This inspection was carried out over two days on the, 27 and 28 of November 2017. Our visit on the 27 November 2017 was unannounced. At the last inspection on 28, 29 September 2016 we rated the service as requires improvement overall. We identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration and systems to monitor the safety and quality of the service were not effective.

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service had been made and the requirement notices had been met.

Cherryfield House is situated in a residential area of Stockport. It provides accommodation and personal care for up to 29 people. It has 21 single and four shared rooms. There are 18 bedrooms that have an en-suite with shower and the remaining rooms have washing facilities. The home is a two storey detached property located in the Edgeley area of Stockport. It has a small front garden and is situated in a residential area within walking distance of a local park. The home was registered to provide nursing care. Car parking spaces are available to the front of the building and public transport links to Stockport town centre are nearby. We found nursing care had not been provided at the home for some time, and the home did not employ nursing staff. Following our inspection the provider submitted an application to cancel their registration for 'treatment of disease, disorder or injury.'

A registered manager was 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.

From our observations of staff interactions and conversations with people living at the service, people told us they felt comfortable and happy living at the service.

There was an established staff team in place, with low levels of turnover. This meant that staff knew the people they provided care and support to very well. There were sufficient numbers of staff on duty to meet people's needs in a timely way. The registered manager worked 'on the floor', which they told us helped determine the required staffing levels and helped to provide good management and support to the staff team.

Staff were recruited following a safe and robust process to make sure they were suitable to work with vulnerable people.

The home was clean and well maintained and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

Procedures were in place to minimise the risk of harm to people using the service. People received their medicines safely and as prescribed by their doctor. The registered manager audited medications procedures. They took action during the inspection regarding the services policies for the safe administration of medications not being appropriately followed by a staff member.

Risk screening tools had been developed to reflect any identified risks and these were recorded in people’s support plans. The risk screening tools gave staff clear instructions about what action to take in order to minimise risks for e.g. for falls.

People’s health needs were monitored, care plans had been developed to incorporate a lot of individual information relevant to each person. People had access to healthcare services Including a district nurse and chiropodist. We received positive feedback from professionals who worked with the home, including a district nurse and a social worker. We saw a range of health professionals had been involved in people's care. Staff

This inspection took place on 28 and 29 October 2016 and was unannounced.

Cherryfield House provides accommodation and personal care for up to 29 people. It has 21 single and four shared rooms. There are 18 bedrooms that have an en-suite with shower and the remaining rooms have washing facilities. The home is a two storey detached property located in the Edgeley area of Stockport. It has a small front garden and is situated in a residential area within walking distance of a local park. The home was registered to provide nursing care. However, we found nursing care had not been provided at the home for some time, and the home did not employ nursing staff. We requested the provider submit an application to cancel their registration for ‘treatment of disease, disorder or injury’, which they did shortly after the inspection. At the time of our inspection there were 28 people living at the home.

We last inspected Cherryfield House on 01 July 2014 when we found the home was meeting the standards for all areas we inspected. At this inspection we identified two breaches of the regulations, which were in relation to the safe management of medicines and governance systems. You can see what action we told the provider to take at the back of this report. We have also made recommendations about reviewing guidance in relation to reviewing processes for determining staffing levels, developing dementia friendly environments and reviewing practices in relation to agreement for shared rooms.

During our inspection we found lots of examples of good practice, and positive and caring support. However, we also identified several areas where improvements were required. The registered manager was responsive to our feedback and had started to take actions to make some of the required changes during our inspection.

There was 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.

People living at the home, relatives and visiting professionals all described staff as being kind and caring. There was a long-standing staff team in place, with low levels of turnover. This meant that staff knew the people they provided care and support to very well. People spoke about there being a ‘warm’ environment at the home.

There were sufficient numbers of staff on duty in the day to meet people’s needs in a timely way. The registered manager worked ‘on the floor’, which they told us helped determine the required staffing levels. We found the level of staffing on the night shift varied between two or three staff. The provider told us this was due to people’s vary level of needs. We made a recommendation that the provider uses a documented process to demonstrate staffing levels were based on assessed needs.

Care plans were detailed and person-centred. Sufficient information was provided to allow staff to deliver care to people in accordance with their needs and preferences. People’s social histories were recorded, which enabled staff get to know people.

The service actively identified and recorded complaints, whether raised formally or informally. Actions taken to resolve complaints and concerns were recorded, and written responses were provided to any complaints raised formally. People we spoke with told us they had not raised any complaints, but would feel comfortable doing so if required.

Staff told us they received adequate training to carry out their roles competently. We saw training had been provided in a variety of topic areas including safeguarding, dementia, communication and first aid.

One staff member described taking an approach that showed a lack of understanding and was based on staff convenience rather than being centred on people’s need

An inspector visited this service on 1 July 2014 to carry out an unannounced inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, visitors to the home and from looking at records.

Is the service safe?

During this inspection visit we observed that people were treated with respect and dignity by the staff and people told us they felt they had everything they needed and were well looked after by staff.

Visiting relatives told us that they were pleased with the care their relative received. One comment was “Our (relative) is settled and happy. She is well looked after and we are comfortable knowing she is safe when we leave her here or go on holiday.”

During our visit we looked at the premises to see if they were suitable for their intended purpose. We found the premises to be suitable and there was evidence of on-going maintenance at the home. During our visit we toured parts of the home and found all areas to be clean and tidy with no unpleasant smells. Since the last inspection we saw refurbishment had been undertaken in many parts of the home. This included refurbishment of en-suite bathrooms and washing facilities, all bedrooms have had new carpets fitted, all bedrooms had been repainted, had new lighting, new curtains and bedding and new wall mounted T,V’s. The dining room and both communal lounges/dinging area have had new curtains.

The environment was clean, tidy and systems were in place to prevent, detect and control the spread of infections.

Visiting relatives told us that the home was always clean and tidy.

Is the service effective?

People living at Cherryfield House had a care file that included assessments of their individual needs and potential risks. The care plan had been developed and implemented to meet those assessed needs. The assessments and care plans were reviewed on a monthly basis and updated accordingly.

Prior to people being admitted into the home, where possible the manager or a senior member of staff visited the person to carry out an assessment of their needs. This meant that people could feel confident that the service could meet their individual and personal care needs when they moved into the home. Where possible people could spend some time at the home having lunch and meeting staff and other people living at the home before a decision was made about moving in. We were told that relatives were encouraged to call in and look around the home at any time without having to make an appointment.

Is the service caring?

The atmosphere in the home felt relaxed, pleasant and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed.

All of the people we spoke with who were living at Cherryfield House said they were happy and had everything they needed. One person told us “The care is brilliant, we go out for a lot of walks and I like that.”

When we spoke with visiting relatives we were told that the staff delivered care in a kind and caring way. Some comments were: “Good care is delivered here,” “Staff always give people choices where possible” and “I have never had any concerns.”

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, the district nurse, the chiropodist, the opticians and we saw that people attended hospital appointments. This meant the provider sought relevant professional advice and guidance appropriately.

Is the service well-led?

The service was led by a manager who was registered with the Care Quality Commission.

Visiting relatives told us that they felt comfortable talking with the manager. Some comments were: “Samantha [the manager] is always here and she is very approachable” and “I have never had any concerns but if I did I would go straight to the manager and I am sure she would sort them out.”

The service worked well with other services to make sure people living in the home received appropriate care and assessments from the right professionals in a timely way.

When we spoke with staff they spoke highly of the support they received from the manager. They told us they received regular supervision and training in the home was good. They also told us they had regular staff meetings and if they had any problem they would go straight to the manager who was always available and approachable.

At our last inspection we found that the statement of purpose needed to be updated as it contained incorrect information. During this inspection visit we saw that the statement or purpose which was also used as a service user guide had been updated and was available for people to access.

During our visit to the home we spoke to five people who lived at Cherryfield House, two visitors, six members of staff, one person on a short placement and a person who provided services to the service users.

The people who lived in the care home could chose to spend time in the privacy of their room if they wanted to, although the majority of people spent time in the downstairs lounge. People who used the service could also have a key to lock their door if they chose and one person who chose not to speak to us locked the door to ensure we did not enter.

The people using the service told us they could decide their daily routines and we observed people to be agreeing to take part in planned activities. The people who lived at Cherryfield House had also consented to having their photograph taken and determined how their room was organised and decorated. One told us “this is my home now” another said the home was “comfortable”.

The staff and carers were observed to be unhurried and respectful especially to service users that were confused and forgetful. Staff also sought the opinions of people who used the service with what and when they wanted to eat and drink. One person said that staff were; “brilliant with me” .

The food was generally considered good by the visitors and people who used the service said there was sufficient choice. Specialised diets were catered for a variety of reasons. When people who used the service rejected what was on the set menu, special efforts were made to cater for their individual preferences.

The visitors were made welcome and felt well informed about the care of the people they visited. They had also said they were supported to understand how to cope with some of the distressing aspects of their relatives’ behaviour and consequently felt their relationship with their relative had improved.

The manager has also undertaken a regular “Quality Questionnaires” with relatives and advocates. It asked relatives to give their opinions on the service and if they understand how to make a formal complaint.

We found an area on non-compliance with a minor impact on people using the service in relation to infection control and hand hygiene. The statement of purpose also needed updating to reflect current organisation and services provided at Cherryfield House The Statement of Purpose is a document that the provider must update and make available to the Care Quality Commission. It should include the aims and objectives of the service provider in carrying out the regulated activity, the kinds of services provided, contact details of the service provider and any registered manager, the legal status of the service provider and details of the registered locations.

We completed an unannounced inspection at Cherryfield House on the 4 September 2012. During this inspection visit 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.

As part of the inspection we spoke with three people who used the service, two visiting relatives and four members of staff.

We observed and heard staff talk to people who lived in the home in a respectful way, people were well dressed and their modesty and dignity was preserved when assisted with personal care.

People told us they were happy with their care and were happy living at the home. Some of the comments were:

“I’m alright here.”

“I have everything I need,” and “I can do what I want, it’s relaxed and easy going.”

"This is a lovely place to live."

The family members we spoke with told us that they liked the relaxed, friendly atmosphere of the home. They told us that they thought their relative’s needs were met and they had no concerns about their safety.

Staff told us that people’s privacy and dignity was respected and personal choice was encouraged. One person said “We treat the residents like we would like our own relatives to be treated.”

As part of this review process we contacted Stockport adult social care quality team who monitor the care of the people who had been placed at Cherryfield House by Stockport Local Authority. They told us that they not received any information of concern about the home.