About the service:

Cherry Tree Lodge provides accommodation, personal care and support for up to 31 older people. At the time of the inspection there were 27 people resident.

People’s experience of using this service:

There was a positive atmosphere in the home which we found to be homily and well run. People living in the home interacted freely and staff were seen to be caring and supportive.

The assessment and planning of people’s care was individualised. We found care records that supported people were completed and reviewed with the person’s input. We found some of the detail could be improved to give a fuller picture of the care being given.

We saw there were systems in place to monitor medication so that people received their medicines safely. We found some of the medication records did not fully meet the provider’s own standards; this was addressed during the inspection.

We were given positive feedback from the people we spoke with who were living at Cherry Tree Lodge. They told us they enjoyed living at the home and their quality of life was enhanced by the care provided and the general running of the home. People said they were well cared for. People were listened to. People had the support they needed to express their needs and wishes. People could make decisions and choices.

All the people we spoke with told us they felt safe and well supported. One person said, “The carers are lovely, every one of them." A visitor commented, “The carers are excellent, nothing is too much trouble for them."

The home was staffed appropriately and consistently. We found staff communicated and supported people with dignity and respect. Staff could explain each person’s care needs and how they communicated these needs. People living at Cherry Tree Lodge told us that staff had the skills and approach needed to ensure people were receiving the right care.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was ongoing. All the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest. 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 support this practice.

We saw people’s dietary needs were managed with reference to individual needs and choice. Meal times were a main feature of life in the home and provided a very good social occasion.

The manager could evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. These were generally effective in managing the home and were based on getting feedback from the people living there. Some of the auditing processes needed to be completed so that there was a better collation and analysis of feedback received which could then plan ongoing development.

Rating at last inspection:

This service had previously been inspected in October 2016 and rated as good. The report was published on 2 November 2016.

Why we inspected:

This was a planned comprehensive inspection. There were no previous concerns about the service.

For more details, please see the ful

The inspection took place on 3 October 2016 and was unannounced, which meant the provider did not know we were coming. We last inspected the service in January 2015 when it was found to be meeting the regulations we assessed.

Cherry Tree Lodge is registered to provide accommodation and personal care for up to 31 older people. It is situated on the outskirts of Southport. There are 25 single and 3 shared bed rooms, all rooms have en-suite facilities.

We observed staff interacting with people and found there were enough staff available to meet people’s needs in a timely manner. People we spoke with said there were always staff available both night and day. Staff we spoke with told us they worked well as a team.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. We found an error with disposal of controlled drugs but this was rectified immediately by the provider.

We spoke with staff about the training and support they received. All staff we spoke with told us they received appropriate training which gave them the skills and knowledge to carry out their role.

Staff we spoke with were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and told us they had received training in this area.

People received food and nutrition in line with their individual preferences. Snacks and drinks were available throughout the day in addition to meals provided.

We spent time throughout the inspection observing staff interacting with people who used the service. We found staff were patient, kind and caring and understood the different needs of people that were supporting.

Training was provided to staff to ensure they were kept up to date with their knowledge. Staff felt training provided them with the skills to do their job well.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff confirmed they had received training in this area and were knowledgeable about consent to care.

People received a nutritious and balanced diet which met their needs and maintained their preferences. People were offered drinks and snack throughout the day in addition to their meals.

Staff showed kindness and understanding in their interactions with people who used the service. They took time to ensure people’s choices were respected. Staff knew people well and was able to support them in line with their individual preferences.

We looked at care plans belonging to people and found they reflected the care and support being provided.

Activities and social events took place and were enjoyed by people who used the service. People were involved in what they would like to do and the activity co-ordinator would arrange events.

The provider had a complaints procedure and people knew how to raise a concern. Everyone we spoke with were very happy and had no complaints about the service.

There were systems in place to assess if the home was operating correctly. Action plans had been put in place to address any areas that needed improving.

We carried out this inspection to check that the provider had taken action since our last inspection in August 2014. Following our inspection in August 2014 we identified concerns because we found that the introduction of surveillance equipment had infringed a person’s right to privacy. The provider had not complied with the law because the person had not been asked to consent to the process. The equipment was removed promptly after that visit.

An adult social care Inspector carried out this inspection. We spoke with three people using the service, three staff and the registered manager. We looked at risk assessments and care plans for one person. We looked at policy and procedure documents relevant to involving people and consent to care and treatment.

During this inspection on 18th of February 2015 we found improvements had taken place in that the managers and staff understood the need to seek consent from people or hold a best interests meeting if a person lacked the capacity to make a decision. Staff understood the correct steps to take if relatives requested installing surveillance cameras in future.

Our inspection was carried out unannounced. The inspection helped answer three of the five questions we review:

• Is the service safe?

• Is the service effective?

• Is the service caring?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records. We also spoke with a representative of the provider [owner] of the home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the homes understanding of the Mental Capacity Act 2005 [MCA] which is the legislative framework for the decision making process regarding people who may lack mental capacity to make such decisions.

Prior to the inspection we received some information that the home had introduced some equipment to help monitor a person’s behaviour. We checked to see how this had been introduced and whether the person had been involved in the decision and how this impacted on their privacy.

We found the introduction of this equipment /procedure had infringed the person’s right to privacy and had not complied with the law. We have asked the provider to take action regarding this.

Staff advised us that one person was subject to a Deprivation of Liberty Safeguards (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. In this instance the home had acted in accordance with DoLS and had protected the person by ensuring their rights.

Those people spoken with were very relaxed around staff and said they were listened to, so any concerns could be addressed. This helped ensure people had good feelings of wellbeing and felt safe.

We spoke with staff on the day of our visit who were able to tell us how they would identify possible abuse and how they would report this through the senior staff in the home.

Is the service effective?

People’s health and care needs were assessed with appropriate referrals being made to external professionals who could assess and support the care of people in the home. Care needs had been identified in care plans and these had been reviewed. We looked at the care of three people and the care plans reflected their current needs.

Visitors confirmed that they were able to see people at any time as visiting times were flexible. They said that staff kept them informed and they were therefore always up to date with any changes to people’s care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented positively about life in the home and about the staff providing the care. A relative we spoke with was very impressed with the care. They said they felt involved in the care and staff were quick to respond to any changing care needs their relative might experience.

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

We saw from training records that staff had received training on mental capacity which supported staff to provide care in a way that respected the decisions people made about their care.

People living in the home spoke positively about the care they received. Comments included, “The food is excellent and I am well looked after. I can come and go around the home as I wish.” A relative we spoke with told us, “Staff keep us [the family ] up to date and contact us if there are any concerns. We feel confident they are well looked after and safe."

The home had a detailed handover report for staff at shift changeover time. This included a colour coded system whereby people with high levels of need or new concerns were easily identified. Staff we spoke with told us this system helped them carry out their job and was a useful visual summary of people’s needs.

Care plans we looked at included details regarding which medication people would manage independently and which they required support with.

People we spoke with told us that staffing levels were good and that they did not have to wait long for call bells to be answered if they needed assistance in the lounge areas or in their own rooms during the day or in the night.

We found that personnel, supervision and training records were kept securely in order to ensure the confidentiality of information held by the home.

We spent time talking with people who live in the home. We listened to their views and experiences of the care and support provided by the home. Everyone we spoke with was positive about the care provided. One person told us, “It is a very lovely place to be”. We were also informed that, “The staff are kind and caring”. Another person, who described being very well looked after, said “The carers are excellent, that is the key to it”.

Overall people expressed a satisfaction with the food. We heard that choice was available at each meal time. People told us there were plenty of activities going on in the home such as, bingo and music events with an external singer. We heard that people went out regularly to shop in Southport, the park or for walks around the local area.