About the service: Cherrytree Residential Home is a care home for older people. The service is registered to accommodate 40 people. On the day of our inspection 26 people were using the service.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 20 December 2018 where we found four breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served a warning notice for Regulation 12, Safe Care and treatment to the provider and told them they must be compliant by 4 February 2019. Our concerns were the cleanliness and infection control practices within the service. We were also concerned about a potential fire risk in a one area and lack of risk assessments identified for some people.

We rated the service as 'Requires Improvement'. The provider submitted information stating what they intended to do to address the shortfalls.

You can read the report from our latest comprehensive inspection by selecting 'all reports' link for Cherrytree Residential Home on our website at www.cqc.org.uk.

At this inspection we found the provider had made improvements to meet the requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• People were protected from the risk of infection because systems and processes complied with the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance. Action had been taken to address all the infection prevention and control concerns identified at the last inspection.

• The premises and equipment were now clean and staff had the equipment they required for effective cleaning, hand washing and hand hygiene.

• Equipment had been replaced and communal bathrooms were being refurbished to meet the needs of people.

• The environment was undergoing a programme of redecoration and ongoing maintenance to fittings and furniture to be completed by September 2019.

• Risks in the environment were identified and managed appropriately.

• The courtyard and side alley had been cleared of all the rubbish and were fully accessible for people to use.

• The fire safety risk had been reviewed and rectified to keep people and staff safe.

Follow up: We will continue to monitor this service and respond accordingly. We plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

We inspected the service on 20 December 2018. The inspection was unannounced. Cherrytree Residential 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. The service is registered to accommodate 40 people.

On the day of our inspection thirty-two people were using the service.

People were not protected from the risk of infection because systems and processes did not comply with the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance. Some areas of the premises and some equipment was not clean and staff did not have the equipment they required for effective hand washing and hand hygiene. Risks in the environment were not identified or managed appropriately.

The environment had not been adapted to meet the needs of people living with dementia and was in need or redecoration and ongoing maintenance. There was a schedule of planned redecoration and replacement of fittings and furniture to be completed by September 2019.

The quality of meals provided was inconsistent and did not always meet the needs and preferences of people who used the service. People had access to the healthcare services they required. People had their needs assessed before moving into the service and staff received the training and support they required. People were asked for their consent before care and support was provided. Staff were following the principles of the Mental Capacity Act (MCA).

People did not always receive personalized care. Care plans did not fully reflect people’s physical, emotional, mental health and social needs and were not up to date. People were not always supported to raise concerns. People were able to take part in activities they enjoyed.

Staff did not always have time to spend with people. Some people’s furniture or equipment in their rooms was broken, worn or dirty. There were unpleasant odours in some people’s rooms.

People told us they liked the staff and had developed positive relationships with them. Staff knew how to protect people’s privacy when providing personal care and information about people was stored securely.

The providers systems and processes for monitoring the quality of service provision had failed to identify risk and did not gather or act on the feedback and experience of people who used the service.

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.

Staff felt supported by their managers and told us their managers listened to them and took action where action was required.

People had their medicines managed in a safe way and usually received their medicines at the times they were prescribed and needed.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

This was an unannounced comprehensive inspection that took place on 1 June 2017.

Cherrytree Residential Home provides accommodation and care for up to 40 people who are aged over 65 and who may also have a physical disability or have a diagnosis of mental health. The home is located on two floors and has three communal lounges, a large garden and a dining room where people could spend time together. At the time of inspection there were 36 people using the service.

The service had 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.

People were protected from the risk of harm at the service because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to report any concerns that they had about people’s welfare.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where risks had been identified control measures were in place.

There were enough staff to meet people’s needs safely. The provider had safe recruitment practices. This assured them that staff had been checked for their suitability before they started their employment.

People’s equipment was regularly checked and there were plans to keep people safe during significant events such as a fire. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were offered to them in accordance with their prescriptions. Staff had been trained to administer medicines and had been assessed for their competency to do this.

Staff received appropriate support through an induction and guidance. There was an on-going training programme to ensure staff had the skills and up to date knowledge to meet people’s needs.

People received sufficient to eat and drink. Their health needs were met. This is because staff supported them to access health care professionals promptly.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed where there were concerns about people’s ability to make decisions for themselves. However, these were not completed to make a specific decision. The registered manager told us that these were being completed with support from Leicestershire County Council. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect. Staff knew people they cared for and treated people with kindness and compassion.

People received care and support that met their individual needs and preferences. Care plans provided information about people so staff knew what they liked and enjoyed. People took part in activities that they enjoyed.

People and their relatives knew how to make a complaint. The provider had a complaints policy in place that was available for people and their relatives.

People and staff felt the service was well managed. Staff felt supported by the registered manager.

Systems were in place which assessed and monitored the quality of the service and identified areas for improvement. This included a plan for maintaining and improving the environment. People were asked for feedback on the quality of the service that they received. The service was led by a manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

This was an unannounced comprehensive inspection that took place on 20 April 2016. At the last inspection completed on 23 February 2015, we found the provider had not met the regulations for three areas; not making the required notifications to the Care Quality Commission, assessing and monitoring the quality of service provision and consent to treatment. At this inspection we found the provider had made the required improvements and the regulations were being met.

Cherrytree Residential Home is a care home registered to accommodate up to 40 people who are aged over 65 and who may be living with dementia or have a diagnosis of mental ill health. The home is located on two floors, with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 35 people were using the service.

The service had 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.’

People told us that they felt safe when staff supported them and that they enjoyed living at Cherrytree Residential Home.

Risk assessments were in place which described how to support people in a safe way. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

The provider carried out checks before staff started to work at the service.

People received their medicines safely and at the right time by staff who were trained and assessed as competent to administer these.

Staff were supported through training and supervision to be able to meet the needs of the people they were supporting. They undertook an induction programme when they started to work at the service.

Staff sought people’s consent before providing personal care. People’s capacity to make decisions had been considered in their care plans. Assessments of a person’s capacity to make a specific decision had not always been fully completed.

People were supported to maintain a balanced diet. People were supported to access healthcare services.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity. Staff understood people’s needs and preferences.

People were involved in decisions about their care. They told us that staff treated them with respect.

People were involved in the assessment of their needs. People and their relatives were sometimes involved in the review of their needs.

People were supported to take part in activities that they enjoyed.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

The service was well organised and led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

People were asked for their feedback on the service that they received. The provider carried out monitoring of the quality of the service.

This inspection took place on the 23 February 2015 and was unannounced.

At the last inspection on 9 January 2014 we found the provider met the requirements of the regulations that we looked at.

Cherrytree Residential Home is a care home for up to 40 people and provides care and support to people with needs associated with age and physical disabilities, and people living with dementia. On the day of our inspection 32 people were living at the home.

Cherrytree Residential Home is required to have 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. At the time of the inspection a registered manager was in post.

People and their relatives told us that they had no concerns about safety. People told us that they received their medicines safely and at the right time. Some relatives thought the staffing levels could have been better to enable staff to have had more time to spend with people. The manager assessed the needs of people and this determined the staffing levels required.

Staff were aware of the safeguarding procedures in place and of their responsibility to protect people and how to report concerns. We found people received their medicines safely but identified some concerns with the management of medicines.

People and their relatives told us that they were supported to maintain their health by having access to healthcare professionals when they needed to. People were positive about the meal choices and said they received sufficient to eat and drink. People had their dietary and nutritional needs assessed and planned for. Referrals were made to healthcare professionals on the whole in a timely manner.

Staff received an appropriate induction and ongoing training. However, we identified that staff had not completed all the training that the manager had identified as required. Staff did not receive regular opportunities to discuss and review their practice and development needs with their line manager.

Some people did not have the mental capacity to make certain decisions about their care and treatment. The manager had not adhered to the Mental Capacity Act 2005 (MCA) Code of Practice. Staff also lacked understanding of this and the majority of staff had not received MCA training. The manager demonstrated they were aware of the Deprivation of Liberty Safeguards and had acted appropriately when required.

People and their relatives were positive about the approach of staff and said staff were kind and caring. We found staff treated people with dignity and respect and that consent was sought before care and support was provided.

People and their relatives told us that care was based on their routines and preferences and what were important to them. However, we found information about how to meet people’s needs lacked some of the key information that staff needed to support people effectively.

People and their relatives received opportunities to share their views and experience of the service. Social activities were provided. The information available to people about independent advocacy services was out of date. Whilst the provider’s complaints procedure was on display its position was not accessible.

We found some concerns with people’s plans of care and associated risk assessments. We saw examples where people had specific health conditions that did not have a plan of care advising staff of their needs and how to meet those needs. We also saw examples of plans of care that lacked detailed information and guidance for staff. Care records had not always been fully recorded.

The quality assurance systems in place had failed to identify some of the concerns we found.

The provider had identified some concerns with the safety of the environment but risk assessments for these had not been completed.

Staff had opportunities to be involved in decisions and discussions about how the service was provided. Staff meetings were held and there were communication systems in place including handover meetings to discuss people’s needs on a daily basis.

We have made a recommendation about the management of complaints.

We found the service was in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Plus one breach of (Registrations) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Our inspection of 08 August 2013 found that people were at risk of being locked in their bedroom. That was due to the type of lock being fitted to some of the bedrooms in the home. The home did not have an up to date plan of decoration so we could not see when the décor in the home was to be updated.

The provider wrote to us and told us that they would make changes to the outcome area by 9 October 2013. We returned to the home and looked at the changes the provider had put in place.

We noted there had been improvements in medication administration and this was now stored and dispensed appropriately. We noted the staff were also using the medication administration charts (MAR) charts more effectively. Staff were now recording medicines coming into the home using their initials instead of a simple tick system. That meant the medication system was more secure.

We saw that the provider had introduced documentation to ensure people had the capacity to make informed decisions, and so protect their human rights.

We saw where the home had been decorated since our last visit. The manager told us that this was an on-going programme, with some bedrooms and corridors having been decorated. New bedroom door locks have been replaced throughout the home. That was due to some locks being an inappropriate type that could have allowed people to lock themselves in their room.

Because many people who live at Cherrytree Residential Home have cognitive disability or communication difficulties, we were unable to ask some people directly about their experiences. We spent time observing people in the home and used a Short Observational Framework for Inspection tool (SOFI) to help us see what people’s experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We observed from a distance, saw and heard where people had the opportunity and chose their preferred meal at lunch. We also saw where people were offered the choice of pain relief medication. This means that people are offered positive and constructive choices on a daily basis. We also looked at food and fluid and saw where people at risk are monitored for their daily intake of nutrition.

We found that people that people who do not have capacity, do not have the necessary legal checks in place to provide them with appropriate protection. We also found where improved monitoring is necessary on medication and the improvements to the security and decorating round the building. We also looked at staff recruitment and noted some of the security checks are not regularly renewed.

We observed staff talking with and assisting people throughout the day, this was done with the peoples’ privacy and dignity in mind and showed the staffs’ awareness of peoples individual support needs.

We spoke with a number of people living in the service and a number of visiting relatives. One of the people using the service stated “it was ham and parsley sauce (for lunch) today, I enjoyed that”. Another stated “the meals are nice, but sometimes the plates are cold”.

People also made the following comments about the home. “(persons name) has only been here a short while, he seems happy here; the staff have been very helpful”. Another stated “When mum went into hospital, they contacted us right away”.

On our tour around the home we saw people in a relaxed state. There has been a number of floor coverings replaced and some areas decorated recently. There is regular maintenance of the equipment in the home where a number of external contractors are used to ensure this is safe for use by the staff.

Staff are employed in sufficient numbers and receive regular training to ensure people are cared for safely.

During our visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent forty five minutes watching people in the lounge and found that overall people had positive experiences. We observed one person with limited communication had not received any interactions with staff for some time. They had needed a tissue but staff had not noticed this. The management team found the learning useful and will be making changes around the deployment of staff.

People told us they were well cared for and happy at the home. People also told us,

“Staff are nice and chatty and will help you in any way they can. They are pretty fair in every respect.” “Very friendly here. We have a jolly good chef and they always ask us what we would like to eat.” “Staff are friendly and we have a laugh. I would tell them if I wasn’t happy.”