Orchard House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to the provision of safe care.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Opportunities to learn lessons and prevent future risk were sometimes missed. We identified 2 occasions on which equipment had been accidentally damaged in the home and the staff had not brought this to the registered manager’s attention in a timely way. Opportunities in these instances to encourage the staff team to be open and honest and share in problem solving had been missed. Although we found no evidence people had been harmed as a result of these delays, there was an increased risk to people because of delays in resolving the issues. We saw examples of written guidance for staff emphasising negative potential consequences for them to highlighting information of concern. Some staff told us they would be worried about telling the registered manager they had made a mistake or broken a piece of equipment. The registered manager explained they had worked hard to improve the care provided by the staff team and had had to be strict with them at times to achieve this. The registered manager told us they would revisit the specific examples we highlighted to reassure staff of the benefits of highlighting quickly when things had gone wrong. We saw incidents and accidents were investigated and action was taken to mitigate risk. We saw evidence showing that complaints were listened to and appropriately dealt with.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. We saw that people’s wishes with regard to emergency care were recorded clearly and easy for staff to access as needed. People and their relatives told us they received good joined up care with other health professionals such as their GP’s. Staff were aware of the instructions professionals had given to ensure people received the changes in care they needed.

Some systems to protect people from possible neglect needed further improvement. We found systems in place to monitor how quickly staff responded to people when they used their call bells had not identified they were often not receiving a timely response. This left people at risk of possible neglect. Two people we spoke with told us they found staff did not always come quickly when they used the call bell to ask for help. How quickly staff responded to call bells was not being routinely checked by the provider. We found no evidence anyone had been harmed because of delays in responding to call bells. We raised these concerns with the registered manager who put measures in place to monitor and improve response times. We found 2 examples of staff not reporting damage to equipment, which meant strategies to prevent possible harm were delayed. Staff we spoke with were unable to tell us who in the home was and was not subject to Deprivation of Liberty Safeguards (DoLS). This is legal procedure used to deprive a person of their liberty when they lack capacity to consent to care themselves. At the time of our assessment there were several people living at the home who were not subject to DoLS. However, staff we spoke with told us there was no one living at the home who was not subject to DoLS. This meant people were at risk of not having their rights fully respected and of having unnecessary or inappropriate restrictions placed upon them. We discussed this with the registered manager who said they would review staff knowledge and training in this area. Staff all received safeguarding training and told us they understood how to identify signs of abuse and neglect. Safeguarding concerns were shared with other agencies so that they could be appropriately investigated. The registered manager also conducted investigations to review occasions where things had gone wrong and people’s safety needed to be reviewed.

The provider did not always work well with people to understand and manage risks. Risk assessments for people who could walk around the home independently were not in place. Some environmental risks to these people had not been identified and reduced. This included concerns we identified in relation to the risk of falls on stairs, an exposed hot surface and the safety and security of the service’s rear exit and garden. We also found safe storage of potentially hazardous substances needed to be more consistent. The majority of people living at the home at the time of our assessment needed staff support to get out of bed and to leave their bedroom. Some staff and one relative told us the number of people supported to get out of bed and be in the shared areas of the home varied depending upon which staff were on duty. During our assessment we saw on one day when there was no care lead present, that 7 people had got up and were using the dining room at lunch time. On 2 other occasions when the care lead was present, double the number of people were up and using the lounge and dining areas. We spoke with the registered manager about the possibility of an inconsistent approach from the staff team to supporting people to leave their rooms. They told us they had had difficulties recruiting to a second care lead post. They gave assurance that efforts were made by the wider staff team to encourage and support people to move around the home and socialise. We also saw some examples of people receiving good support to manage their risks. For example, systems ensured staff could easily check on people’s need for modified food and drink, which reduced their risk of choking.

The provider did not always detect and control potential risks in the care environment. For example, we saw stairgates which were in place to prevent people from accessing steep flights of stairs were being left open regularly. We saw that people could easily leave the home via the open back door and side entry gate and walk out into the main road. We saw keys to areas which were not safe for people were left out where they could be accessed and codes to keypad locks on doors written clearly nearby. We found hot pipes in one area had not been covered to prevent possible risk of burns. We found cupboards which should have been locked were unlocked and some contained substances which would be harmful if consumed. We shared these concerns with the registered manager who arranged for changes and put strategies in place quickly to protect people from the risks we had identified. We found no evidence people had been harmed as a result of the risks we had identified during our assessment. We also found some improvements were needed with fire safety arrangements. Although everyone had their own personal emergency evacuation plan (PEEP) in place, there was no summary available to the fire service of people’s related support needs. This meant in the event of an emergency, responders would have to review 29 people’s records to assess what support they would need. The registered manager said they would arrange for a summary of people’s needs to be completed. We saw for a person who was prescribed oxygen, their PEEP did not guide staff on what action to take in the event of a fire emergency to ensure they had their portable oxygen tank. The guidance staff needed was added to the person’s PEEP during our assessment. We also found that although a fire safety risk assessment had been completed, it had not been reviewed since the introduction of stairgates. The stairgates were on planned evacuation routes and their impact upon people’s ability to evacuate quickly had not been assessed. The registered manager made changes to emergency response plans when we brought this concern to their attention. The fire service also reviewed these changes to ensure people could still safely and quickly evacuate the service in the event of a fire emergency. Staff told us they received regular fire safety training and practiced what action to take in an emergency. Fire safety equipment was available and appropriately maintained. Equipment such as hoists had been recently checked to ensure they were safe for people to use.

Although the provider made sure there were enough staff to support people with their care needs, we found recruitment practices were not always as thorough as they could be. We found on 2 occasions people had been recruited previously by companies who did not provide any detail in their references. No additional steps were taken to consider how the candidate’s suitability and safety to perform their role could be assessed. Large gaps in 1 candidate’s employment history showed no evidence of being identified and explored. One candidate’s character reference did not include a legible name to show who had provided it. Failure to take steps to ensure candidates’ previous work conduct was satisfactory put people at risk of poor care. Disclosure and Barring Service (DBS) checks were conducted for all staff. These record individuals’ criminal history and are used by employers to help determine if they are safe and suitable to work with vulnerable adults. Staff had to complete an induction which included shadowing more experienced staff. The registered manager told us they prepared the staff rota to try to ensure a mix of more experienced and more newly recruited staff. Staff told us they felt the induction and training they received helped them to have the skills they needed. Some staff members and 1 relative told us they were concerned about the skills and confidence of the newer staff. A catheter care competency checklist which was being used to ensure carers knew how to meet people’s catheter care needs. One member of staff told us they were concerned that this competency checklist was not sufficient. We reviewed the checklist and noted several important aspects of catheter care were not included. The registered manager agreed with our finding and told us they would arrange for training for care staff in catheter care. At the time of our assessment 4 people living at the home had catheters in place. Overall staff compliance with refresher training was good. We did note that 2 care staff had not completed a significant proportion of their annual refresher training in the time allocated to do so. The registered manager told us they would investigate how this had happened and would make sure they had time to catch up. We found no evidence anyone had been harmed as a result of not receiving training. Some staff felt more face to face training and less reliance on computer-based learning would be more beneficial, especially for staff whose first language was not English. Staff told us they received regular supervision. Staff also told us the registered manager always made sure enough staff were on duty to maintain safe care. They told us if a staff member was not available at short notice, the registered manager always arranged for someone else to cover their shift. Each day staff were allocated to specific areas of the home. This included the lounge area, therefore ensuring there was always a staff member available to monitor people’s needs in the lounge and make sure they were safe. As we walked around the home, it was always easy to find a member of staff.

Overall, the provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. We did find some damage to a couple of areas of the home which had not been repaired in a timely way. This made cleaning these areas more difficult. We brought these to the registered manager’s attention and they were addressed. There were some areas of the home where there were marks on skirting and door frames, we also saw a wall appeared to be stained. The registered manager explained that there was a plan to gradually redecorate the home. Some of the work had already been completed. This included new flooring being installed in some areas of the home. Staff told us they were supplied with everything they needed to keep the home clean and clutter free. People told us they were happy with the cleanliness of their home. People were also supported to maintain good personal hygiene to promote wellbeing.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Staff competencies were assessed to make sure the support they offered people to take their medicines remained safe and consistent. People told us they were happy with the support they received to take their medicines. People had care plans which guided staff about how they wanted to be supported with their medication. Staff knew about people’s preferences regarding their medication. Medication was ordered and stored safely to ensure people did not run out of their medicines. Guidance for staff ensured they knew how and where to apply creams to promote skin care.