CQC report explained · a residential care home
What the CQC found at Cherry Tree
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2023
Rated Requires Improvement; inspectors found major progress in safety and effectiveness, but dignity, communication and management still needed improvement.
This was an unannounced follow-up inspection on 30 January and 2 February 2023. Inspectors observed care, spoke with people, relatives, managers and staff, and checked care plans, medicine records, staff files, complaints and quality checks.
The home had improved since its previous inspection, when it was rated Inadequate and placed in Special Measures. Risk assessments, staffing, medicines, care planning, consent, food and activities had all improved. The home was no longer in Special Measures and was no longer breaching regulations.
However, inspectors still found that people's dignity was not always protected. Some staff did not always support people in the right way, visual communication tools were difficult to follow, and some records about fluid intake and health checks were not up to date. The overall rating was Requires Improvement, with Safe and Effective rated Good, and Caring, Responsive and Well-led rated Requires Improvement.
Improved safety
Risk assessments contained detailed information about people's health, behaviour, allergies and personal care needs. Staffing levels had also improved and were sufficient to meet people's needs.
“At this inspection, we found risks relating to people's health and care needs were assessed more thoroughly.” from the report
Safer medicines
Medicines, including controlled drugs, were stored securely and administered by trained staff. The only medicines issue found was that refrigerator temperatures were not always recorded.
“Otherwise, we found staff ensured that medicines (including controlled drugs) were stored securely.” from the report
Personalised care
Care plans included people's health needs, preferences, interests, communication abilities and goals. Plans were reviewed and updated when people's needs changed.
“Care plans were comprehensive and descriptive which gave a person-centred profile of the person.” from the report
Activities and community life
People had individual activity plans and were supported to follow their interests, spend time with family and friends, and access activities inside and outside the home.
“Each person had their own individual weekly activity plan.” from the report
Improved staff support
Staff had relevant training, their competence was checked, and supervision had become more regular. Staff said they felt better supported than at the previous inspection.
“Staff were supported with suitable training to provide people with safe care.” from the report
Privacy and dignity
needs fixingA communal bathroom door was not always kept closed when people were using it. Inspectors also saw a staff member fail to follow a person's care plan, and some staff did not always pay attention to people.
“During our inspection, we observed that a door to one of the communal bathrooms was not always kept closed when people used it, which could mean they had no privacy.” from the report
Inconsistent staff support
needs fixingSome agency staff who were less familiar with the home did not know people's likes and dislikes. Inspectors said there was a continuing risk that people might not always be supported appropriately.
“However, due to different staff being recruited to fill the duty rota at certain times, there was continued risk of people not being supported appropriately.” from the report
Communication tools
minorSome visual displays were crowded or unclear, and staff were not always sure how activities were explained to people. Some staff also used language that was too complicated.
“Some people had visual timetables for their activities, which were displayed behind a protective screen.” from the report
Incomplete records
needs fixingStaff did not always record people's fluid intake, and some health-check information had not been updated in every relevant record.
“For example, staff were not always recording information about people's fluid intake and we found some information about people's health checks had not been updated in all their records.” from the report
Medicine refrigerator records
minorStaff did not always monitor and record the temperature of the refrigerator used to store some medicines. Inspectors judged this was unlikely to have affected the medicines at the time.
“We noted staff were not monitoring the temperature of the medicines refrigerator, in line with best practice.” from the report
- 01How will you make sure communal bathroom doors are kept closed while people are using them?
- 02How do you check that agency staff understand each person's care plan, communication needs, likes and dislikes?
- 03What changes have you made to visual timetables and other communication tools so people can understand them?
- 04How are fluid intake records and health-check records checked for completeness and kept up to date?
- 05Who is currently responsible for managing the home while the manager's registration application is in progress?
This was an unannounced follow-up inspection covering all five key questions, carried out to check action taken after the previous Inadequate inspection. This explanation was written from the published report of 17 March 2023 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, June 2022
Cherry Tree rated Inadequate and placed in special measures; inspectors found serious shortfalls in safety, staffing, medicines and person-centred care.
This was the home’s first inspection as a newly registered service. It was unannounced. Inspectors visited on 5 and 6 May 2022 and reviewed care records, medicines records, staff files and management records. They also observed people, spoke with staff and a relative, and contacted a health and social care professional.
Inspectors found people were at risk because risks had not been properly assessed or managed. Medicines records had gaps, controlled drugs were not recorded correctly, and people did not always receive medicines as prescribed. There were not enough suitable and experienced staff to meet people’s assessed needs.
Care plans were incomplete, confusing and not always personalised. Staff did not always understand people’s communication methods, including Makaton and PECS. Inspectors also saw some people treated without enough dignity, had limited activities, and were not always involved in decisions about their care.
The overall rating was Inadequate. Safe, Effective, Responsive and Well-led were rated Inadequate, while Caring was rated Requires Improvement. The home was placed in special measures, meaning CQC would keep it under review and re-inspect it to check for significant improvement.
Some infection controls
Inspectors saw staff using protective equipment and were assured about several parts of infection prevention, including testing and outbreak management.
“We were assured that the provider was using PPE effectively and safely.” from the report
Health professional links
The home worked with health professionals and people attended appointments. Relatives were contacted when people were unwell or their health changed.
“Healthcare professionals, such as GPs, neurology and dieticians were all engaged in supporting people to have their health needs met by the service.” from the report
Action after inspection
The provider accepted some of the concerns and created an action plan. It also arranged for the garden to be maintained and planned further face-to-face staff training.
“Over the course of the inspection the provider took positive action to make improvements.” from the report
Unsafe risk management
seriousImportant risks, including transport, bare feet, allergies and behaviour that could challenge, did not have enough guidance for staff. Inspectors said this placed people at risk of harm.
“Robust risk assessments were not in place to ensure people received safe care.” from the report
Medicines problems
seriousMedicine administration records had unexplained gaps. Controlled drug records contained discrepancies, and staff training and competency checks were not adequate.
“Medicines were not managed safely. Policies and processes for managing medicines were not always followed.” from the report
Not enough staff
seriousStaffing did not match people’s assessed needs. One person who required two staff members was supported by one staff member, and staff shortages reduced activities and outings.
“The service did not have enough staff to meet peoples assessed needs.” from the report
Poor care records and consent
seriousCare plans contained conflicting information about mental capacity and did not consistently record best-interest decisions or involvement from people and their representatives.
“People's care plans contained conflicting and confusing information about their mental capacity.” from the report
Dignity and communication
seriousInspectors saw some staff interactions that were not respectful. Staff did not always understand people’s individual communication methods, increasing the risk of frustration and self-injury.
“Staff failed to protect and respect people's privacy and dignity.” from the report
Limited activities and unsuitable information
needs fixingPeople had few opportunities for activities or new experiences. Menus and activity timetables were not provided in formats everyone could understand.
“There was little in the way of activities in the home at the time of our inspection.” from the report
- 01What immediate changes have been made to ensure there are enough experienced staff for people who need one-to-one or two-person support?
- 02How are medicine records, controlled drugs and staff competency checks now being audited?
- 03How are people’s Makaton, PECS and other communication needs recorded and taught to permanent and agency staff?
- 04How are mental capacity assessments, best-interest decisions and DoLS records now being completed and kept up to date?
- 05What activities and outings are now available, and how are people’s own preferences used to plan them?
This was the first comprehensive inspection of the newly registered service and covered all five key questions, including infection prevention and control; the report also notes that the service under a previous provider had been rated Good. This explanation was written from the published report of 30 June 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. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Cherry Tree
7 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- March 2023Requires improvementcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2022Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- October 2018Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2015Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvement
- May 2015Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2021
Registered with the Care Quality Commission on 5 March 2021.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Havering
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,230 a week. 81 can care for a couple. 11 years' experience on average.
“Sidonia is a first class live-in carer whose dedication and thoughtfulness made her stay a happy experience.”
“Always on time and with a lovely smile for my mum. Theresa is kind and sensitive to my mum's needs.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.