Cherry Tree house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Cherry Tree house is registered to provide accommodation with nursing and personal care for 81 people.

At the time of the inspection Cherry Tree House was accommodating 73 people in one building across 3 units. The Bramhall and Romiley units supported people needing nursing care, whilst the Marple unit, on the middle floor, offered specialist dementia nursing care. All bedrooms were single occupancy with en-suite toilet and shower facilities and each unit had its own living and dining areas.

At the time of inspection, the service did not have a registered manager in place. 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. The previous registered manager had left in early autumn 2018 and the new manager had recently commenced employment at Cherry Tree house and was in the process of registering with the CQC.

At the last comprehensive inspection, undertaken in November 2016, the service was rated as overall good. At that inspection we rated the well led section as requires improvement because we found a breach of the Health and Social Care Act 2008 regulation 17 (Regulated Activities) Regulations 2014 (good governance). This was because at that time there was a new manager in post and we needed to see consistent and sustainable good practice in the well led domain.

A focused inspection was completed in October 2017, following concerns raised in relation to the management of choking risk. At that inspection we looked at the effective and well led domains. We found the home was good in the effective domain but continued to require improvement in the well led domain.

At this inspection we looked to see if the service continued to be good overall and whether improvements in the well led domain had been made. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to regulation 12 safe care and treatment; and regulation 17 good governance. You can see what action we told the provider to take at the back of the full version of the report.

There was a high use of agency staff at the time of inspection. People, family members and staff all identified this as an area of concern. There were processes in place to improve consistency of the agency staff used, however our observations during inspection, and feedback we received indicated that not all agency staff had a good understanding of the needs of the people living at Cherry Tree House. Following inspection, we received information from the management team that all positions had been recruited to and the use of agency staff was being significantly reduced.

People’s medicines were not always safely stored, and records were not accurately and consistently maintained across the home.

Policies, procedures and governance were not sufficiently robust to ensure good practice and consistency throughout the home.

The home was clean and tidy. People were able to personalise their bedrooms and there were a variety of areas for people to use within each unit

The service had a new manager, deputy and unit managers in place. They told us of the plan they had to create consistency and stability within the home and drive improvement.

Recruitment procedures were in place which ensured staff were safely recruited. Some staff had not completed all required training.

Staff were aware of their responsibilities in safeguarding people from abuse and could demo

Cherry Tree House is a purpose built three-storey care home owned by London and Manchester Healthcare (Romiley) Ltd. It provides nursing care for up to 81 people. Accommodation is provided across three units. Bramhall Unit, situated on the ground floor, and Romiley Unit, on the third floor, catered for people who needed nursing care. Marple Unit, which predominantly supported people living with dementia, was situated on the first floor. All bedrooms are single occupancy with ensuite toilet and shower facilities. The home has a secure garden and off road parking is provided. There were 77 people living in Cherry Tree House at the time of our visit.

This focused inspection was carried out over one day on 12 October 2017 and was unannounced.

The inspection was prompted by notification of an incident following which a person using the service died. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the risk of choking. This inspection examined those risks.

We last inspected the service in November 2016 where we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The identified breach was because a new manager was in post and we needed to see evidence that longer term, consistent and sustainable good practice and management of the service had been maintained. During this inspection we looked to see if the consistent management of the service had been maintained. We found the breach in regulation had been met.

The service had a registered manager in place. A registered manager is a person who has been 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.

Staff spoken with and training records seen confirmed that appropriate and regular training was taking place to make sure staff had the appropriate knowledge and skills to carry out their job roles effectively.

Staff were receiving formal supervision on a consistent basis.

We saw records that identified individual people at risk of potential choking and, since the incident the registered manager had reviewed each care plan to make sure all relevant information was available to support staff should a choking incident occur, including clear directions on the action to take based on professional medical advice.

At the time of the inspection new medical equipment (suction machines) had been provided in the event of a choking incident.

In addition, introduced on the day of our inspection was a Clinical and Care Equipment Training Booklet for Nurses and Senior Assistant Practitioners (SAP’s).

This inspection was carried out over three days on 23, 24 and 25 November 2016 and the first day was unannounced.

The service was last inspected in May 2016 following which the service was rated overall as ‘Inadequate’ and was therefore placed in ‘special measures.’ Services placed in special measures are kept under review and, following any immediate action taken, will be inspected again within six months. This inspection was carried out to check if sufficient improvements had been made to the service.

Cherry Tree House is a purpose built three-storey care home owned by London and Manchester Healthcare (Romiley) Ltd. It provides nursing care for up to 81 people. Accommodation is provided across three units. Bramhall Unit, situated on the ground floor, and Romiley Unit, on the third floor, catered for people who needed nursing care. Marple Unit, which predominately supported people living with dementia, was situated on the first floor. All bedrooms are single occupancy with ensuite toilet and shower facilities. The home has a secure garden and off road parking is provided. There were 51 people living in Cherry Tree House at the time of our visit.

The service had a registered manager in place. A registered manager is a person who has been 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.

Sufficient numbers of appropriately trained care staff and qualified nursing staff were available to support people and help meet their assessed needs. People who used the service, who we spoke with told us, “We seem to have more staff about now” and “Yes, I think there are enough staff.”

Staff meetings and formal staff supervision had been taking place on a regular basis since the last inspection of the service and this was confirmed by staff we spoke with and records seen.

Medicines had been effectively managed since the last inspection of the service.

People told us they enjoyed the food on offer. We saw meals were fresh and looked and smelled appetising. People were offered choices of various alternative foods and beverages on each of the units.

Fluid and diet charts were being completed in enough detail to accurately monitor what people were eating and drinking. Any advice from healthcare professionals such as nutritionists was being recorded in relevant documentation.

Each person using the service had an up-to-date care plan, risk assessments and other associated documentation in place.

The service employed activity co-ordinators on each unit who actively engaged with people individually or in groups. There were activities on offer throughout the day to suit peoples tastes, including visiting performers.

The premises were kept secure, with keypad entry to each unit. Deprivation of Liberty Safeguard (DoLS) assessments had been completed and authorisation requested for those people with limited capacity and unable to use the keypad entry system. The communal areas and the bedrooms we looked at were clean. Policies and procedures to minimise the risk of infection were followed.

Where people who used the service lacked capacity to consent to care and treatment the appropriate steps were taken to protect their rights.

We observed some good interaction and communication between staff and people who used the service.

We saw that the service had a written complaints policy and a procedure which was visible at the entrance to each unit.

Systems were in place to monitor the quality of service and to identify where improvements to the quality of care could be made.

At the last inspection in May 2016 we rated the well-led domain as ‘inadequate’ as we found the management of the service was not, at that time, well-led and staff lacked clear management leadership. At this inspection we found t

This inspection took place on 11, 12 and 16 May 2016. Our visit on the 11 May was unannounced.

Our inspection was brought forward because we had received concerns relating to staffing levels and the high number of safeguarding alerts raised with the local authority by health and social care professionals.

When we previously inspected this location in December 2015, we identified seven breaches of the Health and Social Care Act Regulated activities 2008 (Regulated Activities) Regulations 2014. We found systems to monitor the quality of care were lacking; consent was not always sought; care plans were not reviewed regularly and did not identify how risks would be managed; there were insufficient staff who had not been recruited safely or provided with adequate supervision, and medicines were not properly managed. During this inspection we found that there had been improvement in some areas but we found further issues of concern and further improvements were still needed.

When we visited the service there was no registered manager in place. 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. The service had recruited a new manager, who was present throughout the inspection, and informed us that she had begun the process of registration.

Cherry Tree House is a purpose built three-storey care home owned by London and Manchester Healthcare (Romiley) Ltd. It provides nursing care for up to 81 people. Accommodation is provided across three units. Bramhall Unit, situated on the ground floor, and Romiley Unit, on the third floor, catered for people who needed nursing care. Marple unit, which predominantly supported people living with dementia, was situated on the first floor. All bedrooms are single occupancy with ensuite toilet and shower facilities. The home has a secure garden and off road parking is provided. There were 56 people living in Cherry Tree House at the time of our visit.

We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, of which some were continued breaches of regulations following our inspection in December 2015. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There had been a high number of safeguarding concerns investigated by the local authority, and we found that staff did not always report issues of concern, leaving people at risk.

There were insufficient numbers of suitably qualified staff to meet the needs of the people who used the service. People told us that at weekends the service was often short staffed, and we saw that during the weekend prior to our inspection only two care staff had been on duty on one of the units.

There had been no staff meetings since our last inspection and staff had not been supervised. One Unit manager told us “Supervision has taken a back seat”.

Medicines were not managed effectively. We found numerous recording errors, some medicines out of date, a confusing ordering and storing system, and evidence of missed medicines. Medicines had been lost and consequently not provided. We saw that the home was conducting a review of the medicines procedures and would introduce a new cycle or ordering and dispensing stock.

People told us they enjoyed the food on offer. We saw meals were fresh and looked and smelled appetising.

Fluid and diet charts were not always completed in enough detail to accurately monitor what people were eating and drinking, and advice from nutritionists was not always recorded.

At out last inspection we noticed that people on the Marple unit had not been consulted following a decision to provi

This inspection took place on 14, 15 and 16 December 2015. Our visit on the 14 December was unannounced.

Our inspection was brought forward because we had received concerns relating to staffing levels and the high number of safeguarding alerts raised with the local authority, by health and social care professionals.

When we previously inspected this location on 30 March 2015, the provider was not meeting the Health and Social Care Act Regulated activities 2008 (Regulated Activities) Regulations 2014. We found that, care plans were not reviewed regularly and did not identify how risks would be managed, repositioning charts to prevent people from developing pressure ulcers were not in place and skin creams were not always applied as directed. During this inspection we found some improvements had been made in these areas, however we found further issues of concern and further improvements were still needed.

When we visited the service there was a registered manager in place. 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.

Cherry Tree House is a purpose built three storey care home owned by London and Manchester Healthcare (Romiley) Ltd. It provides nursing care for up to 81 people. Accommodation is provided across three units, one on each of the three storeys. Bramhall Unit, situated on the ground floor, and Romiley Unit, on the third floor, catered for people who needed nursing care. Marple unit, which predominantly supported people living with dementia, was situated on the first floor. All bedrooms are single occupancy with en-suite toilet and shower facilities. The home has a secure garden and off road parking is provided. There were 75 people living in Cherry Tree House at the time of our visit.

We identified nine 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.

There were insufficient numbers of suitably qualified staff to meet the needs of the people who used the service. During the inspection we saw staff were unable to meet the requests for support from people who used the service, and people had to wait for assistance.

The staff recruitment and selection procedure in place was not followed to make sure new staff were recruited safely. For example some pre-employment checks such as obtaining references before people started working at the home were not carried out.

The systems in place for monitoring the performance of individual staff members were inconsistent.

At our last inspection in March 2015, we found that some skin creams had not been written up on a medication administration record (MAR) and there was a risk of the wrong skin cream being applied. At this inspection we found that there was no consistent system used across the home to show how or if creams had been applied, each of the three units were working to different processes. This meant that there were insufficient safeguards to ensure the safe management of topical creams.

Care plans were not always informative. We looked at a communication care plan for a person who was extremely hard of hearing, yet this was not mentioned in their care plan when considering how best to communicate with the person.

The service employed three activities co-ordinators who actively engaged with people individually or in groups. There were activities on offer throughout the day to suit peoples tastes, including visiting performers. However on the Bramhall Unit people told us, and we saw that people who used the service were left in their rooms for long periods of time.

We found discrepancies in risk assessments, where the risk of pressure sores developing had been identified there was no evidence of appropriate care planning, treatment and support to make sure people’s skin integrity needs were met. Turning charts to indicate when a person at risk of developing pressure sores were not completed.

People who used the service told us that they felt safe because staff were kind and available when they needed them.

Care plans were completed and records included short and well written biographies to give care workers a good understanding of the individual. Care plans were person centred and focussed on people’s abilities and aimed to maximise people’s independence.

The premises were kept secure, with keypad entry to each unit.

Where people who used the service lacked capacity to consent to care and treatment the appropriate steps were taken to protect their rights.

On the Marple Unit we found that people did not always have the opportunity to make choices for themselves.

The communal areas and the bedrooms we looked at were clean. Policies and procedures to minimise the risk of infection were followed.

People told us the food was of an acceptable standard and we saw meals were fresh and looked and smelled appetising. Dietary needs were taken into account, and people were given choices of foods to eat.

We saw good interaction and communication between staff and people who used the service.

Care was taken to ensure that individual’s privacy and dignity was respected.

Where the home received complaints, we saw evidence of an acknowledgement, investigation and follow up report.

We found that audits completed had not highlighted the concerns we raised during this inspection and detailed in this report, nor had the provider’s quality assurance and governance systems resolved some of the concerns raised at our last inspection in March 2015.

The staff we spoke to were confident that the registered manager was helping to improve the service. We saw that she has begun to implement systems for improving the quality of care, but

systems were not yet robust enough to ensure that practices were consistent across the whole of the service.