CQC report explained · a residential care home
What the CQC found at Cherry Leas Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found improved risk assessments, enough staff, safer medicines procedures and better infection control. Fire safety and environmental risks identified previously had also been addressed.
- Effective?
- Requires improvement
- This key question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Good
- Leadership, staff support and quality monitoring had improved. The provider had an action plan, regular audits, clearer oversight of risks and more organised staff and residents' meetings.
What inspectors found, November 2022
Cherry Leas Care Home is now rated Good and has left special measures; inspectors found major improvements, with some work still unfinished.
This was an unannounced focused inspection. The inspector visited the home on 25 October 2022 and reviewed information, care records, medicines records, staff files, meetings and quality checks. They also observed care, spoke with relatives and staff, and contacted other professionals.
The home had improved since its previous Inadequate rating. Inspectors found better risk assessments, enough staff, safer medicines processes, improved infection control and clearer checks on quality. People were supported by staff who knew them, and relatives spoke positively about the care.
The inspection only checked Safe and Well-led. Both were rated Good. The other areas were not inspected during this visit, so their previous ratings were used when calculating the overall Good rating.
Better risk management
Risk assessments had become more detailed and were updated when people's needs changed. The home also took action to reduce identified risks.
“There were systems in place for appropriate action to be taken to mitigate future risk.” from the report
Enough staff
Inspectors found enough staff to meet people's needs. Staff were observed supporting people calmly and kindly.
“At this inspection there were enough staff available to support people with their care needs.” from the report
Improved culture
Staff said they felt more supported and able to raise concerns. Inspectors saw a calm atmosphere and person-centred support.
“The culture of the service had improved under the new registered manager.” from the report
Stronger oversight
The home had introduced regular audits and was using meetings to share learning and make improvements.
“At this inspection, there was a programme of quality assurance audits completed.” from the report
Medicines managed safely
People received medicines as prescribed. Staff had medicines training and their ability to administer medicines had been checked.
“People received their medicines as prescribed. The provider had assessed staff competency to ensure they understood how to support people appropriately with their medicines.” from the report
Outstanding liberty safeguard applications
needs fixingThe provider had not yet received the outcomes of applications to deprive people of their liberty. The report says the provider had taken action to address this.
“However, the provider had not received the outcomes of the applications to deprive people of their liberty.” from the report
Some maintenance unfinished
minorThe home was clean and hygienic, but the premises still needed attention. Some maintenance had started, including redecoration of two empty bedrooms.
“At this inspection, the premises still required attention however, we observed that some maintenance had been started, with two empty bedrooms re-decorated.” from the report
Feedback not yet formally recorded
minorThe provider was collecting feedback from people, relatives, staff and professionals, but had not yet put the information into a formal document.
“The provider was in the process of compiling feedback from professionals, staff, relatives and people who use the service.” from the report
Training postponed
minorMoving and handling training had been booked but postponed. Families may want to ask when it will take place.
“Moving and handling training had been booked for the staff team but had been postponed.” from the report
- 01What is the current position on the applications to deprive people of their liberty, and have all outcomes now been received?
- 02Which maintenance jobs are still outstanding, and when will they be completed?
- 03When will the postponed moving and handling training take place, and is all staff training currently up to date?
- 04How are care plans and risk assessments being checked while records are transferred to the electronic system?
- 05How is feedback from residents, relatives, staff and professionals now being recorded and acted on?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried forward from the previous inspection when calculating the overall rating. This explanation was written from the published report of 19 November 2022 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, May 2022
Cherry Leas Care Home was rated Inadequate and placed in special measures; inspectors found serious safety, staffing, cleanliness and management problems.
This was an unannounced focused inspection on safe care and well-led management. Two inspectors visited, spoke with people, relatives and staff, observed care, and checked care records, risk assessments, medicines records, staff files and safety documents.
Inspectors found that risks were not always identified, recorded or acted on. There were concerns about falls, weight loss, fire safety, staffing levels, infection control and incomplete medicines records. The home was not consistently clean or hygienic.
The provider did not have effective systems to monitor quality, learn from incidents or make required notifications to CQC. Staff described feeling stretched and not always able to raise concerns. Relatives and people also gave positive comments about caring staff and the care received.
The overall rating changed from Good at the previous inspection, published in January 2018, to Inadequate. The home was placed in special measures, meaning CQC will keep it under review and usually re-inspect within six months.
Staff knew people
Inspectors found that staff knew the people living in the home. Relatives spoke positively about the care they received.
“People were supported by staff who knew them well and people's relatives spoke positively about the care they received.” from the report
Medicines were usually given correctly
People received their medicines as prescribed, and staff competency had been checked. Some records for newer residents were incomplete.
“People received their medicines as prescribed.” from the report
Respectful medicine support
Staff were observed giving medicines respectfully.
“Staff members were observed giving medicine respectfully to people.” from the report
Some positive family feedback
Relatives said staff were caring, friendly and responsive. Some relatives also said communication was good and the manager was approachable.
“Relatives spoke positively about the care provided at the service.” from the report
Risks were not managed
seriousFalls, weight loss and changes in people's needs were not consistently investigated or reflected in care plans. Fire safety risks and evacuation arrangements also needed improvement.
“The provider had not effectively assessed and managed risks to people's safety.” from the report
Not enough staff
seriousThe home often had two staff on morning and afternoon shifts when three were expected. Inspectors saw people waiting for support, and one person was assisted by fewer staff than their care plan required.
“There were not enough staff available to support people to stay safe and meet their needs.” from the report
Poor cleanliness and infection control
seriousToilets, commodes, bins and other areas were dirty or unsuitable for effective cleaning. Some bathrooms were being used for storage, creating infection risks.
“The home was not clean.” from the report
Incidents were not properly reported
seriousThe provider did not notify CQC about safeguarding referrals and serious injuries as required. There was also no reliable system for identifying patterns and preventing repeat incidents.
“None of these had been raised as a statutory notification to CQC.” from the report
Weak management checks
seriousQuality audits were not consistently up to date, and the provider did not reliably act on known concerns or recommendations.
“The provider did not have robust processes to monitor the safety and quality of the service.” from the report
Staff did not feel supported
needs fixingSome staff reported low morale, limited training and a lack of confidence about raising concerns confidentially.
“Staff members told us they did not always feel able to be open when things went wrong, and they did not always feel they were treated equally.” from the report
- 01How many staff are now scheduled on each morning and afternoon shift, and how do you check this meets each person's needs?
- 02What has changed in the way falls, weight loss and other risks are assessed, reviewed and recorded?
- 03What evidence can you show that the home is now clean, hygienic and ready to manage infection outbreaks?
- 04How are safeguarding concerns, serious injuries, accidents and incidents now reported to CQC and reviewed for repeated patterns?
- 05What quality audits, staff meetings and training are now in place, and how can staff raise concerns confidentially?
This was a focused inspection of Safe and Well-led only; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 26 May 2022 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.
Every inspection of Cherry Leas Care Home
4 rated inspections over 6 years: the service has held its Good rating throughout.
- November 2022Goodcurrent ratingup from InadequateSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- May 2022Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- January 2018Goodstayed GoodSafe: GoodWell-led: Good
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 14 January 2011.
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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