About the service:

• Cherry Tree Nursing Home is a residential care home that was providing personal and nursing care to 45 older people at the time of the inspection. The service is registered to accommodate up to 52 people.

People’s experience of using this service:

• During our previous inspection in February 2018 we identified areas that required improvements. These included records that were not up to date and accurate, and a lack of management oversight and quality assurance. During this inspection we found improvements had been made in all areas. The service has been awarded a rating of good in all domains.

• We found systems were in place to ensure the safety of people living in the service. Records were up to date, and risk assessments had been completed to minimise risks to people.

• Checks had been completed on essential safety apparatus such as fire protection equipment and hoists. Services such as gas and electricity had been maintained.

• People’s nutritional and dietary needs were assessed, documented and care was provided in line with their needs. External professional provided professional advice when needed.

• Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). 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. Where appropriate, advocates were employed to support people with making choices about their lives.

• Information about people was being recorded in a respectful and dignified way. Records were up to date and clear in their content whilst providing appropriate direction for staff in how to care for people. People’s health care needs were monitored.

• People were treated equally by the staff. Training was provided to staff the area of equality and diversity.

• Staff told us they felt supported by senior staff. The staff in the service were caring. They told us they worked well as a team. They respected each other and supported each other. They received support from the provider and the registered manager. They also received support through regular training, supervision and team meetings.

• Staff were trained and knew how to protect people from the risk of abuse. Where concerns had been raised these had been dealt with appropriately.

• A recruitment system was in place that minimised the risk of unsafe candidates being employed.

• Medicines were stored, administered and disposed of by trained staff. However, we observed staff signing to indicate they had administered medicines before doing so. This is not safe practice. We have made a recommendation about medicine training for staff.

• Effective quality assurance tools were in place to drive forward improvements, these had been used and their impact was apparent.

• People spoke positively about their experience of living in the service. Comments included “You do feel safe here, I do, seriously. I love this room and I feel safe here. I feel cared for and looked after, they (staff) are there for you and they don’t go missing”.

• Where possible people could feedback to the provider and share ideas for improvement. This could be done daily via the senior staff or through meetings or filling in questionnaires.

• Activities were available to people. A new activity coordinator had been employed to develop this area of the service.

• Complaints were dealt with effectively and efficiently.

Rating at last inspection:

• The previous inspection was carried out on the 12 February 2018. (Published on 5 April 2018). The service was rated Requires Improvement at that time.

Why we inspected:

• Following our last inspection in February 2018 the provider sent us an action plan. This stated how they would improve the areas we identified that required improvement. We carried out this inspection to check whether the actions had been comp

This unannounced inspection took place on 12, 13 and 14 February 2018. Cherry Tree Nursing Home 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 Nursing Home is registered to accommodate up to 52 older people. At the time of the inspection 37 people were permanently living in the home; one person was receiving respite care.

The accommodation is spread over two floors. The ground floor had dining rooms and communal areas. The home is surrounded by extensive gardens which contained a stream and pond.

As part of the requirements for the registration of Cherry Tree Nursing Home a registered manager is required. At the time of our inspection there was no registered manager in place. A new manager had taken up employment the week before our visit. They intend to become the 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.

We found the home was not always safe as records were not always up to date, accurate or accessible. Risk assessments did not always reflect the hazards people faced. Care plans were bulky and information was difficult to locate. Medicines records related to diabetes and body maps were not always completed when required. This placed people at risk of unsafe care.

Other areas where records were not completed appropriately included recruitment, health and safety and accidents and incidents. Staff were not always able to find information or files when requested to do so. The manager and deputy manager plan to take action to improve record keeping in the home.

We observed there were sufficient numbers of trained and experienced staff to enable people to receive care when they needed it. People told us they felt safe living in the home and support was available to them when needed.

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. Where required appropriate Deprivation of Liberty Safeguards had been submitted for authorisation. This protected people’s human rights.

People were supported with their healthcare needs.

Support was offered to staff through training, supervision, appraisals and daily or monthly meetings. Staff told us they felt supported and appeared to be happy with their work.

People told us the staff were caring, we observed positive and meaningful interactions between staff and people in the home. Staff were trying to ensure their own communication skills were improved upon. For example, staff who did not speak English as their first language were offered English lessons.

People were treated with respect by staff, and their privacy and dignity was maintained. We did not always see in people’s care plans that they had been involved in planning and reviewing their care. We have made a recommendation about this.

Whilst people told us there was a lack of activities in the home, staff were trying to encourage social interaction with people. The provider had recruited a new activity staff member, and the manager intended to put in place an activity programme for the home.

Staff spoke positively about the new manager and the work the deputy manager had completed during their time as interim manager. The manager agreed with our findings and assured us audits would to take place to ensure the improvements were made. We have made a recommendation about audits.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) R

The inspection team included two inspectors. They gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Assessments of people’s needs had been carried out prior to them arriving at the home. Care plans and risk assessments were in place to ensure staff knew how to meet each person’s needs in a safe and respectful way. We had concerns about the way some staff carried out moving and handling techniques, which we believed to be unsafe and not respectful of people’s dignity. We reported this to the provider and the local safeguarding team. The provider took immediate steps to address these concerns.

We found the standards of hygiene in some parts of the home placed people at risk of infection, whilst other areas appeared clean and well maintained. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to standards of infection control and hygiene in the home.

We noted the provider did not have in place a needs analysis to determine how many staff were required to meet the needs of people in the home. Neither had a risk assessment been completed to determine the minimum number of staff needed to maintain a safe service. We had concerns regarding the number of staff available to meet people’s needs at night. Without a need analysis in place people may be placed at risk of harm. We have asked the provider to tell us what they are going to do to ensure they know what the required staffing levels are and how they are going to meet this requirement.

The provider did not have suitable arrangements in place to assess the ability of people to consent to care and treatment in line with the Mental Capacity Act 2005 code of practice. This meant people may have their liberty unlawfully deprived. We have asked the provider to tell us what they are going to do to meet the requirements of the law to ensure people are not deprived unlawfully of their liberty.

A concern had been raised with the Care Quality Commission that some staff were unable to speak English. We found some staff were unable to communicate clearly in English. We have asked the provider to us what they are going to do to ensure staff can both speak and understand English.

We found recruitment practices were safe and all necessary checks had been carried out prior to staff being employed in the home.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Care plans were up to date and reflected their current needs.

We met with five people and one person’s relative who told us they were happy with the care provided to them at the home. One person told us “It is a lovely place; they look after us very well.” Another person told us the service “couldn’t be better.”

The provider took note of people’s comments about the service and where changes were required had taken the appropriate action.

Is the service caring?

People told us the staff were caring in their dealings with them. People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

Weekly medication audits were undertaken to ensure correct procedures were being followed and where any concerns were evident they were acted upon. Regular medication spot checks were also undertaken. We saw documentation to evidence this and the actions taken in response to these where any concerns were evident.

During the inspection we found any concerns we raised with the provider were responded to quickly and appropriately. Two people told us they had never had to use their call bells as staff were able to plan for their needs.

Is the service well-led?

People who used the service and the staff told us they felt the service was well-led.

We saw evidence the manager carried out regular supervision sessions with staff and observations of their practice. This ensured they could support staff to carry out care to the required standards.

People told us they were happy living at the home and the care staff were described as "Marvellous" and "Very caring." We spoke with four people and two relatives. They all commented positively about their experience there. One person said they were content to live there, another told us they would recommend it to their friends and the third and fourth people both commented on the kindness of the care staff. A relative told us her mother was looked after "very well; she is quietly content". Another relative told us the care delivered by the staff was good, but added they thought the staff were not always able to respond as quickly as the person would like. No-one we spoke with had cause to write a formal complaint.

We were told that all staff had been trained in the safeguarding of vulnerable adults, and we saw documentation to confirm this. This demonstrated that people who use the service were supported by staff with the appropriate skills and knowledge to recognise and deal with any concern regarding abuse.

Staff told us they felt supported in their roles. Training had been provided to ensure staff had the skills and knowledge to meet people's needs, and to help them perform to a high standard.

There was regular monitoring of the service. We heard that surveys had been sent to people and their relatives to seek their views. Regular relative and residents meetings were held; we viewed minutes of these. Audits had been undertaken of various areas of the home.

A person who used the service was able to tell us about their experience. They said that their needs were being met at the service. They said "I am well cared for. The food is good." They told us that they were able to choose what time to rise and retire and what activities they wished to participate in. The person said "I have never had to make a complaint about the care."

We spoke to two relatives of people who used the service. They told us they were happy with the care that their family members were receiving. They said that staff made them aware if there were changes to their family members care.

The five people whom we spoke with told us that they were able to choose what clothes they wished to wear, what time they wished to rise and retire and what activities they wished to participate in. They said that staff always knocked on their bedroom door and waited for a reply before entering.

People said that they were registered with a general practitioner (GP) who visited the home weekly or as and when required. They said that they had access to other health care professionals such as the optician and chiropodist.

The majority of the people that we spoke with told us that they felt safe in the home. They said that they knew who to speak to if they were not happy with a situation. They said that staff always spoke to them in a calm and respectful manner.

People said that they had no problems with how their medication was being managed. They told us that staff administered their medication at the prescribed times.

Two people told us that there was always a trained nurse on duty. She provided advice and support about care and treatment if required.

The people we spoke with were confident that staff were adequately trained to meet their needs.

The majority of the people we spoke with told us that they were encouraged to give their opinion on how the home was run. They said regular residents and relatives meetings took place. Any suggestions made were acted upon.

This unannounced inspection took place on the 13 and 14 July 2015. Cherry Tree Nursing home provides nursing care to up to 42 older people. At the time of the inspection there were 34 people living in the home. The home is set on two floors, the ground and first floor. A lift is available to assist people to move between both areas. Wet rooms, bathrooms and toilets were available on both floors, three of the bedrooms have en suite facilities, The building is surrounded by well-maintained gardens, a pond with a fountain and footbridge to provide access.

A registered manager has been in place for over three years. 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.

People told us they felt safe in the home and staff knew and understood how to meet their needs. Assessments of people’s needs were completed prior to people moving into the home. Where appropriate people’s relatives were involved in the assessment process. People told us they were happy living in the home, and staff were kind and supportive.

We observed staff carrying out care with people who had difficulties. They showed respect towards the people they cared for; they were encouraging and sensitive to individual people’s needs. Where people needed specialist care this was provided through referrals to speech and language therapists and community psychiatric nurses as well as the local GP and hospital.

Staff told us they felt supported by the registered manager. Records showed staff received induction, training and regular supervision alongside annual appraisals. Staff were comfortable feeding back to the registered manager concerns or ideas for improvement. Staff were encouraged to note positive aspects of their colleague’s performances. Alongside the opinions of people living in the home, their relatives and visitors these comments were recorded on a wellbeing tree. This acknowledged the good practice of staff.

Staff recruitment was undertaken in such a way as to minimise the risk of employing staff who might be unsuitable to work with the people living in the home. Checks were made on the suitability and previous conduct of applicants.

People told us they enjoyed the food in the home, with their choices and preferences being supported. Where people required support to enjoy their mealtimes, this was provided. Specialist advice was available from external professionals to ensure people nutritional health was maintained.

Medicines were stored and administered safely. Staff were trained in how to administer medicines and the registered manager regularly reviewed the medicines records to ensure people received them when needed. Where discrepancies or concerns arose these were investigated.

The registered manager and the staff had a clear understanding of the Mental Capacity Act 2005 (MCA) and how it applied to their role. There were no restrictions in place for people in the home, and people had the freedom to access all parts of the home apart from areas that stored hazardous materials or equipment.

People and their relatives were involved in making decisions about their care, how the home was run and were able to give feedback to the registered manager and staff. When complaints were raised these were dealt with quickly and appropriately and in line with the providers policy.