Orchard Home Care Services Limited

Orchard Home Care Service Ltd is a domiciliary care agency providing personal care to people of all ages. Some people using the service had a learning disability and/or autism. At the time of our inspection there were 142 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Staff helped people to live as independently as possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. No one using the service at the time of our inspection lacked capacity to make their own decisions, but staff understood how to make decisions in people’s best interests. Risks were assessed and staff had guidance to support people safely. People were supported to take medicines safely. The provider continued to face challenges with recruitment but had introduced several incentives to attract and retain staff. People told us they knew the staff who supported them and were happy with the support they received.

Right Care:

People using the service were able to express their own views. When things went wrong, actions were put into place and lessons learned were shared with staff to improve the standard of care delivered. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff worked with health professionals where they had concerns about people’s health.

Right Culture: People told us the service was consistent, reliable and they received a caring service. Some staff told us that the way visits were planned meant they were sometimes late or felt rushed. Although office staff monitored visits daily to ensure people received care, the provider had limited oversight of the timeliness of visits so they could monitor and improve this. We have made a recommendation about the provider continuing to review their systems to ensure care and support is delivered as planned. The management team understood their roles and responsibilities and had made improvements to governance systems. The provider worked closely with the registered manager, they were aware of their focus for further development and were introducing new electronic systems which they hoped would give them better oversight.

The management team sought feedback from people using the service, their relatives, and staff. Most feedback was positive. Some staff told us communication could be improved or they raised issues several times before they felt listened to. The provider was working on better communication and demonstrated sharing the actions they had taken on issues staff raised. Staff understood and spoke positively about the importance of person-centred care and helping people to live as independently as they wished. They were confident concerns about people’s care would be addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 December 2021) and there was a breach of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 22 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard Home Care Services Ltd on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation that the provider continues to review their systems to ensure they have effective oversight that care, and support is delivered as planned.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Orchard Home Care Services Limited is a domiciliary care agency providing personal care to people living in their own homes. It provides a service to children, young adults and older adults. At the time of inspection, 168 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Quality assurance measures were in place, but audits had not identified some of the issues we found during the inspection. Some records needed further strengthening, and positive changes needed to become embedded within the service.

Call times continued to be inconsistent. Travel time had been introduced between each call, but this was not always sufficient. We have made a recommendation about continuing improvements to call times.

The provider had improved its systems for assessing and managing risks to people. The provider was reviewing and updating people’s care records. However, guidance in care plans was not always consistent or robust enough.

Systems for the safe management of medicines had improved. Some inconsistencies within the records remained, however the provider had started to address these.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice. Best interest decisions were not always robustly recorded.

Staff were recruited safely. Although the provider had faced difficulties with staff retention, there was an ongoing recruitment programme. Effective safeguarding procedures were in place and people told us they felt safe. Lessons had been learnt following the previous inspection. The provider had safe infection control procedures in place.

The provider worked well with professionals and referrals were made when appropriate. Staff had the right competence, knowledge and skills to carry out their roles.

People were well supported and treated with kindness and respect. Systems were in place to promote people’s privacy, dignity and independence. Care plans had been updated to reflect individual preferences. People were encouraged to express their views in a way which was suitable for them.

Care plans were person-centred and took into account people’s preferences and their likes and dislikes. Complaints and concerns were investigated and were discussed in person where possible. Communication care plans were in place to support staff to communicate effectively with people. People were supported to make decisions about their end of life care.

Staff morale was improving, and staff told us the registered manager was approachable and supportive. The provider understood the need to be open and honest when things go wrong. People, relatives and staff were involved and engaged with the service. Feedback was sought through questionnaires and meetings. Professionals spoke positively about their involvement with the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 25 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made, however, not enough improvement had been made and the provider was still in breach of regulation.

This service has been in Special Measures since 25 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We checked to see whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Orchard Home Care Services Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Orchard Home Care Services Limited is a domiciliary care agency providing personal care to people living in their own homes in the community. It provides a service to children, young adults and older adults. At the time of inspection, 215 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Risks to people were not always identified or monitored safely. Medicines were not safely managed. We were not assured people were receiving their medicines as prescribed. People did not always receive visits at a consistent time or for the right length of time.

Staff were recruited safely. However, staff did not always have sufficient or up to date training to support people safely. New carers were not always introduced formally to people. Most people told us they felt safe and spoke positively about the carers themselves.

People’s needs were not consistently assessed and there was a lack of guidance for staff to help them support people safely. People’s preferences, such as whether they would prefer a female or male carer, were not always met. Care plans were not always up to date and did not always have key information about a person.

We received mixed feedback about the management team. People, staff and relatives said the office was not well-led. Audits were ineffective and did not identify the issues we found on inspection. The service did not always comply with regulatory requirements. The provider had failed to make improvements following the last two inspections.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, care plans did not record whether people had capacity to consent to different decisions or document the impact of certain medical conditions on a person’s capacity, such as dementia and mental health needs.

Communication plans were in place to support staff to communicate with people effectively. Communication aids were used where appropriate. People and staff were asked for their opinions through surveys.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 February 2020) and there were two breaches of regulation. The provider completed an action plan after that inspection to show what they would do and by when to improve.

We returned and carried out a targeted inspection, looking at the breaches only, on 27 October 2020 (report published 18 November 2020). At that inspection we found enough improvement had not been made and the provider was still in breach of regulations. The overall rating for the service remained requires improvement. The provider completed a further action plan after that inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the breaches of regulation and other concerns identified at the last two inspections had been addressed.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

We initially undertook a targeted inspection and found not enough improvement had been made and there were still concerns around safe care and treatment and good governance. We therefore widened the scope of the inspection to become a focused inspection of the key questions safe and well-led. This meant that we looked at those entire key questions.

We undertook a targeted inspection of the key questions effective, caring and responsive. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. The ratings from the previous comprehensive inspection for those three key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection and our last targeted inspection, by selecting the ‘all reports’ link for Orchard Home Care Services Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection. We have also identified a new breach in relation to staffing.

We have identified a breach in relation to the service’s regulatory requirement to notify CQC of important incidents. This will be dealt with outside the inspection process.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Orchard Care Home Services is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to younger and older adults. At the time of the inspection 182 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Further improvements were needed with medicine records. Risks to people were not always effectively assessed. Quality assurances process had identified some of the concerns we found but needed to be more robust. Missed or late calls were looked at but not fully analysed with learnings or outcomes.

People felt safe and were supported by staff who were recruited safely.

There were enough staff to cover all calls.

Staff felt supported by the management team and enjoyed working at Orchard Care Home Services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 5 February 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of some regulations.

Why we inspected

We undertook this targeted inspection to check whether the breaches of regulation and other concerns identified at the last inspection had been addressed. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified continuing breaches of regulation in relation to safe care and treatment and good governance.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Orchard Homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults. At the time of inspection 250 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and governance.

People said they felt safe with the service provided. However, systems were not robust and staff deployment was not effective to ensure people's needs were met in a safe, timely and consistent way.

Records did not provide guidance to staff to ensure people received safe, person-centred, appropriate care and support. Systems were not all in place for people to receive their medicines in a safe way.

A robust quality assurance system was not in place to assess the standards of care in the service. Audits that were carried out were not effective as they had not identified issues that we found at inspection.

Systems were not all in place to treat all people with dignity and respect to ensure they were kept informed and received consistent care from the same staff, with choice of gender of carer.

Information was not always accessible to involve people in decision making about their lives.

People had the opportunity to give their views about the service. There was consultation with staff and people. People said they knew how to complain. However, some people and relatives said they did not always feel listened to.

People were not always supported to have maximum choice and control of their lives, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff knew about safeguarding procedures. There were other opportunities for staff to receive training. Staff worked well with other agencies to ensure people received care and support.

All people and relatives were complimentary about the direct care provided by support staff. They trusted the workers who supported them. They said staff were kind, caring and supportive of people and their families.

Staff said they felt well-supported by the organisation and were aware of their responsibility to share any concerns about the care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was last inspected by CQC in August 2014, at which time it was compliant with the regulations and rated Good. At this inspection the service remained Good.

Orchard Home Care Services provides personal care to people who live in their own homes in Chester-le-Street and surrounding areas, including Consett and Durham. There were 250 people using the service at the time of our inspection.

The service had a registered manager in place. 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.

People using the service felt safe. The provider operated an out-of-hours phone line in case of unforeseen circumstances. Staff had received training in safeguarding and displayed a good understanding of what signs could indicate someone who used the service was at risk of harm.

Risks were assessed and managed through pre-assessment and ongoing review, with the involvement of people and their relatives.

We saw there were sufficient numbers of staff on duty to meet the needs of people who used the service. Pre-employment checks, including Disclosure and Barring Service checks, were in place.

We observed no errors in the documentation pertaining to medicines administration. Staff displayed a good knowledge in this regard and regular auditing was in place.

Training was a blend of face-to-face and distance learning, and included safeguarding awareness, moving and handling, infection control, health and safety, first aid and dementia awareness. The registered manager kept a record of when staff were due to refresh training courses.

Staff at all levels liaised well with external healthcare professionals, from who we received positive feedback about the service.

Staff were supported through regular supervision and appraisal, as well as ad hoc support from care co-ordinators regarding whom we received consistently positive feedback.

People who used the service, relatives and healthcare professionals told us staff were compassionate, caring, and treated people with dignity and respect. People confirmed staff were encouraging in helping them retain their independence.

People who used the service and staff confirmed they generally received good levels of continuity of carers. They confirmed they were introduced to staff.

We saw people were encouraged and supported to contribute to their own care planning and review, with family members also involved. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We saw that personal sensitive information was stored securely.

People who used the service and healthcare professionals told us staff were accommodating to people’s changing needs and preferences.

People who used the service knew how to complain should the need arise and we saw this information was provided to all people who began using the service.

The registered manager and care co-ordinators were described in positive terms by people who used the service and other staff. We found the leadership of the service was strong.

We found auditing and quality assurance systems were in place.

The culture of the service was in line with the goals of the statement of purpose and the customer service guide, focussed on ensuring people could maintain their independence whilst receiving dignified support from staff.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and people who use the service, looking at supplies of medicines and looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with use and management of medicines. People who used the service received appropriate assistance with their medicines to enable them to receive their treatment safely in accordance with their plans of care.

Is the service effective?

We found that care plans for managing medicines were much improved and reflected the current needs of people so that they received appropriate care.

Is the service caring?

We saw that people were treated in a caring way and with respect.

Is the service well led?

We saw that audits, or checks of medicines records, were done regularly to assess the way medicines were managed. Care workers were also assessed regularly to make sure they followed safe procedures.

'The girls are really good, cannot complain, they are nice and jolly'.

'I take my own tablets and the girls make certain I have my Careline with me'.

'Fine, visits regularly. They prepare the medicines for me'.

However, there were concerns raised about the time of some visits. One person said 'sometimes they are a bit early or a bit late and that can affect my medicines. I have to have food within a certain time and sometimes I have to wait'. Another person also commented that recently the teatime visit to prepare tea and assist with medicines was too early and the care worker had to be told to return later.

Overall, we found that medicines were not managed in a safe way because records did not clearly indicate the medication that care workers assisted people with, or the support that people needed.

People we spoke with told us they were involved in decisions about their care. One person said 'Someone from the company came out and went through everything with me.' Another person said 'I've got a care plan, we went though it together.'

We reviewed staff records and saw they had annual appraisals. Supervisions were generally held every few months, however staff said if they did have any concerns in between formal meetings, they were able to discuss them with their supervisor.

We looked at ten medication administration records. We saw several gaps where staff had not recorded either the name of the medication, the dosage or whether it had been taken by the person. It was not therefore evident whether people received their medication in accordance with their care plan.

People said that they knew they could speak to a member of staff if they had a complaint. Comments included "I would go direct to them', 'I would say if something wasn't right' and 'Too right I would.'

People told us they generally had the same staff coming to their home. One person said 'I get on very well with her, she supports me well.' We also saw some completed client surveys, of the 20 we looked at, 14 people said they usually had the same team of staff. However, one relative we spoke with said '(relative) knows when someone is coming, but not who it is."

People told us they felt able to say if they were unhappy. One person said "I would ring the office if I had a problem." Other comments included "I have their contact details" and "if I have any problems I would speak to (staff member)."

Staff were knowledgeable about people and were able to explain, with examples, about how they would promote people's independence and choice. We spoke with five members of staff and asked them how they made sure people they supported were treated with dignity and respect. One member said 'I always make sure people are covered and ask how they want things done,' another said 'if a person has visitors I always ask if they want me to leave the room so they can have privacy.'