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The Orchards Residential Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 December 2017

This inspection took place on 10 October 2017 and was unannounced.

At our last inspection in July 2016, we found a breach of Regulation 17 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. This was because robust systems were not in place to identify risks to the service and individuals. At this inspection carried out on 10 October 2017, we found that the service had implemented an environmental audit to monitor risks that may occur in the building, but that this had not been wholly effective. Other quality audits had also failed to identify the areas we found as requiring improvement. This means the provider remains in breach of Regulation 17. You can see what action we took at the back of the full version of the report.

The Orchards Residential Care Home is registered to provide accommodation and personal care for up to 13 older people, some of whom may be living with dementia. At the time of our inspection there were 12 people using the service.

There was a registered 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.

A provider audit had been implemented to take account of environmental risks, but had not identified all risks. There was now a legionella risk assessment in place and control measures to monitor the water system. Other quality audits the service was carrying out had failed to identify areas which we found as requiring improvement. The service was not analysing falls data in detail as a method of identifying any trends.

The provider had not considered how to maximise the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

Staffing levels were meeting people’s physical needs; however, we have requested that the current arrangements are reviewed to ensure that staffing levels cover both the routine and emergency work of the service.

The registered manager had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. However, Best Interests processes were not fully understood, and we found documentation was not completed correctly.

Systems were in place for managing medicines and people received their medicines in a timely manner. However, where people were having medicines as required, or at a variable dose, improvement was required to ensure it was clear what had been administered and why.

Risks were identified, assessed and managed. However, we found that the level of information documented in certain areas needed to be more detailed to ensure that staff had up-to date and clear guidance to help them support people safely.

Activity provision was provided by care staff. Feedback from some people and their relatives indicated that the current provision of activity was not always meeting individual or specialist needs.

Staff respected people's privacy and dignity and interacted with people in a caring, respectful and professional manner. Systems were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

People and relatives said if they needed to make a complaint they would know how to. There was a complaints procedure in place for people to access if they needed to. The views of people, relatives, professionals and staff were sought via an annual survey.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

The culture in the service was welcoming, friendly, and person-centred. The management team presented as open and transparent throughout the inspection, seeking feedback to improve the care provision.

Inspection areas

Safe

Requires improvement

Updated 6 December 2017

The service was not consistently safe.

Systems were in place for managing medicines and people received their medicines in a timely manner. However, documentation and safe storage of certain medicines required improvement.

Staffing levels were meeting people’s physical needs; however, we have requested that the current arrangements are reviewed to ensure there is adequate staffing should emergency situations arise.

Risks relating to the environment had been assessed; however, we found some furniture needed to be secured to the wall to prevent an accident.

Risk relating to falls needed to be more detailed within care plans.

Staff knew how to recognise abuse or potential abuse and how to respond and report these concerns appropriately.

Effective

Requires improvement

Updated 6 December 2017

The service was not consistently effective.

People were asked for their consent before any care, treatment or support was provided. However, the Best Interests decision process was not implemented correctly or fully understood by the registered manager.

Staff received training relevant to their role and were encouraged to

continue their learning.

People were supported to maintain good health and had access to healthcare support in a timely manner.

People's nutritional needs were assessed and professional support was obtained for people when needed.

Caring

Good

Updated 6 December 2017

The service was caring.

Staff were kind and attentive to people’s needs.

People were supported to see their relatives and friends.

Responsive

Requires improvement

Updated 6 December 2017

The service was not consistently responsive.

Activity provision was not at a level which would meet the individual and specialist needs of all people using the service.

The provider had not considered how to maximise the suitability of the premises for the benefit of people living with dementia.

There was a complaints procedure in place. People and relatives knew how to complain.

Care records were updated in line with people's changing needs.

Well-led

Requires improvement

Updated 6 December 2017

The service was not consistently well-led.

The auditing system in place to monitor the quality and safety of the service had not identified the areas we found as requiring improvement. Falls data was not being analysed in detail.

There was an open and transparent culture in the service. Staff felt able to voice their opinions and had confidence in the management team.