CQC report explained · a nursing home
What the CQC found at Cherry Garden
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2018
Rated Good; inspectors found safe, kind and personalised care, with further improvements still needed to the premises.
The inspection was unannounced and took place on 7 and 8 February 2018. Inspectors spoke with people living at the home, relatives and staff. They reviewed care records, staff files, medicines records and information about how the home was managed.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines management, good infection control, suitable risk assessments and appropriate safeguarding arrangements. People were treated with dignity and received care based on their preferences.
This was an improvement from the previous inspection, when the overall rating was Requires Improvement and there were breaches about personalised care, consent and governance. The home had acted on those issues. Inspectors said the legal requirements were now met, but recommended further review of the premises for people living with dementia.
Safe medicines
Medicines were securely stored, records were complete and people received medicines as prescribed. There was also clear guidance for medicines given only when needed.
“The records showed people received their medicines as prescribed and any reasons for not giving people their medicines were recorded.” from the report
Personalised care
Care plans contained more useful information about people's likes, dislikes and support needs. Staff knew people well and adapted activities and care to individuals.
“The service had achieved person-centred care.” from the report
Respect and dignity
Inspectors saw staff communicating respectfully and protecting people's privacy during personal care. People were well-groomed and staff used people's names.
“The care was handled with dignity and compassion.” from the report
Improved management
The home had strengthened its audits, action plans and monitoring of care. Inspectors found a better workplace culture and improved governance.
“Governance of the service had improved.” from the report
Premises still need work
needs fixingAlthough investment and refurbishment had taken place, some areas still needed further redecoration and improvement. Inspectors made a recommendation about the environment for people living with dementia.
“We recommend that the service reviews the premises and environment in accordance with national guidance for people living with dementia.” from the report
Mixed views about food
minorSome people found the food basic or not to their taste, although relatives gave more positive feedback. Ask how menus are reviewed and adapted.
“People's opinions of the food were mixed.” from the report
- 01Which bedrooms and shared areas have been redecorated or refurbished since this inspection, and what work is still planned?
- 02How do you adapt activities and communication for people living with dementia who do not want to join group activities?
- 03How are registered nurse vacancies covered, and how often are agency nurses currently used?
- 04How do you collect and act on people's views about the food and menus?
- 05How will you make sure consent and best-interest decisions continue to be recorded correctly?
This was an unannounced inspection of the home, its premises and care, covering all five CQC questions; it also checked improvements required after the previous inspection. This explanation was written from the published report of 10 March 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2017
Rated Requires Improvement; inspectors found kinder care and better safety, but staffing, consent, records and access to the community still needed work.
This was an unannounced, comprehensive inspection over three days. Inspectors spoke with people, relatives and staff, observed care, checked medicines and reviewed care records, staff information and quality checks.
The home had improved since the previous inspection. Risks were better assessed, moving and handling had improved, safeguarding arrangements were stronger and the environment had received investment. People and relatives generally described staff as kind and caring.
Important problems remained. Agency staffing was still used heavily, some medicines records were incomplete, and staff were still confused about consent, mental capacity and restrictions on people's liberty. Care plans were not always personal enough, access to the local community was limited, and management systems needed strengthening.
The overall rating was Requires Improvement. Caring was rated Good. Safe, Effective, Responsive and Well-led were all rated Requires Improvement.
Kind and respectful care
People and relatives gave positive feedback about staff. Inspectors saw staff communicate more pleasantly, protect privacy and treat people with greater dignity.
“People received kind and compassionate care from staff.” from the report
Better moving and handling
Manual handling assessments were up to date and observed transfers usually followed the written guidance. People were also repositioned more often than at the previous inspection.
“The safety of people who used the service had increased.” from the report
Improved safeguarding
More staff had safeguarding training, policies had been updated and the manager understood the local safeguarding process. The provider had worked with relatives, the local authority and police when needed.
“We found the service had improved the prevention of abuse and neglect.” from the report
More varied activities
Activities included music, singing and support for physical and mental wellbeing. Some people who did not usually communicate joined in with songs.
“One activities coordinator was able to play the guitar and piano, and people participated in songs and were encouraged to sing along.” from the report
Staffing and agency use
seriousThere were vacancies and frequent use of agency nurses. Rotas showed frequent changes and cancellations, and the manager often worked as a nurse despite earlier assurances that managers would be additional to the care staff.
“We found there continued to be high numbers of agency use, particularly for registered nurses.” from the report
Medicines records and storage
seriousSome as-required medicines records had blank entries, and instructions did not always match. The medicines fridge temperature was above the recommended range for 40 days, and audits had not identified missing signatures.
“The MARs were not always complete for patients receiving 'as required' medicines.” from the report
Consent and restrictions
seriousStaff remained confused about mental capacity assessments and Deprivation of Liberty Safeguards. Four applications had been made for people who had capacity and were not required.
“This was a continued breach of Regulation 11 of the Health and Social Care Act 208 (Regulated Activities) Regulations 2014.” from the report
Personalised care and community access
needs fixingCare plans were sometimes repetitive and did not contain enough information about the individual. People had limited opportunities to go out, and faith visits did not appear to happen as described in the service guide.
“Care plans we reviewed were not always person-centred and required better information specific to the individual needs.” from the report
End-of-life records
needs fixingSome people's end-of-life wishes were not recorded, and some do-not-resuscitate forms had old addresses, photocopies or had not been reviewed after admission.
“People's files did not contain care plans specific to end of life care.” from the report
- 01How many permanent nurses and care workers are currently in post, and how often are agency staff used?
- 02How do you make sure the front door is secured and that people at risk of leaving are kept safe?
- 03How are as-required medicines, missing signatures and refrigerated medicines now checked?
- 04How do you assess mental capacity and record best-interest decisions for people who cannot make particular decisions?
- 05How will my relative be involved in their care plan, activities, trips out and end-of-life choices?
This was an unannounced, comprehensive inspection of all five CQC questions, carried out to check progress after the previous comprehensive inspection. This explanation was written from the published report of 25 February 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Cherry Garden
3 rated inspections over a year: the service has improved, from Requires improvement to Good.
- March 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2016Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- August 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 23 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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