The Care Quality Commission
  • Care Home
  • Care home

Archived: The Orchard

Overall: Inadequate read more about inspection ratings

56 High Street South, Stewkley, Leighton Buzzard, Bedfordshire, LU7 0HR (01525) 240240

Provided and run by:
Mrs P M Hannelly

All Inspections

6 January 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 07 and 09 October 2015. We found breaches of a number of the regulations of the Health and Social Care Act 2008. This resulted in the Commission serving four warning notices on the provider. These warning notices were in relation to safe care, protection of people, quality monitoring and staffing. The timescale for meeting the warning notices was the 18 December 2015. In addition to the warning notices we asked the provider to take action to improve the running of the home.

The registered manager sent us an action plan detailing actions anticipated to ensure future compliance with the regulations. We undertook a focused inspection on 06 and 07 January 2016 to check that they were meeting the legal requirements which the warning notices related to. This report only covers our findings in relation to these breaches of regulations. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘The Orchard’ on our website at www.cqc.org.uk. We will follow up on the other breaches referred to in that report at a later stage.

The Orchard is a care home for older adults. It is registered to provide accommodation for 11 people. At the time of our inspection eight people lived at The Orchard. The Orchard is a family owned and run care home. It has a family home atmosphere and rooms are personalised.

The service had 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.

At this focused inspection on 06 and 07 January 2016, we found that some improvements had been made to rectify issues identified at the previous inspection. However, we found a number of issues still of concern.

Medicine administration did not follow national guidelines. One person was not offered prescribed medicine for 11 days.

Staff had been offered training but failed to demonstrate that they had knowledge of this learning. We observed poor manual handling practice and disregard for respecting dignity.

The provider had responded to improvements required in fire safety. Door releases were now in place allowing doors to shut when the fire alarm was activated.

We found the provider had taken steps to improve its monitoring of the quality of the service provided. Questionnaires had been sent out to people, relatives and staff.

Staffing numbers had increased since our last visit. This meant that people’s safety at lunchtime had improved.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. We found a number of continued breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is now considering the appropriate regulatory response to resolve the problems we found.

We have made a recommendation about staff training on the subject of Safeguarding people from abuse.

07 & 09 October 2015

During a routine inspection

The Orchard is a family run care home in rural Buckinghamshire, it can accommodate up to 11 people over the age of 65. At the time of our inspection 9 people were living there. Accommodation is over two floors. The Orchard has a 'family home' atmosphere and has a number of different seating areas for people to use.

We previously inspected the service on 08 May 2015. The service was meeting the requirements of the regulations at that time. This inspection took place on 07 and 09 October 2015 and was unannounced. This meant staff and the provider did not know we would be visiting. The inspection was planned in response to concerns raised by a member of the public.

The Orchard has 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.

People were not consistently protected from avoidable harm. Staff were not always knowledgeable regarding how to recognise abuse and what actions they would take if concerns were highlighted.

People were not protected from the risk of fire because advice from the fire officer had not been followed. For example, removing wedges and other items holding fire doors open. Risk assessments for fire had not been updated.

Some of the required pre-employment checks had not always been completed. For example, some staff had been recruited using an interpreter. This was because English was not their first language and they were unable to take part in interviews without this support. This also impacted on the staff ability to effectively communicate with people and understand their needs.

We found staffing levels were not sufficient to supervise people to ensure their safety. Staff had received training in key areas, however we poor practice in particular communication and manual handling.

Medicines were not managed safely. For example, we observed poor practice in how medicines were administered and recorded, which placed people at risk of harm.

Personal risk for people were routinely reviewed, however we found evidence of failure to reduce the risks relating to the health, safety and welfare of people and others who may be at risk. In addition, there was a failure to assess, monitor and improve the quality and safety of the services provided. The systems in place had not identified the shortfalls we found for people or driven improvement in the quality of care or service provided.

We found a number of breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of The Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.



08 May 2015

During a routine inspection

The Orchard is a family run care home which accommodates up to 11 older people It does not provide nursing care. At the time of our inspection 9 people were living at The Orchard

The Orchard 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.

The inspection took place over one day on 08 May 2015 and was unannounced.

We noted a warm caring atmosphere when we visited the home. Staff were clearly dedicated to providing people with a high quality of care and support. The general feeling and observations of the interactions between people living in the home and their relatives was one in which the provider and staff cared for people like one of their own family. The general overall impression was it was very much ‘home from home’ for people who lived at The Orchard.

People told us they felt safe living at The Orchard and knew who to speak with if they were not happy. Likewise people’s relatives were confident people were cared for safely and staff were attentive to their needs. They knew who to speak with if they had any concerns.

Any risks to people using the service were identified and incorporated into their care plans to enable staff to manage any identified risks appropriately and to keep people safe and free from any harm wherever possible. These included risks in relation to moving and handling, falls, and nutrition.

People’s care plans were person centred and described what they were able to do themselves and what they required support with. They contained documentation to show people and/or their representatives had been involved in the care planning process.

Staff were well trained and there were enough staff during the day and night to meet the needs and wishes of the people they supported.

People's health and well-being was assessed prior to them moving into The Orchard and measures put in place to ensure people's needs were met in a person centred way.

Staff were supported by the registered manager to maintain and develop their skills and knowledge through training and supervisions. The registered manager accompanied staff on training sessions to ensure they kept their own knowledge and skills updated too.

People’s medicines were administered by staff who had received training to ensure they were administered safely and in a timely manner.

We have made a recommendation that the provider considers current guidance on the recruitment of staff and take action to update their recruitment policy and procedure accordingly.

17 December 2013

During an inspection looking at part of the service

When we visited The Orchard on 30 August 2013, we found concerns in relation to the storage of people's care plans and daily reports. This was because we found them stored in open shelves and not stored securely, which had the potential to compromise people's confidentiality. A compliance action was set.

The provider wrote to us and provided us with an action plan. They informed us they had reviewed the storage of people's care plans and daily reports and actions had been taken to ensure people's confidentiality was maintained. We spoke with three members of staff who all confirmed people's records had been moved since our last visit. They told us they were now stored in a locked filing cabinet which could only be accessed by staff and the manager of the home. We were shown the filing cabinet and saw people's care plans and other personal information was stored within it. This showed the propvider had taken appropriate measures to ensure people's records were stored securely and their confidentiality was not compromised.

30 August 2013

During a routine inspection

At the time of our visit the service accommodated six people who received care and support. We spoke with three people using the service and three relatives who were visiting. People we spoke with told us the staff were polite, respectful, and encouraged them to do as much as they could for themselves.

People told us they and/or their family had been given the opportunity to visit the home before they moved in. This ensured it met their needs and expectations. They said the staff treated them as individuals and respected their views and choices. They were consulted about any changes to their care and could choose how they spent their day.

Care plans were in place to document people's individual needs. They were detailed, reviewed and updated regularly. Risk assessments had been written to identify and reduce the likelihood of injury or harm, with guidelines in place for staff.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

Daily activities were provided for those who wished to take part. They included one to one activities and group sessions.

17 January 2013

During a routine inspection

People's health, social and personal care needs had been assessed before a placement at the home had begun. This ensured their needs could be met appropriately.

Care plans addressed people's individual needs, were detailed, reviewed and updated regularly. People had access to healthcare professionals and specialist support to ensure they kept healthy and well. The care and support was planned and delivered in line with their care plan.

There were safe established systems in place for the management of medicines and people told us they received their medication on time.

The premises were nicely decorated, comfortable and kept warm. Each person had their own room, which they had personalised to their taste.

People told us they felt safe and they had no concerns about the care and support they received. They found the staff and management approachable and knew who to speak with if they had any concerns. They told us they found the staff to be caring and polite. One person said ''the whole atmosphere here is lovely. The staff are very good and always happy. I think if they are happy then everybody is happy...if I needed to I would come back here, I can't speak more highly of it.'' Another person told us staff respected their choices ''staff do everything the way I want them to.''

2 December 2011

During a routine inspection

During the visit we spoke to people living in the home who told us that they were happy with the care and support that they received. They told us that they were involved in decisions about their care and the care planning process. They were confident in raising any concerns that they had.

People told us that the staff were always on hand to attend to their needs. They found them to be knowledgeable about their individual needs.

During the visit we spoke to people living in the home who told us that they were happy with the care and support that they received. They told us that they were involved in decisions about their care and the care planning process. They were confident in raising any concerns that they had.

People told us that the staff were always on hand to attend to their needs. They found them to be knowledgeable about their individual needs.