in ensuring people received a good and continually improving quality of service. The audits had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

The provider’s recruitment processes were not consistently robust and did not always ensure the necessary security checks were completed to make sure persons employed by the provider were safe and appropriate to provide care and support to people living at the home.

Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments and best interest decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interests; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People and relatives had not received satisfaction questionnaires to comment on the quality of the service being delivered. However, the management team had started to put in place systems to gain feedback from people living at the home, relatives and visitors. People, their relatives and staff told us the management of the home had improved, was organised and ‘well-led.’

Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. However, staff did not always follow the provider’s own safeguarding procedures when unexplained bruising or marks were noted on people’s bodies. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm, although the information contained within some risk assessments was not always effec

This unannounced inspection took place on the 30 and 31 August 2016. At our last inspection on 17 and 18 September 2015, we found the service to be requires improvement in all the areas inspected and was not meeting the regulations in one area. This related to people, who used the services, being unlawfully deprived of their liberty, for the purpose of receiving care, because the provider had not sought lawful authority to do so. A requirement notice was issued. The provider sent us an action plan detailing what action they had taken.

During this inspection we found the provider had made some improvements to the service. Although we found some further improvement was still required.

Cherry Lodge is a residential long term care home providing accommodation and residential care for up to 46 people. The home also provides short stay interim beds for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home. At the time of our inspection 38 people were living at the home.

There was no 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 and associated Regulations about how the service is run. At the time of the inspection, the acting manager showed us they had started the application process to become the registered manager.

At the last inspection, we found that staff understood their responsibility to take action to protect people from the risk of abuse and harm, because the provider had systems in place to minimise the risk of abuse. However we saw that staff did not always follow the assessments to minimise the risks associated with people‘s care and this put people at further risk of injury. At this inspection we found there had been some improvement.

People were supported by a sufficient number of staff on duty to meet people’s identified needs. The provider’s recruitment processes required improvement to ensure suitable staff were recruited. People were supported by suitably trained staff.

People were supported to receive their medicines as prescribed.

At the last inspection we found the home had not been maintained to an acceptable standard of cleanliness. Although we found there had been an improvement, further improvements were still required.

At our last inspection we found that people did not participate in interests and hobbies that were personalised to their individual needs. There had been some improvement, however further improvement was required to meet people’s individual choices.

At the last inspection we found relatives had experienced inconsistencies as to the effectiveness of the complaints process. At this inspection, systems were still not in place to help the provider learn and develop the service from feedback and outcomes of complaints and required improvement.

At the last inspection we found although systems were in place to monitor the quality and safety of the service, they had not always been effective. We found there had been a slight improvement in monitoring the quality of the service but that the systems required further improvement.

At the last inspection the provider had not always recognised when the care being offered had put restrictions on people’s ability to choose and move around freely. At this inspection we found there had been some improvement.

People were supported by caring and compassionate staff who demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. Although preserving some people’s dignity had not been consistently maintained.

People were able to choose what they ate and drank and were supported to maintain a healthy diet w

This was the provider’s first inspection since registration in October 2014. The inspection was unannounced and took place on 17 and 18 September 2015. We planned this inspection to address concerns that had been shared with us about people falling and a number of safeguarding notifications.

Cherry Lodge is a residential long term care home providing accommodation and residential care for up to 46 people. The home also provides short stay interim beds for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home. At the time of our inspection 45 people were living at the home.

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 and associated Regulations about how the service is run.

The home had not been maintained to an acceptable standard of cleanliness. This failed to provide people with a pleasant and homely place to live. It also posed a risk of contamination with the potential to cause people illness.

Staff understood their responsibility to take action to protect people from the risk of abuse and harm because the provider had systems in place to minimise the risk of abuse. However, we saw that staff did not always follow the assessments to minimise the risks associated with people‘s care and this put people at further risk of injury.

The provider had not always recognised when the care being offered had put restrictions on people’s ability to choose and move around freely. Restricting people’s freedom to move around without the necessary authorisation meant that the provider was not meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, therefore people’s human rights were not protected. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to receive their medicines but some people did not always receive their medicines as prescribed.

People were supported to receive care and treatment from a variety of healthcare professionals and received treatment if they were unwell.

There was some caring and compassionate practice and staff demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. Although preserving some people’s dignity had not been consistently maintained.

People were asked to join in a range of activities but they were not always person centred and suitable to meet people’s individual choices. There was little evidence to support people had been able to maintain interests that they had before moving to the home. For much of our inspection people were sleeping and there were limited opportunities for people to engage or be motivated

There was a complaints process that people and relatives knew about. There were inconsistencies experienced by relatives as to the effectiveness of the complaints process. Systems were not in place to help the provider learn and develop the service from feedback and outcomes of complaints.

Systems were in place to monitor the quality and safety of the service but they had not always been effective and timely action had not always been taken to bring about the improvements needed.

People were able to choose what they ate and drank. Although some people did not always have a pleasant meal time experience. The provider was not always effective when people requested a different choice of meal, from that being offered on the day.

There were sufficient staff to meet people’s identified needs. The provider ensured staff were safely recruited and they offered the necessary training to meet the support and care needs of people.