What life is like for people using this service:

• People continued to experience good outcomes as a result of their care and support.

• People lived as independent lives as they wanted.

People’s experience of using this service:

Cherry Tree Lodge is a Victorian House. It was adapted to support people’s needs, but the décor was faded and untidy. Two rooms, including the manager’s office, were unsuitable for the purpose they were used. This was addressed by the provider after our inspection visit.

People were safe because staff understood their responsibilities to protect people from abuse and avoidable harm.

People were safe because their care plans included risk assessments that staff followed to keep people safe without undue restrictions.

People were supported by enough competent and skilled staff. Staff supported people safely and according to their individual preferences. Staff knew people well and had developed meaningful relationships with them.

People were supported to have their medicines at the right times. Arrangements for the management of medicines were safe.

Staff knew how to use the provider’s procedures for reporting concerns, for example concerns about poor or unsafe practice or incidents between people where one or more experienced harm. The provider had whistle-blowing procedures and staff knew how they could report concerns direct to the local safeguarding authority or the Care Quality Commission.

Staff were kind, caring and passionate about the service provided and there was a positive culture. Staff supported people with dignity and respect.

People’s needs were met by staff who had the relevant training and support.

People had a choice of meals and enjoyed a varied and balanced diet. Staff understood the cultural diversity of people and ensured that their cultural dietary needs were met. Staff also supported people to follow their faith and cultural needs.

Staff communicated well to ensure that people experienced care and support that was consistent, irrespective of which staff were on duty. People’s health needs were met. Staff supported people to access health services when they needed them.

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 were involved in how the service was run and were supported to maintain their independence. They made their own choices about where they spent their time and how. They participated in a range of recreational, social and individual activities.

There was a registered manager who was away from the service; it was being managed by an acting manager. There were quality processes were in place to monitor the service but these were based on standards that ceased to exist from 1 October 2014. The views of people, relatives, staff and visiting professionals had not been sought since 2017.

The provider had not ensured that the details of their registered office were correctly notified to CQC and Companies House; each organisation was notified of a different address.

Rating at last inspection: Good (report published 15 June 2016)

About the service: Cherry Tree Lodge is a care home for up to 12 people with learning disabilities. It is located in West Bridgford in Nottinghamshire. At the time of our inspection visit nine people were using the service.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This inspection took place on 18 May 2016 and was unannounced.

Cherry Tree Lodge provides accommodation for up to 12 people living with a learning disability. Eight people were living at the service at the time of the inspection.

Cherry Tree Lodge 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. Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Not all staff had received adult safeguarding training but this had been identified and plans were in place for staff to receive this where required.

Risks to people's needs had been assessed. Staff had information available about how to meet people’s needs, including 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. Records of incidents relating to people’s behavioural needs were analysed for patterns and possible triggers. 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. This included a refurbishment plan for the interior of the service.

Safe recruitment practices meant as far as possible only suitable staff were employed. Staff 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 staff available to meet people's needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. Staff had a good understanding and awareness of meeting people’s healthcare needs. People received a choice of meals and independence was promoted. Where people required support with eating and drinking this was provided appropriately and in a caring and dignified manner. People's healthcare needs had been assessed and were regularly monitored. The provider worked with healthcare professionals to ensure they provided an effective and responsive service.

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. Where people lacked mental capacity to consent to specific decisions about their care and support, appropriate assessments and best interest decisions had been made in line with this legislation. Where people had restrictions on their freedom and liberty this had been appropriately authorised by the supervisory body.

Staff 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, routines and what was important to them.

The provider enabled people who used the service and their relatives or representatives to share their experience about the service provided. Communication with relatives could be improved upon.

People were involved as fully as possible in their care and support. There was a complaint policy and procedure available but relatives were not all aware of what this was. People had information to inform them of independent advocacy services.

People were supported to participate in activities, interests and hobbies of their choice. Staff 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. In addition the provider had further systems in place that provided

We spoke with two people using the service. They told us staff asked them about their preferences and respected their choices. They told us their needs were met and they received good care. One person said, “If I get a problem they [staff] come to us” and, “They’re all good to me.”

We spoke with a relative of a person using the service. They told us staff members asked their family member for consent before carrying out care and did not act against their wishes. They said, “I think they ask [their family member] all the time.” They told us their family member’s dignity and privacy were “definitely” respected and they were well cared for.

During our visit we saw positive interactions between staff and people using the service. We spent 25 minutes observing the care in the dining room at lunchtime. We saw staff promoted people’s independence and provided support when needed.

One person told us they always got their medication on time. We found medicines were handled appropriately.

People using the service who we spoke with told us they felt there were enough staff. We found there were enough qualified, skilled and experienced staff to meet people’s needs.

People using the service also told us they knew how to make a complaint. One person told us they were happy with the service and said, “It’s nice here” and, “If I wasn’t happy I’d soon tell them.” We found people were made aware of the complaints system.

We spoke with three people using the service. They told us staff respected their dignity, offered choices and communicated well with them. One person told us, “They are very nice to me.” Two people told us staff had discussed their care with them. They also told us they knew how to make a complaint and would report concerns to the manager or deputy manager.

They told us they were well cared for and staff delivered care that met their needs. One person told us, “They do look after me.” Another person said, “Of course they do,” when asked if staff supported them well. They told us they saw the GP, dentist and other professionals when they needed to. They told us they had enough to eat and drink. One person told us the food was, “Smashing.”

However, other evidence did not support that proper steps had been taken to ensure that people using the service were protected against the risks of receiving care or treatment that was inappropriate or unsafe.

People using the service also told us there were enough social activities. Two people told us they had been on holidays and day trips.

They told us they felt safe and their belongings and finances were protected. They told us they would report any concerns.

They told us they were happy with their bedrooms and had everything they needed. One person told us they had been provided with equipment in their bedroom to alert staff when they needed assistance.

People using the service told us staff were well trained and good at their jobs. One person told us, “I think they are good at their jobs” and said, “They work very very hard.” They told us they could have a say in how the service was run and managed. They told us that monthly residents’ meetings took place where they could express their views on the service.