Cherry Orchard 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 Orchard is registered to provide accommodation and nursing care for up to 40 people. The accommodation was arranged across three separate units on ground floor level, each with separate adapted facilities. All units specialise in providing care to people living with dementia. We inspected the service on 2, 3 and 4 May 2018. This was an unannounced inspection. There were 31 people using the service at the time of our inspection.

The service had a manager who was in the process of applying to become the registered manager for the service. 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.

At the last inspection on 10, 11 and 17 February 2016 the service was rated Good overall with a rating of Requires Improvement in effective. We made a recommendation because staff did not always receive regular one to one supervision and some staff needed to improve their knowledge of the Mental Capacity Act (2005). At this inspection we found improvements had been made to meet the recommendation.

People told us they felt safe using the service and their relatives agreed. Staff received safeguarding training and knew how to report safeguarding concerns. Recruitment checks were in place to ensure new staff were suitable to work at the service.

Risk assessments were completed and management plans put in place to enable people to receive safe care and support. Staff had a good understanding of infection control procedures and used personal protective clothing such as aprons and gloves to prevent the spread of infection. There were systems in place to manage people’s medicines so they received them when needed.

There were effective and up to date systems in place to maintain the safety of the premises and equipment. Lessons were learnt when accidents and incidents occurred to minimise the risk of recurrence.

People’s needs were assessed before they began using the service and they had access to healthcare professionals as required to meet their needs. Personalised care plans were in place, reflected people’s needs and were updated regularly.

Staff had a clear understanding of the application of the Mental Capacity Act 2005 and appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. People using the service had access to healthcare professionals as required to meet their needs. People were offered a choice of nutritious food and drink to maintain good health.

Staff knew people they were supporting including their preferences to ensure personalised care was delivered. People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people’s privacy and dignity and encouraged independence. People had the opportunity to participate in a programme of meaningful activities. People and their relatives knew how to make a complaint.

Regular meetings took place for staff, people using the service and their relatives. The service had systems in place to seek the views of people and their relatives regarding the quality of the service. Quality monitoring systems were in place to identify areas of improvement.

People and their relatives told us the manager and management team were supportive and approachable.

Cherry Orchard was registered to provide accommodation and nursing care for up to 40 older people. There is a 12 bedded unit for older people with mental health care needs and two units for 28 people living with dementia and complex nursing needs. The service is a purpose built property. The accommodation is arranged with all three units on the ground floor level. There were 36 people living at the service at the time of our inspection.

The service had a registered manager. 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.

At the last inspection on 14, 15 and 17 November 2014 we found people were not always safe at the service. There were poor arrangements for the administration of medicines and incidents and accidents were not reported or managed in an appropriate way. Risk assessments did not address the risk to people using the service relating to behaviour that challenges which put people at risk of harm. People were not protected against the risk of receiving inappropriate care and treatment because their medical conditions were not monitored. Meals were not always served in a timely manner and people’s dietary requirements were not identified.

Staff did not always receive up to date training and we did not see evidence of regular clinical supervision for registered nurses. We were concerned about the staffing rotation at the service which meant people did not get to know their key worker well. The service did not send in notifications to the Care Quality Commission about applications to deprive people of their liberty.

We inspected Cherry Orchard on 10, 11 and 17 February 2016. This was an unannounced inspection. At this inspection we found the service had improved, however further improvements could be made regarding the nursing and care staff understanding of the Mental Capacity Act (2005). Some staff did not always receive regular one to one supervision. We have made a recommendation regarding this.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. Risk assessments were completed and management plans put in place to enable people to receive safe care and support. There were effective and up to date systems in place to maintain the safety of the premises and equipment. We found there were enough staff working at the service and recruitment checks were in place to ensure new staff were suitable to work at the service. Medicines were administered and managed safely.

Appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. Staff received appraisals and group supervisions. People using the service had access to healthcare professionals as required to meet their needs.

People were offered a choice of nutritious food and drink. Staff knew people they were supporting including their preferences to ensure personalised care was delivered. People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people’s privacy and dignity and encouraged independence. People and their relatives knew how to make a complaint.

Regular meetings took place for staff, people using the service and their relatives. The provider carried out satisfaction surveys to find out the views of people and their relatives. The provider had quality assurance systems in place to identify areas of improvement. Staff, people and their relatives told us the registered manager was supportive.

During this inspection we spoke with four people using the service and the relatives or friends of four other people. We also looked at the experiences of people who could not speak with us through carrying out an observation. People told us they were happy with the service. One person using the service told us the staff knew they liked to be given spicy food as they had travelled extensively due to their former occupation. We saw they were given a curry. A relative said, "it's a very nice place and they look after [my relative] well."

Records showed that staff sought people's consent and took appropriate actions when people were not able to give consent.

Cherry Orchard provided a comfortable, safe and well maintained environment. Recruitment practices ensured that staff were safely recruited in order to protect people who used the service. People and their representatives were provided with information about how to make a complaint and any complaints were properly investigated.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and was joined by an Expert by Experience, people who have experience of using services and who can provide that perspective.

We used a number of different methods to help us understand the experiences of people using the service. A number of the people who lived at this care home had complex needs, which meant they were not always able to communicate verbally with us in a meaningful way. During the morning and at lunch we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Everyone we spoke with commented favourably on the service, the quality of the staff and the choice of food provided. One person said “I have my tea and biscuits whenever I want”. People told us that they were supported by a respectful and kind staff team. One person told us “I love it here the staff are so nice and kind”.

Cherry Orchard provides accommodation and nursing care for up to 40 older people. There is a 12 bedded unit for older people with mental health care needs and two units for 28 people living with dementia. The home is a large purpose built property. The accommodation is arranged with all 3 units on the ground floor level. There were 38 people living at the home at the time of our inspection.

This was an unannounced inspection, carried out over three days on 14, 17 and 24 November 2014. The home had 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.

We last inspected Cherry Orchard on 10 October 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

We observed care and support in communal areas, spoke with people in private, and looked at care and management records.

People were not always kept safe at the home. There were poor arrangements for the administration of medicines. Incidents were not reported or managed in an appropriate way. Risk assessments did not address the risks to people using the service relating to behaviour that challenges which put people at risk of harm.

Each person had a care plan which set out their individual and assessed needs. However some people were not protected against the risks of unsafe or inappropriate care and treatment by monitoring of their medical condition.

Staff told us they undertook regular training. However the training matrix showed that staff had not received up to date training in relation to dementia, behaviour that challenges and care planning. We did not see evidence of regular clinical supervision for registered nurses.

Staff demonstrated they had an awareness of the Mental Capacity Act 2005, which meant they could support people to make choices and decisions where people did not have capacity.

People told us they felt cared for. People were treated with dignity and respect. The staff knew the care and support people needed. However the current staffing rotation meant that people did not get to know their key worker well.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the back of the full version of this report.