Archived: Orchard Residential

Orchard Residential is a ‘care home’ providing accommodation, nursing and / or personal care for up to 26 older adults; some of whom lived with dementia. At the time of the inspection 18 people were living at the home.

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

Management of risk and safety monitoring had improved. People received safe, timely and effective care that was centred around their support needs. Care records contained up to date, consistent and relevant information that staff needed to know and risks were regularly reviewed, evaluated and followed up on when needed.

Improved medicine management processes had been identified. Medicines were safely stored and temperature checks were routinely taken, PRN (‘as and when required’ medicines) protocols had improved and controlled drugs were safely managed and administered in accordance with medication administration policy.

Infection prevention and control (IPC) measures, procedures and processes had improved. Staff were engaged in the required COVID-19 testing regime, all visitors were screened for symptoms of COVID-19 and Government guidance and best practice in relation to PPE was followed.

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.

Staffing levels and the deployment of staff was closely monitored. People received support from a consistent staff team who were skilled, experienced and competent to provide the level of care they needed. Staff received regular supervision and were supported with the necessary learning and development opportunities.

Recruitment procedures had improved and new processes had been implemented. Pre-employment recruitment checks were carried out and people received care and support from staff who had been appropriately vetted.

Overall quality assurance and governance measures had improved. The quality and safety of care was routinely monitored, the provision of care was assessed and improvements were being identified. A new manager had been appointed following the last inspection. They were aware of their regulatory roles and responsibilities and understood the importance of delivering safe, high-quality, person-centred care. We received positive comments about the improved provision of care people received.

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 ‘inadequate’ (published 4 November 2021) 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.

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

We undertook this focused inspection to check whether the breaches of regulations and warning notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met.

The focused inspection reviewed the key questions of safe, effective 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 IPC 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.

The overall rating for the service has improved to ‘requires improvement’. This is based on the findings at this inspection.

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

Follow up

We will work alongside the provider and local authority to monitor progress and continue to monitor information we receive about the service until we return as per inspection programme. If we receive any concerning information we may inspect sooner.

Orchard Residential is a ‘care home’ providing accommodation, nursing and / or personal care for up to 26 older adults; some of whom lived with dementia. At the time of the inspection 24 people were living at the home.

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

People were not receiving a safe level of care and areas of risk were not robustly monitored, reviewed or safely managed. Care records did not always contain the most relevant information or guidance that staff needed to follow, and people were exposed to unnecessary risk. One staff member told us, “Residents are not provided with a good or safe level of care.”

Unsafe medication practices were identified. Medicines were not safely stored as temperatures were not regularly monitored, controlled drugs were not always signed out by two members of staff and PRN (as and when required medicines) protocols were not in place for all residents living at the home.

Infection prevention and control (IPC) measures and arrangements were not embedded and we were not assured that people were protected from harm. Staff were not routinely engaged in a COVID-19 testing regime, enhanced cleaning regimes were not in place and regular COVID-19 symptom checks were not being carried out.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Sufficient numbers of suitably qualified, competent, skilled or experienced staff were not deployed across the home. There was no systematic approach to determine the numbers of staff needed in relation to the dependency needs of people living at the home. Staff were not supported with the necessary training, learning or development opportunities.

Recruitment of 'fit and proper' staff could not always be assured. There was evidence to suggest that the provider did not have robust recruitment procedures in place, or the relevant recruitment checks were being carried out.

Inadequate quality assurance and governance measures meant that the provision of care people received was compromised. Quality performance measures were not effectively in place, areas of risk were not safely managed, and regulatory requirements were not complied with.

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 ‘good’ (published 20 December 2020).

Why we inspected

We carried out an unannounced inspection to follow up on concerns we had received in relation to the provision of care that was being delivered. The information The Care Quality Commission (CQC) received indicated that there were concerns around IPC, staffing, safe care and treatment and good governance. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 IPC 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.

The overall rating for the service has deteriorated to ‘inadequate’. This is based on the findings at this inspection. We found evidence that the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard Residential Care Home 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 have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed and good governance. Please see the action we have told the provider to take at the end of this report.

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 following the publication of this report to discuss how they will make changes to ensure they improve their rating to at least ‘good’, we will request an action plan to understand what they will do to improve the standards of quality and safety and we will work with the 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 Residential is registered to provide residential care to up to 26 older people and those living with dementia. At the time of our inspection 26 people were living at the service.

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

At our last inspection the provider had failed to robustly assess the risks relating to the health safety and welfare of people. We also found governance systems were not effective at ensuring regulations were met. Enough improvement had been made at this inspection and the provider was no longer in breach of Regulations.

Risks relating to the environment, infection-control and the care needs of people were safely managed. Action to reduce risk had been taken in response to any accidents and incidents. People received their medicines as prescribed by competent staff. Medicines were stored and recorded in line with national guidance and best practice. People spoke positively about the safety of the care provided at Orchard Residential. Staff understood their responsibility to report anything of concern and had done so in accordance with the relevant guidance. Staff were safely recruited subject to the relevant checks and deployed in sufficient numbers to meet people’s care needs.

Following the last inspection, the service had improved systems to monitor, assess and improve the safety and quality of care being provided. Staff demonstrated kindness and respect in their interactions with people. It was clear they knew people well and provided care in an individualised manner. Staff and relatives spoke positively about the level of communication from managers at the service. People had been provided with information regarding COVID-19 and changes that were being implemented to keep people safe. Referrals to other health services were managed well and appropriately followed up on. For example, where people did not meet the criteria for specialist support, staff engaged with GP’s to ensure health conditions were managed in the person’s best-interests.

Rating at last inspection and update

At the last inspection the service was rated requires improvement (report published 22 November 2019).

During the last inspection we found a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks. 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 carried out an unannounced comprehensive inspection of this service on 19 and 2 September and 4 November 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard Residential 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 Residential accommodates up to 26 people who require personal care. At the time of the inspection there were 21 people using the service.

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

People's health and safety was placed at risk. Kitchens, food serving areas and mobility aids such as wheelchairs and sensor mats were unclean increasing the risk of the spread of infection.

The systems in place for monitoring the quality and safety of the service were not always effective in identifying and mitigating risks to people. Some audits carried out did not always accurately reflect the findings and where audits had identified risks to people’s health and safety they were not mitigated in a timely way.

Staff understood their responsibilities for safeguarding people from abuse and the risk of abuse. Safe recruitment processes were followed. Learning took place from accidents and incidents.

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’s needs were assessed to make sure they could be met at the service. People received effective care and support by the right amount of staff who had received training and support relevant to their roles.

People were treated with kindness and their dignity, privacy and independence was promoted and respected. Staff responded sensitively to people’s emotional needs. People and their family members were given opportunities to express their views about the care provided. Personal information about people was treated in confidence.

People received personalised care and support in line with their choice and preference. People were offered a variety of activities to meet their needs. People and others were provided with Information about how to make a complaint and they were confident about complaining should they need to.

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 good (published May 2017). We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

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 Residential is registered to provide accommodation and personal care for up to 26 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 23 people using the service at the time of this inspection.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. 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 last inspection of the service was carried out on 15 September 2015 and we found that the service was not meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations. The registered provider sent us an action plan following the last inspection detailing how and when they intended to make the improvements in relation to good governance. During this inspection we found that the required improvements had been made.

Checks on the quality and safety of the service had improved making them more effective. Checks were carried out as required on things such as care records, infection control, medication and the environment. Action plans were put in place to address improvements identified and they detailed who was responsible for following up on the action and the timescales for completion.

People received their medication on time by staff who had received the appropriate training and competency checks. Medication was stored safely and records of medication were appropriately completed. Protocols for the use of PRN medication, medicines to be taken ‘when required’, were in place and staff followed instructions given by GPs for its use.

Staff had undertaken safeguarding training and they were confident about recognising and reporting actual abuse or suspected abuse. The registered manager and other senior staff were aware of their responsibilities to report abuse to relevant agencies.

There were sufficient numbers of suitably skilled and qualified staff to keep people safe. All staff had completed training in emergency procedures and they were aware of their responsibilities for keeping people safe.

The procedure for recruiting staff was safe and thorough. Applicants were required to provide information about their previous employment history, skills and experience. A series of pre-employment checks including a check with the Disclosure and Barring service (DBS) were obtained before employment was confirmed.

The registered manager and staff had good knowledge and understanding of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. The registered manager worked alongside family members and relevant health and social care professionals to ensure decisions were made in people’s best interests when this was required.

People’s nutritional and hydration needs were assessed and planned for and staff had a good understanding of them. People received the support and assistance they needed to eat and drink, and those who needed it had their food and fluid intake monitored to help minimise the risk of malnutrition and dehydration. Menus did not reflect healthy food options which people were offered and they lacked some variety. However following the inspection we were assured that menus were being revised.

Care plans identified people’s needs and any associated risks, and they instructed staff on how to meet them. Care plans were kept under review so that they remained relevant and up to date. Communication amongst the staff helped to ensure that people received consistent and effective care and support.

Staff received an appropriate level of supervision and training for the roles and to enable them to meet people’s needs. New staff completed a period of induction and training was ongoing for all staff. One to one supervisions and group meetings which took place provided staff with an opportunity to discuss matters relating to their work and any training and development needs.

The registered manager was described as being approachable, supportive and caring towards people who used the service and family members. There was an open door policy operated at the service which enabled people to speak openly and in confidence with the registered manager. People were provided with information about how to complain and they said they were confident about complaining should they need to.

Each person had a care plan with up to date information about the care and support they

needed and they told us that they were happy with the care they received. They also told us that they felt safe living at the home and they knew who to tell if they were unhappy with anything. Their comments included:

'There is nothing to find fault with any of them".

"Staff are always available to help".

"The staff are excellent".

"They get everything right'.

We found the home to be clean and regular checks had been carried out to ensure the

required standards of cleanliness and infection control. We also found that the relevant checks were made on staff working in the home.