Orchard Nursing

Orchard Nursing accommodates up to 31 people over three floors who require personal and nursing care. At the time of the inspection there were 30 people using the service.

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

Risks assessments were completed and included risk management plans. Staff monitored people’s health safety and wellbeing in line with their plans. Regular checks were carried out on the safety of the premises and equipment. There were effective systems in place to protect people from the risk of abuse and staff understood their responsibilities for keeping people safe.

People told us they were treated well and felt safe. People received their prescribed medicines at the right times by appropriately trained and competent staff. There were enough suitably skilled and experienced staff to meet people's needs and keep them safe and they were recruited safely. Most parts of the service were clean and hygienic although some areas and equipment were not cleaned as often as they should have been. There were some inconsistencies with staff around the use of PPE and disposal of clinical waste. These issues were addressed immediately by the manager.

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.

Improvements had been made following previous inspections. The manager and other senior staff had made good use of the providers systems and processes for assessing, monitoring, and improving the quality and safety of the service. The providers performance management systems were followed to promote improvement, learning and development.

People’s needs were met through good partnership working with others including families and other external professionals and agencies. Lessons were learnt when things went wrong and shared with the staff team for their learning. Relevant others were notified about incidents, events, and outcomes of investigations. The provider and manager acted in an open and transparent way with relevant others following incidents.

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 February 2022).

Why we inspected

This was a planned inspection.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Orchard Nursing is a care home registered to provide nursing care to up to 31 people, including people living with dementia. At the time of the inspection there were 18 people living in the service.

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

Improvements to how risks to people were assessed, monitored and managed were evident. There were clear plans in place to guide staff on how to manage risks relating to the health, safety and welfare of people. Risks to people were monitored in line with risk management plans and monitoring records were completed as required. However, these improvements were recent, and they needed to be sustained.

Regular safety checks were carried out on the environment and equipment and records of the checks were maintained.

Safe infection prevention and control (IPC) measures were in place and followed. There was a COVID-19 testing programme in place for all staff including agency staff and a record of tests carried out was maintained. The hygiene and cleanliness of the service was maintained to a good standard. There was a good stock of PPE and staff used and disposed of it safely.

There was the right amount of suitably skilled and experienced staff to safely meet people’s needs. More than 80% of staff had completed the required training and further training was planned. The successful recruitment of permanent staff had led to a significant reduction in the deployment of agency staff. Applicants underwent a series of pre-employment checks to make sure they were right for the job.

Medicines were now more safely managed. Staff responsible for managing medicines had completed the required training and competency checks. There was detailed guidance for staff to follow on how to administer people’s prescribed medicines including 'when required' medicines. Records were maintained of medication room and fridge temperatures and stocks of medicines kept at the service. The service needs to demonstrate that these improvements can now be sustained.

People were protected from the risk of abuse. Most staff had completed safeguarding training. Staff were knowledgeable and confident about recognising and reporting any allegations of abuse. People told us they felt safe at the service and were treated well by staff. Family members were confident their relatives were kept safe.

A new manager was appointed following the last inspection. The manager understood their role and responsibilities and regulatory requirements. We received positive comments about the way the service was managed and about the positive changes made, including improvements to the culture of the service.

Governance systems were now being used effectively. Audits and checks were carried out consistently and used to drive improvement to the quality and safety of the service. However, these improvements were all relatively new and the new systems needed to be embedded into the service.

There was good partnership working and communication with external health and social care professionals and good communication with people, family members, staff.

For more details, please see the full report for 'Orchard Nursing' which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published November 2021). At the last inspection, significant breaches of Regulations 12 (Safe care and treatment), 17 (Good Governance) and 18 (Staffing) were identified. The service was placed in Special Measures.

At this inspection, the service has improved to requires improvement. Improvements were found across the service and the provider was no longer in breach of Regulations 12 (Safe care and treatment) 18 (Staffing) and 17 (Good Governance). However, improvements made were recent and needed to be embedded and sustained over a longer period to achieve a rating of good.

This service has been in Special Measures since November 2021. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection in September 2021. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Orchard Nursing is a care home registered to provide nursing care to up to 31 people, including people living with dementia. At the time of the inspection there were 28 people living in the home.

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

The systems in place to monitor the quality and safety of the service were not effective. They did not identify the risks to people we highlighted during the inspection. When audits identified actions, it was not always clear if they had been addressed. There was no oversight of the completion of records regarding care provided to people to enable the provider to be assured that people’s care needs were met. The Commission had not been informed of all reportable incidents and events providers are required to inform us about.

Risks to people had not all been assessed to ensure measures could be put in place to minimise risks. When risks had been identified, steps were not always taken to reduce the risk and maximise people’s safety and wellbeing. Checks were made by external companies to help maintain the safety of the building and equipment. However, required internal checks were not completed robustly. Medicines were not all stored and managed safely and not all staff had completed assessments to ensure they were competent to administer medicines safely. Appropriate infection prevention and control measures were not all in place to prevent the spread of infection. Not all parts of the home were clean, and we could not be assured that all staff had completed COVID-19 testing in line with government guidance.

People were supported by staff who had been safely recruited, however the high use of agency staff had an impact on the quality of the care people received. Not all staff had completed necessary training to ensure they had the knowledge and skills to undertake their role safely.

People’s relatives told us they felt their family members were safe in Orchard Nursing. Staff were aware of safeguarding procedures and knew how to raise any concerns they had, although only half of the staff had completed safeguarding training recently.

There was no registered manager in post at the time of the inspection. A new manager had been appointed and was due to start the following week. There had been several changes in the management of the service and not everybody knew who was managing the home. Staff did not feel supported and did not all know who to turn to when they needed support.

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 22 December 2020).

Why we inspected

We received concerns in relation to staffing levels, infection prevention and control procedures and the management of the service. 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 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risk, infection prevention and control, staffing levels and the governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider and request an action plan to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Orchard Nursing is registered to provide nursing care to up to 31 older people and those living with dementia. At the time of our inspection 24 people were living at the service.

People’s experience of using the service and what we found:

The service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control. The recommendations made from a recent inspection by the local infection control team had been addressed.

People's experience of using the service was positive. People received the care and support they needed when required. People and family members told us staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

The people we spoke with told us, and our observations confirmed, they felt safe living at Orchard Nursing. We were told, “We are getting looked after well” and “Staff are very good.” One relative told us, “I can’t fault care, amazing, [relative] has come on in leaps and bounds.”

People reported good support regarding the management of their medicines and told us they got their medicines on time. The medications records we looked at were clear and supported best practice. Nursing staff administering medicines were suitably trained and competent.

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records mostly identified risks clearly and there were plans in place to help keep people safe.

Since the last inspection there had been changes of management. The current manager was providing effective leadership and was supported by a senior management team. The provider’s governance systems and organisational structure was well developed and provided effective monitoring and support for the service.

Rating at last inspection and update

At the last inspection the service was rated requires improvement (report published 4 June 2019).

Why we inspected

We received concerns in relation to infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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.

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.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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

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 Nursing is a care home that provides personal and nursing care for up to 31 people in one building. Accommodation was over three floors. At the time of this inspection 26 people were living at the service.

Improvements had been made since the last inspection in relation to people’s living environment, identified risks to people had been minimised and people were treated with dignity and respect. In addition, some improvements had been made to the systems in place to monitor the quality and safety of the service.

We have made four recommendations in relation to the storing of equipment, reviewing the number of staff available to meet people’s needs, the completion of records and quality monitoring systems in place within the service.

People’s experience of using this service:

Peoples' needs and wishes were assessed and planned for. Care plans identified the intended outcomes for people and how their needs were to be met. People received care and support from appropriately trained staff. People were offered a choice of diet and their healthcare needs were understood and met.

Systems for assessing and monitoring the quality and safety of the service were not fully effective in identifying areas of improvement within the service. However, there had been improvements from our previous inspection. People and their family members described the staff as "Nice” and “Really respectful.” Systems were in place to gather people’s views on the service.

People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Risks to people and others were identified and measures put in place to minimise harm. This was an improvement from the previous inspection. Infection control practices were followed to minimise the risk of the spread of infection. Regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and how they were to be met. People and their family members knew how to raise a concern or make a complaint about the service. Staff provided care and support with positive outcomes for people.

Details are in the key questions below.

Rating at the last inspection: The service was rated as Requires Improvement on 23 April 2018.

Rating from this inspection: Requires Improvement.

Why we inspected: This was a planned inspection to assess what improvements had been made by the registered provider following its previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last inspection of the service was carried out in August 2015 and at that time the service was rated as good.

Orchard Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Orchard Nursing is registered to provide accommodation, personal and nursing care for up to 31 people. There were 26 people living at the service at the time of the inspection.

The service does not have a registered manager, the last registered manager left in November 2017. 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. A manager has been appointed and they have applied to CQC to become the registered manager.

At this inspection we found breaches of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were related to Regulation12 Safe care and treatment, Regulation 15 Premises and equipment, Regulation 10 Dignity and respect and Regulation 17 Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Parts of the premises and equipment used by people were unsafe. Fire exit routes were obstructed and call bell cords in bathrooms and toilets were tied up out of people’s reach. Rooms containing hazards which posed a risk to people’s health and safety were not secured. At the time of inspection fire exit routes were cleared, call bells were made accessible to people and rooms containing hazards were secured.

People were placed at risk of the spread of infection. Items of equipment used to help people with their comfort and mobility were unclean. This included easy chairs, hoists and stand aids. Clinical waste had not been disposed of in line with safe infection control procedures. At the time of the inspection equipment was cleaned and clinical waste disposed of appropriately.

People were placed at risk of receiving ineffective care. Supplementary care records including fluid balance and positional change charts were not accurately completed to reflect the care and support people received. In addition the records did not include important information about people’s needs. The records were amended at the time of inspection to include the required information about people’s needs and the expected outcome.

People’s dignity was not always respected. People were left waiting for assistance to use the toilet which caused them unnecessary stress and discomfort. Staff left people waiting whilst they focused on tasks rather than responding to people’s personal care needs. Despite this we observed examples where staff provided personal care to people in a dignified way.

Checks to monitor the quality and safety of the service were not always effective. There was a lack of robust checks on the environment and cleanliness of equipment which resulted in a failure to identify and mitigate risks to people’s health, safety and wellbeing. There was also a failure to carry out regular checks on care records and staff practice resulting in people being placed at risk of receiving ineffective care which was not responsive to their needs.

We have made a recommendation about activities and the environment. Throughout the three days of inspection we observed a lack of activities for people to take part in. The majority of people were sat in lounges either watching TV or asleep and staff did not offer them any form of stimulation. Improvements to the environment had been made, however it lacked stimulus and wayfinding for people living with dementia.

Medication was safely managed. Staff responsible for the management and administration were suitably trained and competent. Safe processes were followed for obtaining, storing, administering and recoding medication. People received their medication on time.

People received care and support from suitable staff. A range of information was obtained about applicants to help the registered provider make safe recruitment decisions. This included obtaining information about applicant’s qualifications and skills and carrying out back ground checks.

People were protected from abuse and the risk of abuse. Staff had received training about how to protect people from abuse and they were confident about recognising and reporting any concerns they had about people’s safety. People told us they felt safe and would tell someone if they were worried about anything.

Staff received appropriate training and support for their roles. New staff commenced a 12 week induction on appointment and all staff were provided with ongoing training relevant to their roles, responsibilities and the needs of people who used the service.

Each person had a care plan which was developed on the basis of assessments carried out. People and relevant others were involved in the development and ongoing reviews of care plans. This helped to ensure they accurately reflected people’s needs, wishes and preferences.

We spoke with three people who used the service and their relatives. People told us that the care they had received had been delivered in a way that respected their privacy and dignity. Their comments included:

"I am very impressed with the whole atmosphere here".

"The staff are very kind, never impatient with me".

"I think it is great, I have nothing to worry about".

During our visit we saw evidence that care plans were detailed and people had been involved in planning their own care in line with their individual needs and wishes. We looked in detail at five care records of people using the service and saw that they were up to date and included relevant risk assessments.

Staff told us they felt well supported and had undertaken training to provide them with the required skills and knowledge to meet people's needs including supporting people who had dementia.

The provider had systems in place to maintain and monitor the care and safety of people using the service.

Records were accurate and included appropriate information and documents. They were kept securely and could be located promptly when needed.