Orchard House Nursing Home

Orchard House Nursing Home is a nursing home providing personal and nursing care to 68 people with mental health needs and dementia at the time of the inspection. The home accommodates up to 72 people in one adapted building. People have access to their own bedroom along with communal spaces including lounges.

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

There were safeguarding procedures in place that were understood and followed by staff. Risks to people were assessed and reviewed. Medicines were managed in a safe way and there were infection control procedures in place. We found there were enough staff to keep people safe.

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.

There were systems in place to monitor the quality in the home, audits were completed. The registered manager was able to demonstrate when lessons were learned when things had gone wrong. People felt happy living in the home and staff felt supported and listened to. We were notified of events within the home as required.

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 30 August 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of moving and handling. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

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

Orchard House is a nursing home providing personal and nursing care to 69 people with mental health needs and dementia at the time of the inspection. The home accommodates up to 72 people in one adapted building.

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

People felt safe and staff knew how to identify and report concerns for people’s safety. Risks were assessed and managed safely. There were sufficient numbers of staff available to meet people’s care and support needs. People received their medicines as prescribed.

Staff received training relevant to their role and had a good understanding of people’s individual needs. Staff felt supported through regular supervision and were given feedback about their role. People were supported to have a balanced diet and staff understood people’s dietary needs.

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 support this practice.

People felt well supported by the staff team who they described positively. People were supported to make their own choices and decisions. People were supported to maintain their independence and their privacy was respected.

People received personalised care which reflected their individual needs and preferences. There was a range of activities available which people could participate in. People knew how to raise a concern about the service and expressed confidence in the staff team and registered manager to address any concerns raised.

People and staff found the registered manager approachable. Regular quality audits were completed which identified any areas for improvement. People and staff had opportunities to give feedback and share their views about the home. The registered manager was open about where improvements could be made and shared their learning with other providers.

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 14 June 2016).

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.

Orchard House Nursing Home provides accommodation, nursing and personal care for up to 72 people who have mental health needs and people who have a diagnosis of dementia. On the day of our inspection 72 people were living at the home.

The home had two registered managers and both were present for our inspection. 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 who lived at Orchard House told us they felt safe. Staff knew how to keep people safe and how to recognise signs of abuse. Risks to people’s safety were managed by staff. People and staff told us and we saw that there were sufficient staff numbers to meet people’s needs. People were given their medicines on time and when they needed it.

People were supported by staff who had appropriate training to meet their needs. Where people lacked capacity to make decisions for themselves assessments had been completed which ensured they got the right support and decisions made on their behalf were in their best interests. People told us they enjoyed the food at Orchard House and they got a choice. People’s nutritional needs were being met. People had access to outside health professionals when their health needs changed.

People told us staff were kind and considerate. Staff knew the care needs of the people in Orchard House. People and their relatives told us they were involved in their care. People’s privacy and dignity was respected by staff.

Staff understood people’s individual care needs. People’s likes, dislikes and preferences were taken into account by staff when supported them with care. People had access to leisure activities. People and their relatives told us they knew how to make a complaint. Systems were in place to monitor complaints made by people and their relatives.

People, their relatives and staff told us that the home was well-led. Staff were supported by the registered manager’s which resulted in a positive culture in the home. People and staff told us they were involved in the running of the home and that they were listened to. Robust systems were in place to monitor the quality of care across the home.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

At the time of our inspection 52 people lived at the home. We spoke with eight people who lived in the home and two relatives. We spoke with four members of staff, two registered managers and the provider.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted inline with the providers policies and procedures. This meant that people would be safeguarded as required.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private. They also told us the staff were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people's views and opinions and acted upon them.

The registered managers told us they regularly provided refresher training for the staff. The registered managers told us that training is specific to the people that they care for. The staff we spoke with confirmed they received specific training that related to peoples individual care needs.

The registered managers had robust audit tools in place. This ensured that people received appropriate care that met their needs.

Is the service caring?

We asked people for their opinions about the staff that supported them. What people told us was positive, one person said, 'All the staff are lovely'. A relative told us, 'They (staff) are fabulous, my X really loves them'.

People were supported by staff who demonstrated a clear understanding of their needs and preferences. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people's preferences and interests and found that care and support had been provided in accordance with people's wishes. We saw that the care people received reflected what we read in their care records.

Is the service responsive?

The registered manager was responsive to people's needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service. People told us they were supported by staff with activities that they enjoyed.

Is the service well-led?

Staff told us the registered managers listened to them. Staff were clear about their roles and responsibilities. This meant that the registered manager listened to staff views and acted upon them where appropriate.

The registered manager told us that they had sent out questionnaires to the people who lived in the home and their relatives. Where comments had been made these had been acted upon. This meant that the provider had taken appropriate steps to gather people's views on the running of the home and had acted upon them.

The provider had quality assurance systems in place. This would ensure that people who used the service were not placed at risk of receiving inappropriate care.

We found that where people had raised complaints they had been responded to in line with the providers policies and procedures and ensured that the complainant was happy with the outcome.

We found that care plans provided staff with relevant information about people's care needs and how to meet them. One care staff said, 'We have access to care plans and it tells us how to care for people.'

Appropriate arrangements were in place for the management of people's prescribed medicines to ensure they received them as directed by the prescriber.

Major building works were in process and we saw relevant measures had been taken to ensure people's safety and comfort whilst this work was being carried out. We observed that environment provided adequate space and essential furnishings to ensure people's comfort.

Staff had access to regular training to ensure they had the skills and competence to deliver an effective service.