Orchid Woodlands Healthcare Ltd

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 requires improvement. At this assessment the rating has remained 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 safe management of people’s medicines.

This service scored 62 (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 had a positive culture of safety, based on openness and honesty. Although staff listened to concerns about safety and documented safety events, lessons were not always learnt to continually identify and embed good practice.

The provider had a process in place for documenting accidents and incidents, with information recorded on specific forms. We reviewed a selection of these and noted information documented included what had happened and the immediate action taken. Each incident or accident was then reviewed by a manager, who included some information about outcomes, but we found limited information relating to any learning and/or what had been done to try and prevent a reoccurrence.

Each month an incident and accident audit was completed. We noted these varied in comprehensiveness, some included a review of actions and outcomes, with lessons learned incorporated, whilst others just detailed the number and type of incidents which had occurred that month.

Through conversations with people and relatives, we were given some examples of the provider’s responsiveness when an incident had occurred. For example, after a person had rolled out of bed, the provider replaced the bed with one which was height adjustable, so could be set lower. De-caffeinated tea and coffee were now used at the home to reduce urgent incontinence and subsequently people trying to rush to the toilet, with the aim of decreasing the risk and frequency of falls. From reviewing care records, we also noted a person was provided with a second sensor mat as they had been able to step over or around the single mat. Sensor mats are used to alert staff a person is out of bed, and ensure support is provided timely.

The provider had an up-to-date complaints policy in place. Overall, any complaints received had been managed in line with policy, although records did not always detail whether the complaint had been upheld, actions taken and outcomes.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care records contained a range of generic and individualised risk assessments, which assessed risks to people, and where necessary explained how these would be managed. A risk profile was used, which summarised key risks to people, with a colour coded system used for grading the severity of risk before and after any risk management process had been implemented. This helped to assess whether the management plan was effective.

Where people required bed rails, detailed assessments had been completed, which included what alternatives had been considered and/or tried, before the use of bed rails had been determined. This is in line with best practice for ensuring the least restrictive option is used when keeping people safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risk assessments of the environment and equipment used within the home had been completed, to ensure these were fit for purpose and used correctly. Ongoing safety checks had also been completed in line with legislation, with certification in place to confirm compliance. This included checks of gas and electrical safety and equipment such as the passenger lift and hoists. Regular fire drills had been completed, which included staff having to locate the source of the fire; represented by a picture of a fire, as part of these. A log had been kept of who took part to ensure all staff had completed at least one per year. The provider had an up-to-date business continuity plan, which explained what action would be taken in an emergency, for example if the home were to have no power, heating or access to water. However, this did not include details of alternative accommodation should the home be uninhabitable for a period of time and how people would be transported there. The provider agreed to add this information in as a matter of urgency.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us enough were deployed on each shift to meet people’s needs and keep them safe. The majority of people and relatives we spoke with stated the same, though some felt more were needed to ensure care was provided timely and to support personal preferences such as more regular baths. Comments included, “I feel safe. I feel that there are enough staff and that they are good” and “[Relative] has told me sometimes they [staff] have been late in getting her up and putting her to bed and I've often wondered if that's to do with staffing levels.” The provider used a system for determining how many staff were needed to meet people’s daily care needs. We found staffing levels were based on this information, with rotas showing the correct number of staff had been deployed during both day and night shifts.

Staff told us they received enough training, support and supervision to carry out their roles. One stated, “Training is good, and we can ask for more training in any areas we want. A session about falls was put on after this was requested.” Another added, “We have supervision, I had one last month, they asked me how I was, how was my work and if I had any suggestions.” Training completion was monitored via a spreadsheet. This showed the vast majority of staff were up to date with sessions the provider considered mandatory, along with specific sessions to meet the specific needs of people living at the home. Staff who were new to care had completed the care certificate. This is a set of 16 standards for the health and social care support workforce in the UK, developed by Skills for Care, Skills for Health, and NHS England to ensure new workers have the necessary skills, knowledge, and behaviours to provide safe, compassionate, and high-quality care. The provider had also carried out spot checks in a range of areas, to monitor staff’s knowledge and levels of competency.

The provider’s supervision policy stated the frequency of supervision meetings was to be agreed individually during staff appraisals. However, to date not all staff had completed an appraisal, so this action had yet to be completed. Supervision sessions were monitored using a tracker. This showed all staff had completed at least 1 supervision so far this year, with some having completed 3.

Staff were recruited safely, with all required pre-employment checks completed, and references sought.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not consistently make sure medicines and treatments were safe and met people’s needs, capacities and preferences.

Where people had thickening powder added to their drinks to prevent choking, records showed the drinks were not always thickened to the correct consistency which placed people at risk of choking. Following the inspection the provider confirmed action had been taken to ensure drinks were thickened to the correct consistency.

Several people were prescribed ‘when required’ medicines, such as paracetamol. Information to support staff to know when to give these medicines was out of date and not always correct. This increased the risk of people not receiving these medicines when they needed them.

The manufacturer’s special instructions, which inform staff of when specifically, to give medicines, for example, before or after food, were not always recorded on the electronic medicines administration record (eMAR). This meant medicines might not be given in line with the manufacturer’s instructions. The lack of special instructions on the eMAR meant the provider was not following best practice guidance published by National Institute for Health and Care Excellence (NICE).

When people had their medicines administered covertly, such as hidden in food and drink, there was not always clear information to support staff to do this safely. We found staff were not always following the provider’s medicines policy around the administration of medicines in a covert way. Following the inspection, the provider took action to address this issue.

Where people were prescribed medicines that need to be given at specific times, we found they had been given on time. Where there needed to be a time interval between doses of medicines, the eMAR showed this had been observed correctly.

Staff completed medicines training and had their competency assessed.