We inspected the service on 6 December 2016. The inspection was unannounced. Cherry Trees Resource Centre is a purpose built residential care home in Nottingham. The service provides care and accommodation for up to 45 people, some of whom live with a dementia related condition. The service is split into four different units with each unit having lounges and dining areas. On the day of our inspection 43 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it and received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

We inspected the service on 5 August 2014. We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

Cherry Trees Resource Centre provides accommodation and personal care for up to 45 people. On the day of our inspection 43 people were using the service.

The home had a registered manager and also a team leader who was responsible for the oversight of care delivery. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 

In January 2014 our inspection found that the care provider was not meeting all of the essential standards of quality and safety in relation to care planning and medicines management. They sent us an action plan telling us what they would do to improve this and we followed this up during this inspection. We found that the provider had made the improvements in line with their action plan.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find.  These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed.

The registered manager told us there was no one living at the home that was currently subject to a DoLS but that they had taken advice on this following the recent Supreme Court ruling. There was a policy in place on the MCA and DoLS and staff we spoke with understood the principles of this. We found the location was meeting the requirements of the Deprivation of Liberty Safeguards.

The manager made safeguarding vulnerable adult’s referrals when needed and staff knew how to respond to incidents if the manager was not in the home. However, decisions made under the Mental Capacity Act 2005 were not always recorded appropriately.  This is an act introduced to protect people who lack capacity to make certain decisions because of illness or disability.

Staff had the knowledge and skills to care for people safely.  Referrals were made to health care professionals for additional support or any required intervention when needed. This meant people would receive support from the appropriate people when their needs changed.

We observed people were treated with dignity and respect. People who used the service told us they felt staff were always kind and respectful to them.

There were audits and customer satisfaction surveys carried out in the home and where issues were identified action was taken to address these. This meant there were effective systems in place to monitor and improve the service.

We spoke with seven people who were living or staying at the service. They were all happy with the care they received. They all described the staff as “kind,” and they said they felt safe in their care. We observed several interactions between the staff and people living at the service and all of these were good. The staff we observed treated people with respect and were kind and caring towards the people they cared for.

We saw there was a very pleasant and accessible outdoor area to the rear of the building which people said they liked to use. The garden had a chicken coop, rabbit run and many sensory objects to appeal to the people living at the service. We saw many people using the reception/cafe area to meet their friends, visitors and other people living at the service.

We saw that people often spent quite prolonged periods without any staff being with them. Although we did not see any identified risks in terms of people falling or coming to direct harm; there were people who became anxious and needed reassurance. In the absence of staff people living at the service were left to provide this for each other. This was not their area of responsibility and it created a risk of situations escalating beyond their control. We found the providers had failed to identify this as a risk and had not taken any action to manage or address this. This placed staff and people living or staying at the service in a vulnerable position.

We spoke with eight people who lived at the service. One person told us, “I think everything here is ok.” A second person said, “They do their very best in difficult circumstances. I’ve seen what happens in some places in the papers and it’s not like that here.” This person also told us they felt comfortable and safe in the care home. A third person said, “It’s alright, it caters for everybody in the best way to help them to cope. I know I have to fit in, but I find that difficult sometimes.”

We found that care was not always planned and delivered in line with their individual care plan.

We found that sufficient quantities of food and fluid were available to meet people’s identified needs.

We found that appropriate arrangements for the recording and handling of medicines had not always been made.

We found that staff were recruited safely and appropriately.

We found that there was a suitable system to support people and their relatives to make comment or complain about the care they received.