This inspection took place on 13 November 2017 and was unannounced.

Our last inspection was in September 2016 where the service was rated ‘Good’ with no breaches of the legal requirements.

Cherry Lodge Rest 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 Lodge Rest Home accommodates 19 people in one adapted building. At the time of our inspection there were 17 older people living at the home, some of whom were living with dementia.

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.

During this inspection we identified three breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities 2014). These related to consent, risk planning, medicines management, record keeping and audits. You can see what action we told the provider to take at the back of the full version of the report. This is the second time that the service has been rated as Requires Improvement.

There was not always a clear plan in place for staff to manage known risks to people. There was a lack of plans in place for specific healthcare needs and the risks associated with them. We also identified shortfalls in the recording of accidents and incidents that meant that the provider could not conduct an effective analysis of them. Safe medicine management practices were not always followed. We identified gaps in the recording of medicines and concerns with how medicines were stored and managed.

People’s legal rights were not protected because staff did not follow the Mental Capacity Act (2005). Restrictions were placed upon people before the legal process set out in the Act had been followed.

There were gaps in record keeping that meant care plans did not always reflect people’s current needs. The provider conducted their own audits but these were not robust enough to identify concerns that we found during our inspection.

Staff understood their roles in safeguarding people from abuse. Staff had been trained in how to carry out their roles and had regular one to one supervision meetings. There were effective infection control practices in place and staff had received training in this area. Staff felt supported by management and had regular meetings. There were enough staff to meet people’s needs safely and the provider had carried out checks on staff to ensure that they were suitable for their roles.

There was a wide range of activities available that reflected people’s interests. People were supported by staff that they got along well with. Staff were respectful of people’s privacy and dignity when supporting them and encouraged people to be independent. Systems were in place to provide people with choices and to involve them in their care. Staff provided care to people in a way that was person-centred and reflected their needs. People were prepared food that matched their preferences and their dietary requirements.

The home was in the process of being redecorated and refurbished. Plans were underway to make the home environment easy to navigate for people living with dementia. Checks were carried out on the health and safety of the home and plans were in place to keep people safe in the event of an emergency.

Staff communicated well with each other to meet people’s needs effectively. The provider consulted people and relatives on the quality of the care delivered in order to identify any improvements to be made. People and their relatives were aware of how to raise a complaint if they were not happy with

Cherry Lodge Rest Home (Cherry Lodge) is a care home which provides accommodation and personal care to a maximum of 19 older people. Some people may also be living with a dementia type illness. There were 17 people living at the service at the time of this inspection.

The inspection took place on 12 September 2016 and was unannounced.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was also the provider of Cherry Lodge.

At the last inspection on 23 July 2015 we asked the provider to make improvements to staffing levels, the way staff were supported, how consent was sought, nutrition and how people received personalised support. We found at this inspection that the provider had taken appropriate action in each of these areas. We made one recommendation as a result of this inspection. As such we asked the provider to consider ways of capturing people’s concerns in order to identify and possible trends and themes.

Cherry Lodge is a small service that provides residential care for people no longer able to live in their own homes. Many of the people accommodated previously lived in the local area and the service prides itself as being part of the community. As such, people benefitted from the ability to maintain previous networks and friendships.

People’s needs were met by a core of staff who worked effectively together as a team. Staffing levels were sufficient to meet people’s needs and provide them with appropriate levels of support. There were systems in place to ensure the appropriate recruitment and continuous monitoring of staff. This helped to ensure that only suitable staff worked at the service.

Staff received on-going training and support from the management team in order to deliver their roles effectively. People were protected by staff who understood their role in safeguarding them from the risk of harm or abuse.

People had good relationships with staff who took steps to ensure care was provided in a way that protected their privacy and dignity. People were encouraged and supported to both maintain and develop their independence and spend their time doing things that were meaningful to them.

People were supported to maintain good health and the service linked with other external professionals to ensure their healthcare needs were met. There were systems in place to ensure that people received their medicines safely and at the right times. People had choice over their meals and were supported to maintain a healthy and balanced diet.

People were involved in making decisions about their care and had choice and control over their daily routines. People and their representatives were able to share their feelings and staff ensured that when people raised issues that they were listened to and people’s opinions were valued.

The management team worked effectively together to ensure the smooth running of the service. Regular monitoring and auditing of the service provided mechanisms for on-going development and improvement.

Cherry Lodge Rest Home provides accommodation for up to 19 people, most of whom are elderly and frail and some, as described by the manager, who are living with mild to moderate dementia. Some of the rooms in the home are shared. At the time of our inspection 15 people were living in the home.

The inspection took place on 23 July 2015 and was unannounced.

There was a registered manager in post at the time of our inspection. The registered manager was also the provider. 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. There was a new manager to the home and also a deputy manager. All three were present during our inspection.

Staff followed correct and appropriate procedures in relation to medicines to ensure people received their medicines safely, however there was no guidance to staff for people who may request PRN (‘as required’) medicines.

Although people were not having to wait for assistance by staff we observed staff constantly working at tasks with little or no time to socially interact with people. The registered manager had not considered the deployment of staff and the kitchen staff were unsupported.

Care was provided to people by staff who, although competent in their role, were not provided with the support to attend training. Some staff were behind on their training.

Staff did not understand their responsibilities in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Best interest decisions were not made in line with legislation.

People were not provided with a varied or diet or involved in developing the menu’s.

Although we observed some good examples of kind care from staff, we found people’s privacy was not always upheld by staff.

Activities were not individualised and did not occur regularly. People were not supported to access the community. The environment in the home was not suitable for people living with dementia.

Care plans were not person-centred and not always accurate. It was difficult to identify if people received care responsive to their needs. For example, in relation to specific conditions.

Staff received supervisions and appraisals, but did not feel supported by the registered manager. Staff told us they were demoralised and unhappy.

Staff supported people to access health care professionals, such as the GP or district nurse, however we were told there were times people with nursing needs were admitted into the home.

Complaint procedures were available to people. People and relatives would speak to the manager if they wished to complain.

Staff knew the procedures to follow should they have any concerns about abuse taking place in the home. Risk assessments were carried out for people to maintain their individual safety, however we found the premises was not necessarily a safe place for people to live.

The provider had ensured safe recruitment practices to help them employ staff who were suitable to work in the home.

Relatives were made to feel welcome when they visited.

Quality assurance checks were carried out by staff to help ensure the home was a safe place for people to live. However, the registered manager did not always adhere to the requirements of their registration.

During the inspection we found some 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.

We carried out an inspection at Cherry Lodge Rest Home to look at the care and treatment that people who used the service received.

As part of our inspection we spoke with four staff, one health care professional and four relatives. We were able to speak with seven people who lived in the home. At the time of our inspection 17 people received personal care.

One inspector carried out this inspection. The inspector considered the inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We saw that people lived in a safe environment. The service was clean and hygienic and people were able to move around the home and garden freely without any risk of harm.

We found that the provider obtained all the necessary information on staff to ensure that they were suitable to work with vulnerable people.

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. Two relatives we spoke with told us they had seen a difference in their family member since they moved in to Cherry Lodge. One relative said, “They had them back walking within two weeks of moving in.” Another relative told us, “They look clean, tidy and so much better since they’ve been here.”

Is the service caring?

We saw that staff showed patience and gave encouragement when supporting people. One relative we spoke with said, “I don’t think I could get better for their needs.”

People's preferences, interests, and diverse needs were met. We saw how two people liked to spend some time in the garden, whilst another preferred to do some colouring.

Is the service responsive?

We saw that two district nurses visited the service during our inspection. The manager told us that one had visited as a result of their telephone call that morning.

Is the service well-led?

There were regular meetings for the people who lived in the home. Staff who we spoke with told us the manager was very supportive and they (the manager) had an open door policy.

We were shown that the service asked people who used the service, their relatives and visiting professionals to complete a satisfaction questionnaire. The results of these questionnaires were used to improve the service.

We saw that people were encouraged to express their views regarding their care. People who used the service or their representative told us that they participate fully in the admission planning process and were encouraged to look around the home before making the choice about living there. We were told that people were supported in promoting their independence and encouraged to maintain any community involvement. The service developed care option with the people who used the service and worked with them to ensure that their views were always paramount. People who used the service told us that “the staff always ask if there is anything we need and give us a choice”.

The evidence that we looked at demonstrated to us that people who used the service could be confident that staff would be able to recognise and respond to safeguarding matters in the correct way. We spoke to staff who were aware of the safeguarding procedures in place. Staff were also aware of other related policies, such as their responsibility for reporting abuse, whistle blowing and deprivation of liberty safeguards.

The provider regularly undertook audits of all care plans and these were updated accordingly. In addition the provider completes regular audits for example medication, catering, infection control, health and safety and risk assessments that ensured the health and welfare of people who used the service and to promote a safe working environment.

This inspection was undertaken to follow up on the findings from our previous inspection of January 2012 to ensure that the provider had taken action to address the concerns.

Suitable arrangements have been made to ensure the dignity and privacy of people using the service is promoted they are always provided with choices in respect of their meals. People living at the home told us that the staff always "chat with us about what we want to eat" and "if there is nothing I fancy they always come up with another choice".

One person said the staff always "come round and ask what we what for our meals about an hour before our meals".

Suitable arrangements have been made to ensure people who use the service are protected from abuse or the risk of abuse, policy and procedure now provide staff with up to date guidance and staff are aware of their role in safeguarding people who use the service.

We saw that all required documents have been obtained to ensure people using the service are protected from persons who are fit to work in a care service.

The social and leisure needs are fully met. One person who lives at the service told us that they attended some of the activates but if they did not want to "someone would spend some time sitting or chatting" with them and "that they did not like to join in with all the activities but they were always asked if they wanted to come down and join in".

We spoke to five people who use the service and they told us that staff were kind, helpful and usually available when needed. The people using the service also told us that they felt safe in the service.

One person using the service said they liked living in the service more than at their previous home. Another person using the service told us they were satisfied at the service but not exactly happy there.

Two people who use the service told us that as no menu was provided they did not know what meal would be available until it was served. Two other people who use the service told us they amused themselves and provided their own entertainment because there was “not much going on”.