This inspection took place on 09, 11 and 14 November 2018. This first day was unannounced but we informed the registered manager we would be returning on the second day to complete our inspection. We conducted telephone calls with relatives of people who lived in the home on the third day.

Cherrytrees Care Home provides residential and nursing care for up to 32 people. At the time of our inspection there were 21 people receiving nursing care and 9 people receiving residential care. The home provides support to older people, people living with dementia and people with physical disabilities, learning disabilities and younger people.

Cherrytrees 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 home has two floors containing bedrooms and bathrooms. On the ground floor there was a large lounge, a dining room and a small quiet room near the entrance. The gardens were secure and accessible from the ground floor. There was a lift and stairs between the floors.

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.

We last inspected Cherrytrees in January 2016 when we rated the service as good overall and requires improvement in the responsive domain. This was because we had not seen evidence of people engaging in activities and found some people had not had regular reviews of their care or their medicines. At this inspection we found both these concerns had been fully responded to and have rated the home as good in all domains and overall.

Both people living in the home and their relatives told us they felt safe and secure.

The service protected people from the risk of harm or abuse. Safeguarding policies and procedures were robust and had been followed when required. Staff could identify safeguarding concerns and knew how to raise them appropriately.

Risk assessments had identified the specific risks people needed support to manage, plans had been developed to minimise the potential for harm.

Staff had been recruited safely with all necessary checks being completed prior to them starting to work with people. Staffing was sufficient to support people safely.

Medicines were managed safely. We saw people had received their medicines as prescribed.

Infection control policies ensured people were protected from the risk of infection and cross contamination. Staff were observed to follow good practice when supporting people to meet their personal care needs.

The home responded to accidents and incidents which had been fully investigated so lessons could be learned to avoid reoccurrence. An example of this had been the falls prediction strategy.

The premises and equipment were being well maintained and we saw certificates and relevant documentation of any work that had been completed. These included checks of electrical installation, fire alarms, legionella, gas safety, hoists/slings, the lift and fire equipment.

The home had assessed people's needs thoroughly prior to them moving in. This ensured the home was confident they were able to meet their needs and people received the correct level of service.

Staff had received relevant training which ensured they were able to support people effectively. People who lived in the home told us staff knew what they were doing and were skilled when supporting them. Training for all staff was kept up to date.

People were supported to maintain their nutritional needs. Information provided by health professionals had been included in people's care plans. The kitchen staff wer

This was an unannounced inspection carried out on the 18 January 2016.

Cherrytrees Care Home is registered with the Care Quality Commission to provide accommodation for persons who require nursing or personal care for a maximum of 32 people. The home is located in a residential area of Salford next to a public park with ample parking available for visitors. At the time of our inspection there were 28 people living at the home.

There was a registered manager in post 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.’

We last inspected the home on in July 2014, when we found the service to be compliant with all the regulations we assessed at that time.

People who used the service, visiting relatives and friends told us they or their loved ones were supported by staff that were kind, friendly and caring, which made them feel safe.

We found people were protected against the risks of abuse, because the home had appropriate recruitment procedures in place. We saw appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults.

We saw safeguarding and whistleblowing telephone contact numbers were displayed in the reception area for the use of people who used the service, their relatives and staff. This information was also available in the ‘service user guide.’

We found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely.

As part of the inspection, we looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. We found there were sufficient numbers of staff on during our inspection to support people who used the service.

The registered manager told us all new staff undertook an induction programme, which included obtaining the care certificate over a 12 week period. Depending on previous experience, all new staff underwent a probationary period of three to six months.

All staff we spoke with confirmed they received regular supervision and appraisals, which we verified by looking at supervision records. Supervisions and appraisals enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner.

The home managed Deprivation of Liberty Safeguards ( DoLS) applications on a comprehensive spread-sheet. Staff we spoke with were able to explain the basic principles of DoLS and knew how to seek advice from the manager if they had any concerns about an individual’s capacity or rights. We were able to verify from training records that staff had received training in the Mental Capacity Act.

People we spoke with were very complementary about the food they received, the skills of the cook and confirmed they received a choice.

The interactions between staff and people who used the service was observed to be caring and respectful at all times. People were given time to communicate their wishes. Privacy and dignity of people who used the service was maintained at all times and the general atmosphere within the home was calm.

Staff we spoke with demonstrated a good knowledge of person-centred care principles and the importance of respecting peoples’ rights and preferences. Throughout our inspection we observed that staff treated people with dignity and respected their privacy.

The home was part of the Six Steps End of Life Care programme delivered by Salford Royal NHS Foundation. This programme is intended to enable people to have a comfortable, dignified and pain free death.

The registered manager advised that there was a scheduled pro

Cherrytrees Care Home is registered with the Care Quality Commission to provide accommodation for persons who require nursing or personal care for a maximum of 32 people. On the day of our inspection there were 26 people who were resident at the home of whom 14 were receiving nursing care and 12 were receiving personal care.

As part of the inspection we spoke to seven people who used the service, four visiting relatives and two health care professionals. We also spoke to seven members of staff.

At the time of our inspection, the manager had been in place since April 2014 and had recently submitted an application to CQC to formally register as manager. We were informed that a number of changes had taken place and that the service was still undergoing a programme of change and improvement.

Our inspection was co-ordinated and carried out by an inspector, who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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, the staff supporting them and from looking at records.

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

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; “Yes I feel safe here, the staff are great.”

Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff we spoke to were able to demonstrate a good understanding of the legislation and its requirements.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore people were not put at unnecessary risk.

The manager set staff rotas having regard to people’s care needs, qualifications, skills and experience of staff required. People told us they felt staffing levels were adequate. This helped to ensure that people’s needs were always met.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

Though people told us they felt they had been involved in determining their care needs, it was not always clear to us from looking at care files that people had been consulted.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, “No concerns, visitors just pop in.” “I think it is a good place, they do take care of people here.” “I go to bed when I want to, or chill out in my room.” “I’m content as you can be in a place like this.” A relative told us; “X seems content here and doesn’t want to move.”

People who used the service and their relatives completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed.

We found care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service.

People knew how to make a complaint if they were unhappy. We looked at how these complaints had been dealt with and found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. One visiting health care professional told us; “Things have improved from what I can tell. No concerns around safety.”

The service had quality assurance systems, records viewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities.

We saw care plans were detailed and described the person’s care needs and the type of support they needed from care staff. Risk assessments were in place in relation to falls, moving and handling and nutrition. Where people had specialist care needs we saw staff had received training to enable them to carry out their roles.

Since the last inspection on 3 September 2013 an additional member of staff; working a three hour shift; had been provided to cover over the lunchtime period.

We looked at staff training records and saw staff had completed mandatory and specialist training to ensure that they knew how to meet the needs of each person.

We spoke with eight people and three peoples relatives during this inspection. People told us they were asked for their consent before they received any care or treatment. People we spoke with told us they made daily decisions for themselves. One person told us, “I can have a lie in if I want one, I am offered choices. I choose the clothes I want to wear and there is a choice of food offered”.

Due to the nature of their conditions not everyone who used the service was able to speak with us. People we spoke with and their relatives were happy with the care provided. Comments included, “I’m satisfied with the staff, I think they are good” and “I always feel safe here, the care is good” and “I think the care is fantastic. I sometimes pop in at any time and I am always satisfied with my relatives care”.

We found people were protected from unsafe or unsuitable equipment as regular servicing and maintenance checks were in place.

During our inspection we observed there were not always enough qualified, skilled and experienced staff to meet people’s needs. We had some concerns that people’s needs and preferences were not always being met.

The provider had an effective system in place to regularly assess and monitor the quality of service people received.

People told us that they were happy with the care and support they received at the service. Comments included, “I am kept comfortable and the staff help me a lot.” One person’s relative told us, “They are all lovely here. They are looking after my X very well. I give them ten out of ten, X always looks clean and comfortable.”

During our visit we saw care staff communicating positively with people who used services. People who required support with their personal care needs were treated with respect and dignity. Where people’s communication abilities were limited, we saw that nurses and care staff had a good understanding of people’s body language and responded appropriately.

Staff told us that they received supervision but, when asked, were unsure of how often this took place. Records seen indicated that supervision was being carried out. The registered manager acknowledged that improvements were needed to ensure staff supervision and appraisals took place regularly and told us she had plans to "crack on with the supervisions and appraisals."

From speaking with the manager and staff it was clear that they had a good knowledge and understanding of people's needs and how best to meet those needs. We saw staff supporting and assisting people at a pace that was unhurried and met their needs.

The provider had systems in place for regular monitoring of the service.

This review took place to check that the provider (owner) had made improvements in relation to some concerns we identified during our last review of the service. People we spoke with during this visit told us that they were happy with the service being provided and they made positive comments about the care and support they were receiving.

People who lived at Cherrytrees told us they were happy with the care they were receiving, that staff treated them respectfully and they felt safe. Comments included, 'I am able to do what I like to do. They help me to wear what I like and I have my hair done regularly.' 'The staff are kind and helpful here.' 'I enjoy being taken out to go the shops.'

People at Cherrytrees told us that they felt well cared for and that staff provided the right level of support which met their individual assessed needs.

We were told that staff were kind and helpful and there was flexibility in the daily routines of the home.

People said they enjoyed the food and this had improved. They told us that they could raise any issues of concern and knew that staff would respond promptly to address them. They enjoyed good relationships with the staff who they said were friendly and kind. People living at Cherrytrees told us that they were asked about their views. They told us that the cook spoke to them about food choices, and there had been meetings where they could put their views forward.

Comments from people living in the home included:

‘I am happy here, the staff are good, they have taken me out to the shops’.

‘‘The meals are very good, and if we don't like something we can have a choice’.

‘If I did have something to complain about I would speak to the manager’

‘If you need a doctor the staff get one.’

‘I like there, it’s clean, comfy and the food is good. The new manager seems very nice, the staff do look after us here.’

We spoke to some relatives who were visiting. They told us that staff were helpful and that they were available to discuss the care of their relative. One person said, ‘I think the staff have tried hard to make things better here for these people.’

Some people who could express a view made the following comments,

‘I will happily talk because there is nothing else going on here’,

‘The staff are kind.’

‘The food is better than it was.’

‘They are doing their best I would say to care for me.’

'The staff had been too busy, I don't think the females like shaving. I would feel better if I was shaved because it makes you feel clean.’

'I am quite worried as I have been told they can no longer meet my needs here.’