About the service:

Cherry Cottage is a residential care home, providing accommodation and personal care to seven people at the time of the inspection. Overseen by the registered manager and therefore effectively attached to the Cherry Cottage care home service are a variety of ‘supported living’ services, where people lived in their own tenancies. These are part of the provider’s overall setup at New Hall in Fazakerley, but offer people a first step into more independent living. There were 12 people living in the supported living bungalows and flats next to Cherry Cottage when we visited. Both the care home and attached supported living services specialise in the care for people with different health and care needs, autism and/or learning disabilities, as well as people with mental health conditions. Cherry Cottage and the attached supported living services are a short walk away from local shops and public transport.

People’s experience of using this service:

We found some very positive examples of the difference staff had made to people’s lives. However, learning and planning to underpin at times complex support needed to be more robust to provide a consistently safe, quality service. We made a recommendation regarding the effectiveness of review systems. This meant we rated Well-Led as Requires Improvement on this inspection. The service continued to meet the characteristics of good in most of the areas we looked at.

People felt safe living at the service. People were proud of the things they had achieved with staff support. One person told us, “[When I need it] Staff will just sit and listen to me. They have helped me to gain confidence and meet new people.” We heard very good examples of how the service embraced and promoted people’s equality and diversity. The trusting relationship between people and staff was evident in what people were happy for staff to know about.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Although Cherry Cottage and the attached services are part of a larger provider setup at New Hall cottages, staff supported people to get involved in the nearby and wider community. Care was person-centred and people were supported to do things they enjoyed, as well as encouraged to learn and try new things.

Managers led the inclusive, caring and compassionate culture of the service with clear dedication and were well respected by people living at the service and the staff. People and staff were involved in the design and delivery of care. There were enough staff to meet people’s needs and staffing was flexible around people’s wishes. Staff felt well supported and told us everyone worked well together to provide a good service for people.

Rating at last inspection:

At the last inspection we rated the service as Good (1 October 2016).

Why we inspected:

This was a planned inspection that was scheduled based on the previous rating. We inspected to check whether the service had sustained its Good rating.

Follow up:

We will follow up on this inspection through ongoing monitoring of the service, through conversations and notifications.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 22 August 2016 and was unannounced.

Cherry Cottage is a residential service which provides accommodation and personal care for a maximum of six people with complex health and care needs. At the time of the inspection six people were living at the home. The main accommodation consists of six self-contained flats and a shared kitchen and lounge. Cherry Cottage also has a small supported living service adjacent to the main building for people who are more independent. At the time of the inspection three people were living there.

A registered manager was 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 told us that they felt safe living at Cherry Cottage and receiving support from the supported living service.

At the previous inspection we identified concerns relating to the currency and accuracy of risk assessment documentation. At this inspection we looked at risk assessments for two different people and found that improvements had been made immediately following the previous inspection.

At the previous inspection we identified that the home’s policy and procedure relating to missing person’s did not accurately reflect current practice. We looked specifically at the procedure and saw that it had been revised appropriately.

Staff had been trained in safeguarding procedures. They clearly understood different types of abuse and neglect and what signs to look out for. Staff were able to explain what action to take if they suspected that abuse was taking place.

Staff were recruited safely subject the completion of appropriate checks. This included a requirement for two references and a Disclosure and Barring Service (DBS) check. DBS checks are used to determine that people are suited to working with vulnerable adults. Each of the staff records that we checked contained an application form, references, DBS check and photographic identification.

People’s medicines were stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. Each of the MAR sheets had been completed correctly. Stock levels tallied with the figures recorded on the MAR sheets.

We saw evidence that staff had been trained in a range of topics relevant to the needs of people living at the home.

Applications to deprive people of their liberty had been submitted appropriately and in accordance with the Mental Capacity Act 2005 and had been made in people’s best interests. Each application had been reviewed and renewed as required.

People were supported to maintain good health by accessing a range of community services. We saw evidence in care records that people had a GP, optician and dentist and had regular check-ups.

Throughout the inspection we observed staff interacting with people living at the home in a manner which was kind, compassionate and caring. Staff adapted their communication style to meet the needs of each person.

We saw that people had choice and control over their life and that staff responded to them expressing choice in a positive and supportive manner.

At the previous inspection we identified a concern relating to the completeness and accuracy of person-centred plans. At this inspection we saw that people’s plans were sufficiently detailed to inform staff of people’s needs and preferences and had been regularly reviewed. The plans had a focus on developing people’s skills and independence which was in-line with the purpose of the home.

People talked positively about the progress that they had made since moving to Cherry Cottage and their plans for the future.

Staff were deployed flexibly so that people had a degree of choice in who p

This unannounced inspection took place on 5 and 7 October 2015.

Cherry Cottage is located in Fazakerley close to local shops and bus routes. The location provides accommodation and personal care to adults aged 18 – 65 who have a learning disability and/or a mental health need. Some people may have behaviour that can be challenging. The property consists of six self-contained flats with fitted kitchens and bathrooms in each, and in addition, a communal sitting room and kitchen downstairs that people can also utilise if they chose to. There were four people living in Cherry Cottage at the time of our inspection.

A registered manager was 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 felt safe and staff knew what actions to take if they thought that anyone had been harmed in any way. Relatives told us they were happy with the care their family member was receiving at Cherry Cottage.

Risk assessments did not always reflect current staff guidance to manage specific risks that may affect people. However, staff communication ensured that this did not place people at risk of harm, because staff understood the actions required to promote people’s safety. We have made a recommendation to the provider about this.

Policies and procedures were in place and staff understood them, however, the whistleblowing policy contained generic information and were not specific to the service.

People received their medicines as prescribed and safe practices had been followed in the administration and recording of medicines.

Relatives and other professionals we spoke with confirmed that there were enough staff available to meet the needs of the people living in the home. People told us there were enough suitably trained staff to meet their individual care needs. Staff were only appointed after a thorough recruitment process. Staff were available to support people to go on trips or visits within the local and wider community This was supported by our observations during the inspection.

Staff were knowledgeable, kind and compassionate when working with people. They knew people well and were aware of their history, preferences and dislikes. People’s privacy and dignity were upheld. Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed.

Staff understood the need to respect people’s choices and decisions if they had the capacity to do so. People who lived at the home had capacity to make their own decisions at the time of our inspection, however the manager did demonstrate a good understanding of the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005)

People’s bedrooms were individually decorated to their own tastes. People were encouraged to express their views and these were communicated to staff verbally.

People were supported to purchase and prepare the food and drink that they chose. People who lived at the home, their relatives and other professional’s had been involved in the assessment and planning of their care. Care records were in place, however these did not fully explain the complexity of some people who lived at the home or how they should be supported. We have made a recommendation about this to the provider.

There was a complaints procedure in place, however it was not displayed appropriately, when we spoke to people living at the home, they told us they felt confident to raise any concerns either with the staff, the deputy manager or the registered manager.