We inspected this service on 12 March 2018. The inspection was unannounced.

Cherry Tree Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 Cottage provides accommodation and care for up to seven people with learning disabilities and autistic spectrum disorder. At the time of the inspection five people were living at the service.

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.” Registering the Right Support.

The service had a registered manager in place and a home manager who had day to day responsibility for the running of 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 in May 2016 the service was rated ‘Good’ in all key questions, at this inspection we found the service had deteriorated to ‘Requires Improvement’ in ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-led’ and remained ‘Good’ for ‘Caring’. Overall the service is now rated as Requires Improvement.

People had not been supported with the required staffing levels to meet their dependency needs. The registered manager took immediate action to address this concern and additional staff were provided. Safe staff recruitment checks were followed. Risks to people’s needs had been assessed and planned for. However, there had been a lack of health and safety checks including risk assessments of the external and internal environment.

The availability of paper towels and liquid soap to prevent the risk and spread of infections were insufficient. There was no effective analysis of behavioural incidents or accidents or learning to reduce further reoccurrence. Some shortfalls were identified in the management of medicines.

Staff had received training in safeguarding and the provider had a policy and procedure to inform practice.

Staff received an induction and ongoing training and support. Some shortfalls in staff training were identified. Staff had not received opportunities to discuss their work, training and development needs at the frequency the provider expected.

People had their needs assessed and planned for and they received opportunities to discuss the care and support the received. People received a choice of meals, had access to the kitchen and made themselves snacks and drinks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s rights under the Mental Capacity Act (2005) had on the whole been considered. Where people had capacity they were enabled to make decisions and their choices were respected. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind and caring and showed dignity and respect. Independence was encouraged and supported. Advocacy information was available to people.

Staff had information to support them to understand people’s needs, preferences and diverse needs. People received a lack of structured and meaningful activities, stimulation and opportunities to pursue their interests, hobbies and aspirations.

The provider’s complaint policy and procedure had been mad

This inspection took place on 11 May 2016 and was unannounced.

Cherry Tree Cottage provides accommodation for up to five people living with a learning disability. Five people were living at the service at the time of the inspection.

Cherry Tree Cottage is required to have 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. A registered manager was in place.

People received a safe service. Support workers were aware of their responsibilities to protect people from abuse and avoidable harm and had received appropriate adult safeguarding training.

Risks to people's needs had been assessed and plans were in place to inform support workers of the action required to reduce and manage known risks. These were reviewed on regular basis. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly.

The internal and external environment was monitored and improvements had been identified and planned for.

Safe recruitment practices meant as far as possible only suitable support workers were

employed. Support workers received an induction, training and appropriate support. Some gaps in staff training were identified and the registered manager had a plan to address this. There were sufficient experienced, skilled and trained support workers available to meet people's needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received a choice of meals and independence was promoted. People's healthcare needs had been assessed and were regularly monitored.

The home manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people's rights were protected.

Support workers were kind, caring and respectful towards the people they supported. They had a person centred approach and a clear understanding of people's individual needs, preferences and routines.

The provider enabled people who used the service and their relatives or representatives to share their experience about the service provided. Communication between relatives, external professionals and the service was good.

People were involved as fully as possible in their care and support. There was a complaint policy and procedure available. People had information to inform them of independent advocacy services.

People were supported to participate in activities, interests and hobbies of their choice. Support workers promoted people’s independence.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits.

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 provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. Cherry Tree Cottage provides accommodation and personal care for up to five people. On the day of our inspection five people were using the service.

The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service was last inspected on 3 March 2014 and at this time was provider was meeting the essential standards of quality and safety in the outcomes we inspected.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. This requires providers to submit applications to a ‘Supervisory Body’ for authority to do so. We found the provider was meeting the requirements of the MCA and DoLS.

People told us that they felt safe living at the home. The management team made safeguarding referrals when needed so that they could be investigated and staff knew how to respond to incidents if the manager was not present. This meant people were protected from the risk of abuse.

Staff had the knowledge and skills to care for people safely. Referrals were made to health care professionals for additional support or any required intervention when needed. This meant people would receive support from the appropriate people when their needs changed.

We observed people were treated with dignity and respect. People who used the service told us they felt staff were always kind and respectful to them. This meant people’s privacy and dignity was respected.

There were audits and customer satisfaction surveys carried out in the home and where issues were identified action was taken to address these. This meant there were effective systems in place to monitor and improve the service.

We carried out this inspection in response to information received regarding the level of maintenance at the home and a lack of transport being available for staff to take people using the service on activities.

We spoke with one person using the service. They liked their room and were happy with it. They told us that their room was cold at times. We discussed this with management at the home who confirmed that a new double radiator would be fitted in the person’s bedroom. They also told us that the downstairs bathroom smelt at times. We discussed this with management who told us the issue was caused by wet weather affecting the septic tank. They agreed to monitor the situation and take action if appropriate.

We found that people using the service, visitors and staff were in safe surroundings that promoted their wellbeing. We also found that there was enough equipment to promote the independence and comfort of people who use the service.

We spoke with two people using the service. One person said, “I’m happy with everything.” Another person said, “I’m happy with things. I go out and do activities, walks, the pub, trips and sometimes ice skating.”

We found that people received care that met their needs. We found that people were safe and they were cared for in a clean, hygienic environment. We also found that there were effective recruitment procedures in place and records were fit for purpose and kept securely.

We spoke with two people who use services and they told us they were cared for appropriately. People told us they took part in a lot of activities. One person said, “I like it here, staff help me with cooking. I like the trampoline and using the internet.” Another person said, “I like it, I’m happy living here.”

Both people told us they received help from staff with their medicines. One person clearly explained why they received their medicine. One person told us they liked their room. Both people told us there were enough staff. They also told us they got on with staff and they were nice.

We found that the service was considering issues of consent and providing appropriate care. Medicines were handled safely and the premises were safe. There were appropriate levels of staff and complaints procedures were in place.

People told us they had seen their care plans. They were happy their privacy was respected. One person said, “I wrote my care plans with staff.” Another person said, “I helped to make my care plan.”

People told us they were cared for appropriately and felt safe. People told us they took part in a lot of activities. One person said, “I love it here, the staff are very helpful.” Another person said, “It is very calm and peaceful here.”

People told us they liked their rooms. A person told us they liked the garden. People told us staff were well trained and they were good at their jobs. Two people told us there were enough staff on duty, one person told us there weren’t enough staff on duty.

People told us there were regular service user meetings. One person said, “We have a chance to say if anything is bothering us or if we have any complaints or want any more activities.” People also told us if they had any concerns they would speak to staff.