Archived: OSJCT Orchard House

We asked the provider to complete an action plan, which we received, to show us what they would do and by when, to improve the overall rating of the service.

During this inspection, 31 October and 1 November 2018, we found improvements had been made to how people received their care and how people’s care had been planned. The breach of regulation had been met. The rating for the key question ‘Is the service Responsive?’ has been changed to ‘Good’.

The previous registered manager had left the service in August 2018 and up until a month before this inspection, there had been interim management arrangements in place. A new manager had been in post for a month prior to this inspection. They planned to become the new registered manager of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Orchard House is required to have a registered manager. 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 found the provider had continued to quality monitor the service and actions had been taken following the completion of audits by interim managers. We again rated the key question ‘Is the service well-led?’ Requires Improvement as a period of time was needed for the newly appointed manager to be registered with the CQC and to get to know the needs of the service. Some improvement was needed, to ensure the new communication systems were in place to ensure people’s skin management plans would always be followed, and that shortfalls in staff response times to people’s call bells improved so these would answered promptly. The new manager planned to complete a reassessment of the services quality performance, using the provider’s existing quality review tool. They then planned to amend the existing service improvement plan to bring it in line with the findings of their quality assessment.

Although the overall rating for the service has improved from ‘Requires Improvement’ to ‘Good’ the CQC will continue to monitor the service to ensure improvements are sustained. Following this inspection we will be asking the provider to complete an action plan to show what they would do and by when to improve the key question ‘Is the service Well-led?’ to at least ‘Good’.

What is life like using this service:

People’s needs were assessed and their care planned to ensure they received the right type of support. Care plans and risk assessments were reviewed regularly and staff had access to up to date information about people’s care requirements. Information about people’s care and treatment was kept secure and confidential.

People told us they felt safe. Staffing had been increased following the inspection and provider’s review of the home’s dependency levels. This would ensure staff were better able to meet people’s physical and emotional needs.

Risks to people had been identified and action taken to reduce these, or remove them altogether. Staff had been trained to recognise potential abuse or discrimination and they knew how to manage and report such concerns. The home was kept clean, well maintained and measures were in place to reduce the risk of infection. Medicines were managed safely and people given the support they needed to take their medicines.

Improved working relationships with external professionals and agencies helped to support people’s needs and wellbeing. People had access to health and social care professionals as needed. All staff, received training and support to maintain and improve their knowledge and skills. Nurses received support to maintain their registration with their professional regulator. Staff had been safely recruited. People received help to maintain their nutritional wellbeing and had a choice in what they ate and drank.

The principles of the Mental Capacity Act 2005 were followed. People were supported to make independent decisions and their care was delivered in the least restrictive way possible. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. Any decisions made on behalf of people had been made in their best interests.

Staff were caring and kind towards people. Staff communicated well with people and we observed laughter and banter, as well as compassion and reassurance being afforded to people. Visitors were made welcome and people’s representatives were kept informed of changes to people’s health. People were treated equally and their diversity understood and supported. People were shown respect and their privacy and dignity upheld.

People had opportunities to take part in social activities and their more personal and meaningful interests were also supported. Plans were in place to improve the activity provision in the home by recruiting more activity staff. The new manager planned to explore more community based social opportunities for people. There were links with local church groups so people’s different faiths could be supported.

Complaints were responded to and managed effectively. People’s end of life wishes were met and they were supported to have a comfortable and dignified end of life.

People were benefiting from the home having a new and experienced manager in place. The new manager had already started to interview and recruit additional staff to ensure they had enough staff with the right skills and experience.

The new manager was aware of their responsibilities in relation to the homes registration with the CQC and in relation to other relevant areas of legislation. This included making sure the CQC were notified of all appropriate events and ensuring the last rating awarded to the home was displayed.

Rating at last inspection:

The overall rating for the home, at the last inspection in December 2017, was ‘Requires Improvement’ and it was the second time in succession, the home had been rated this.

Why we inspected:

The inspection of the 31 October and 1 November 2018 was a planned comprehensive inspection based on the rating at the last inspection.

About the service:

Orchard House is a care home which also provides nursing care. It provides care and treatment to people with complex physical needs; also, to people who live with dementia. People in care homes receive accommodation and nursing or personal care as a 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 is registered to provide care to 50 people; during the inspection 44 people were receiving this.

Further information is in the detailed findings below.

Orchard House is registered to provide accommodation for 50 people who require nursing and personal care. There were 45 people were living in the home at the time of our inspection. The home is set over two floors. It has large dining room, several lounges and quiet areas and a hair dresser.

A registered manager was in place as required by their conditions of registration after a period of the home not having a permanent 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.

At the last inspection in March 2017 we rated the service as ‘Requires improvement’. The provider sent us an action plan to show what they would do to improve the key questions of: Is the service safe, effective and well-led? to at least good. They told us they would make these improvements by 31 July 2017. Whilst we found at this inspection improvements had been made in the areas we had identified as requiring improvement, we found new concerns in the planning of people’s care to ensure their changing needs would be met. These shortfalls in people’s care plans had not all been identified by the provider’s internal quality monitoring systems.

As a result, we found the service had not improved in its rating and continues to be rated as ‘Requires improvement’. Orchard House has been inspected eight times since it was registered under the Health and Social Care Act in 2010. Five of these inspections, including this one, have identified breaches of regulations. The provider has not demonstrated they are able to consistently meet the requirements of their registration. Under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we will be asking the provider to send us a written report of the action they plan to take to achieve a rating higher than ‘Requires Improvement’ to support us to monitor the provider’s planned improvements.

Staff were aware of people’s likes, dislikes and support needs. Improvements had been made to the recording of the management of people’s risks. People’s care plans did not always show how people’s changing care had been planned with them to meet their specific needs, which increased the risk of them receiving inappropriate care. The provider’s quality assurance systems had not identified that people’s changing needs had not always been incorporated in their care plans to ensure they would always receive the individualised care they need and prefer.

Since out last inspection, an established staff team was now in place so people were supported by staff who were familiar with their needs. Improvements had been made to the management of people’s medicines. Staff had been trained in their role and told us they felt supported by the new registered manager. Plans were in place for staff to receive additional training.

Staff were aware of their responsibilities to report any concerns of abuse or harm. Accident, incidents, concerns and complaints were reported and investigated into. Actions were taken and lessons were learnt when shortfalls had been found. People’s health care needs were monitored and any changes in their health or well-being had prompted a referral to their GP or other health care professionals.

A new registered manager was in post which had provided the home with stability. The registered manager had made improvements to the systems and running of the home. Quality assurance and communication systems were being implemented and reviewed to improve the quality of the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was no registered manager in place as required by their conditions of registration, however an acting manager was in position. 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. However a new manager had been appointed by the provider and would be applying to be registered with CQC immediately.

People and their relatives were mainly positive about the care they received. We observed the relationships between staff and people receiving support demonstrated dignity and respect at all times. Staff knew, understand and respond to each person’s needs in a caring and compassionate way. However, whist we found most people’s risks were mainly managed well, some people’s risks

were not always being monitored in accordance to their needs. People and staff felt that the staffing levels had not always been consistent and there had been a high use of agency staff which had impacted on people’s well-being. However we were assured that the home was actively recruiting permanent staff.

People received their prescribed oral medicines as required; however some people did not always have their creams applied as recommended. The safe management of sharps was not in line with current guidance.

The home was generally well maintained and clean; however the cleanliness of some areas had not always been upheld. We were told the level and deployment of housekeepers was being reviewed.

Safe recruitment practices were being used to employ new staff. Staff told us they felt trained to carry out their role; however we received mixed comments about the level of support they received. Not all new staff had received probation meetings at the start of their employment to ensure they were competent to carry out their role. The background and qualifications of agency staff had not always been checked and verified before they provided care in the home.

Staff were responsive to people’s needs. People’s care plans provided them with the guidance they needed to support people according to their needs and choice. Not everyone one received meaningful activities and social engagement, however an activities coordinator had been appointed to improve the range of activities in the home.

The acting manager and provider responded to people concerns and monitored the quality of the care provided. The home had been acknowledged for their achievements by the provider.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

The provider sent us an action plan which showed the action they needed to take and by when. We looked at the care files for 12 people who used the service. We looked at training records and quality reports held by the provider. We spoke to staff, but we did not speak to people who used the service during this inspection because we had received very positive feedback from people who used the service at out last inspection. During this inspection we saw that significant improvements had been made since our last visit and the provider was compliant in all three outcomes.

We found that some people's risk assessments were not kept up to date. Some people had not been receiving their six monthly reviews of their care. This put them at risk of receiving inappropriate care from staff. The staff training records showed that not all staff had received all the training required by the provider. Some of the issues we found during this visit had been identified in the provider's quality report from May 2013 but had not been resolved at the time of our visit.

We spoke to four people who used the service and one of their relatives. They all had positive things to tell us about the home and their comments included 'I love it here, they look after me really well'. 'There is always lots to do, but if I don't want to join in I don't have to'. 'The staff can't do enough for me'. 'It's very pleasant here and I am very happy with everything'. 'I have no concerns about the care my brother is getting, there is nothing they could do better'.

We found that record keeping had improved since our previous visit. However we had not been notified of the deaths of people who used the service since September 2012.