Quorn Orchards Care Home

Quorn Orchards Care Home is a residential care home providing personal care for up to 30 older people. At the time of our inspection, there were 27 people using the service.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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

Improvements were needed to records where people were at risk from poor skin integrity. The provider had not ensured effective contingency planning where work was in progress to improve and upgrade the environment, to ensure people were protected from the potential risk of harm. People's medicines were administered safely. Further improvements were needed to ensure all medicines were stored safely and in line with best practice guidance.

Oversight of the service required further development. The provider and registered manager had identified where improvements were required, though not all the concerns we found during the inspection had been identified.

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.

People were protected from abuse, systems and processes were in place to identify and report any abuse or harm. Staff were kind, caring and attentive and understood people's individual needs well. There were enough staff deployed to meet people's needs and keep them safe. People and relatives described a responsive, compassionate service led by an approachable and supportive registered manager.

Rating at last inspection

The last rating for this service was good (published 31 October 2019)

Why we inspected

The inspection was prompted in part due to concerns received about care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found evidence the provider needs to make improvements. Please see the safe section of this report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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

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

Quorn Orchards Care Home is a residential care home providing accommodation and personal care for up to 30 people aged 65 and over. At the time of the inspection 24 people were living at the service.

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

People were safe and well cared for. Staff provided support with empathy and compassion and knew people well. There were good relationships between people and staff, and the atmosphere in the service was warm and calming.

People were protected from the risk of avoidable harm. The environment was a safe place for people to live and risks to their health were managed well. People were protected from the risk of infection and received their medicines when they needed them.

Staff were trained and were supported to fulfil their roles. People could be assured they were cared for by staff who had been recruited using safe recruitment procedures.

People were supported to eat and drink enough, and staff supported people to live healthier lives and access healthcare services.

People and relatives, where appropriate, were involved in their care and support. Care plans reflected people’s individual needs and conscientious staff protected their privacy and dignity.

There were effective systems in place to manage the quality of the service and actions taken when things went wrong. People and staff were confident if they had a complaint they would be listened to.

The provider had plans to improve the décor and presentation of the service and an activities programme was implemented during the inspection.

The registered manager was open, honest and routinely consulted people about their views of the service.

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.

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 09 January 2019) 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

This was the second comprehensive inspection carried out at Quorn Orchards Care Home, the last inspection in February 2016 was rated as good.

Quorn Orchards Care Home provides residential care for older people. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 30 people. On the day of our visit, there were 29 people using the service, some people were living with dementia.

At this inspection we found that Quorn Orchards Care Home were in breach of five regulations relating to safe care and treatment, safeguarding, complaints and governance of the home. They were also in breach of one registration regulation.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The provider had not ensured there were sufficient processes in place to assess, monitor and to maintain the health, safety and welfare of people. The provider had not carried out environmental audits to identify where repairs and maintenance were required. People living with dementia were at potential risk of harm due to access to the stairs, hot water, hot radiators and hot pipes.

The registered manager did not meet all the requirements of notifying CQC of important events.

The provider had not ensured the fire safety systems and procedures were in place; the provider had not acted upon fire safety recommendations in a timely way.

People were at risk of abuse as the registered manager had not reported unexplained injuries or recorded all incidents where people had altercations.

People did not have all of the required risk assessments or care plans in place to mitigate risks associated with dementia or deteriorating mental health. Staff did not always follow people’s care plans, putting people at risk of acquiring pressure ulcers.

People did not have the opportunity to be involved in the assessment and planning of their care or make their preferences known.

There were not enough staff to provide care to meet people’s needs. People did not always have the opportunities to carry out activities they enjoyed.

People’s complaints were not recorded or responded to appropriately. People did not always receive their medicines in a safe way.

The provider had not always ensured the conditions of people’s Deprivation of Liberty Safeguards were met. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care.

Staff did not always record key events in people’s daily records, making it difficult for health professionals to assess people’s conditions.

Staff did not have all the information they required about people’s dietary requirements. People were supported to have enough to eat and drink to maintain their health and well-being.

People were not always adequately supported to access relevant health and social care professionals.

Staff received supervision and support to carry out their roles. Safe recruitment processes were in place.

We made three recommendations relating to accessible information, dementia friendly environments and end of life care.

Further information is in the detailed findings below.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Quorn Orchards Care Home on our website at www.cqc.org.uk

Rating at last inspection: Requires Improvement, 9 February 2019

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 16 October 2018 where we found five breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included breach in Regulation 17, Good Governance. We served a warning notice for Regulation 17, Good Governance, to the provider and registered manager and told them they must be compliant by 20 December 2018.

We rated the service as 'Requires Improvement'. The provider submitted information stating what they intended to do to address the shortfalls. You can read the report from our latest comprehensive inspection by selecting 'all reports' link for Quorn Orchards Care Home on our website at www.cqc.org.uk.At this inspection we found the provider had made improvements to meet the requirements of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Our findings showed that improvements were made to provide a well-led service. However, checks were not consistently effective to assure the service that people’s medicines were administered and recorded in a safe manner.

• The environment had been improved to meet the needs of people living with dementia and keep people safe from harm and reduce the risk of falls, burns and contact with hazardous substances.

• People and their relatives were involved in planning their care.

• The registered manager used the feedback they received from people to improve the service.

• The registered manager submitted appropriate notifications as they are required to do by law.

Follow up: We will continue to monitor this service and respond accordingly. We plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

Quorn Orchards Care Home provides accommodation and personal care for up to 30 older people with dementia or similar conditions. There were 26 people using the service at the time of our inspection.

The service had a registered manager. 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 were safe at the home. They felt safe because of their confidence in staff’s ability to meet their needs. They also felt secure in the premises. Staff knew their responsibility to keep people safe from harm and abuse. The provider deployed sufficient skilled staff to meet people’s needs.

The provider completed relevant pre-employment checks which as far as possible assured the provider that only people suited to work at the service were employed.

People received their medicines as prescribed by their doctor.

Staff were provided with the training that they required to carry out their role effectively.

People were supported in accordance to the Mental Capacity Act (MCA) 2005. We observed that staff sought people’s consent before they provided care and treatment.

People nutritional needs were met. They had access to a choice of nutritious meals. Staff provided appropriate additional support to meet people’s nutritional needs where this was required.

People had prompt access to health care services when they needed it. Staff supported people with monitoring their health needs.

Staff were kind and compassionate to the people that used the service. They were knowledgeable about the needs of the people they supported. They respected their dignity and human rights, and promoted their right to privacy.

As far as possible staff involved people or their relatives in decisions about their care and support.

The relatives and friends of people using the service had no restrictions to visiting the home.

People’s care plans reflected their individual needs and preferences. Their care was provided in a person centred manner. The provider listened to feedback from people using the service and their relatives and reflected this in the service they provided.

Staff were supported by the registered manager. People using the service had easy access to the manager. The provider had effective procedures for monitoring and assessing the quality of service that people received.

During this inspection, we spoke with five people using the service and one relative visiting their family member. We also spoke to six members of staff and one visiting professional.

We found that there were sufficient numbers of staff on duty to ensure people were safe and found that their health and welfare needs were met at all times. One person told us: 'I am very, very, very well looked after.' A relative told us that 'staff appear busy, but not hectic.' A member of staff told us 'there are enough staff on duty to meet people's needs.'

We found people's privacy, dignity and independence were respected. One person told us 'all the staff are nice; they are wonderful and you don't have to wait long if you need assistance.'

We found people experienced care and support that met their needs and protected their rights. One relative of person using the service told us they had 'no concerns, worries or problems' relating to the care provided. We found people's care needs had been assessed. Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

People were protected from the risk of abuse and staff knew how to raise any concerns. We found the provider had policies in place relating to the safeguarding of vulnerable adults, and whistle blowing.

We found there were effective systems in place to reduce the risk and spread of infection.

On the day of our inspection, we found that there were not sufficient numbers of staff on duty to ensure people were safe and their health and welfare needs were met at all times.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.