Archived: Orchard Cottage

Orchard Cottage is a residential care home providing personal to up to 10 people. The service provides support to older people who had varying care needs including, dementia, diabetes and mental health needs. At the time of our inspection there were 10 people using the service.

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

Individual risks were not effectively identified and managed to keep people safe. Lessons were not learnt from accidents and incidents to prevent future occurrences. People were not always protected from the risk of abuse as staff did not have a good knowledge of what action to take. Peoples medicines were not managed well or in a safe way. There were not sufficient staff on duty to effectively meet people’s needs and keep them safe.

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.

People did not have a full assessment of their needs in order to develop care plans that were individual and reflected their health and care needs. People did not always have access to advice and treatment from the appropriate healthcare professional. The environment was not suitable for some people living at Orchard Cottage, such as people living with dementia.

Staff training was insufficient to meet staff needs. There were gaps in staff skills and knowledge which meant people did not always receive the help they needed.

The provider and registered manager did not have sufficient oversight of the service. Records did not reflect the changing needs of people. There was no process to monitor the quality and safety of the care provided to people to identify areas for improvement or take action when needed.

People received sufficient food and snacks and had a choice. People could request certain meals and their requests were acted upon.

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 5 May 2022).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about fire risks, staffing, response to incidents and access to healthcare. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the assessment of individual risk and care needs, staff understanding of the Mental Capacity Act and the management and oversight of the service. We widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, medicines management, capacity and consent and monitoring and oversight of quality and safety at this inspection.

Please see the enforcement action at the end of this report.

Follow up

The provider told us during the inspection the service was no longer financially viable and made the decision to close the service. They worked with the local authority to find suitable alternative accommodation for all the people who were living at Orchard Cottage at the time of the inspection.

Orchard Cottage is a care home which provides accommodation with personal care to older people, some of whom may be living with dementia. The accommodation is provided over two floors and care is provided for up to 10 people. There were 8 people using the service when we inspected.

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

People told us they felt safe with comments including, “Oh yes I feels safe here” and “I am helped with things I need. They are very good.”

People and staff had good relationships. Staff had worked at the service for several years and knew people well, their needs, likes and dislikes and called everyone by their name and spoke to them in a friendly yet professional way.

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.

Care staff and the registered manager safely managed people’s medicines. Medicines were stored securely, and records were kept up to date and accurate to ensure medicines were administered safely.

The service was following the latest government guidance relating to COVID-19, Cleaning schedules had been increased to minimise the risk of infection and staff used personal protective equipment such as masks and gloves appropriately.

Feedback from people, relatives and professionals was sought and used to make improvements to the service including learning lessons from things which had gone wrong.

People and their relatives felt the service was well led and knew who to go to if they were not happy with something or wished to request a change. The staff felt supported by the registered manager and told us they are always available for support and guidance.

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 May 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Orchard Cottage provides accommodation with personal care to older people, some of whom may be living with dementia. The accommodation is provided over two floors and care is provided for up to 10 people. There were 8 people using the service when we inspected.

People’s experience of using this service:

People told us they felt safe with staff. Comments included, “Yes, I am safe here” and “We are well looked after, it is our home.”

People had good relationships with staff, who were knowledgeable of their physical and emotional needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

People felt included in planning their care. Care plans were person centred, achieved good outcomes and showed people were offered choice and involved wherever possible.

People’s rights, their dignity and privacy were respected. One relative said, “The staff are very good, we see the same regular staff and are always welcome.”

Staff supported people to maintain a balanced diet and monitor their nutritional health.

Medicines were stored and managed safely by staff and the registered manager. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People received care from staff who were well supported with induction, training and ongoing supervision.

People knew how to complain and that any concerns would be listened and responded to by the provider. Actions were taken as a response to complaints as appropriate.

Feedback from people and relatives was sought and used to make improvements.

The provider had made changes to improve the service for people. On-going redecoration was planned over the next twelve months.

Quality monitoring systems included audits, checks on staff practice and checks on people's satisfaction with the service they received.

The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

Lessons were learnt and used to make improvements.

The service was led by an experienced, competent manager who understood their role and responsibilities, as did staff. The service had a clear management structure and people had confidence in the manager and provider.

Rating at last inspection: The service was rated as Requires Improvement at the last comprehensive inspection on 24 August 2016. Subsequently a focussed inspection was carried out on 02 March 2017, showing improvements had been made and the Safe domain was rated as Good.

At this inspection, the service met the characteristics of Good in all domains.

Why we inspected: This was a comprehensive inspection scheduled based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

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

Due to our concerns and the breach of regulation, we issued a requirement notice where the provider and the registered manager were required to take action to ensure they met with our regulation.

We undertook a focused inspection on 7 March 2017 to check that the service now met the legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Orchard Cottage’ on our website at www.cqc.org.uk.

Orchard Cottage is a residential care home that provides accommodation and support for up to 10 older people. Nine people were using the service at the time of our inspection on 7 March 2017.

At our focused inspection on 7 March 2017, we found the registered manager and provider met the legal requirements in relation to staffing. There were sufficient numbers staff deployed to enable them to support people safely and to complete their duties in an unhurried manner. People’s requests for support were attended to without delay. Staffing levels were reviewed and increased where appropriate to meet people’s needs. The duty rotas consistently and adequately covered routine shifts and planned absences to ensure there were sufficient staff to meet people’s needs safely and appropriately.

Orchard Cottage provides accommodation and support with personal care for 10 older people. At the time of the inspection there were nine people at the service. One person was on holiday.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Although some people and their relatives felt that there were enough staff at the service, we found that the level of staff available was not always sufficient to ensure people’s assessed needs were met. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

Risk assessments had been completed for people and staff were aware of the actions they needed to take to reduce risks to people. People and their relatives told us the staff were kind and they could trust them. We noted staff knew what adult safeguarding meant and the procedures to follow to record and report any incidents of abuse.

People had their medicines administered by staff who had relevant experience and training. Staff and records showed that new staff were checked properly before their employment to ensure they had the knowledge and experience needed to support people who used the service. We noted staff had the opportunity to attend training relevant to their roles including the Mental Capacity Act 2005.

The service had a homely feeling with people being able to access communal areas. People and their relatives told us staff were caring. We observed staff giving people plenty of time to listen to and chat with them. People told us staff treated them with respect and ensured their privacy. Records showed people had access to health care and were provided with food that reflected their preferences.

Although some activities were provided at the service, we noted that these were not available when and as people wanted. We also noted that the shower on the ground floor was not ready and safe to use. We have made a recommendation for the provider to make improvements. Overall we found the service was well managed with an effective staff team.

People's needs were assessed, and care and treatment was planned and delivered in line with their individual care plan to protect people's welfare.

People told us that staff looked after them well, that they were always treated with respect, that the food was good. People told us that they felt the home provided safe care.

People who used the service and staff we talked with told us that there was enough staff to meet people's needs. We observed that the staff on shift during our inspection were meeting people's needs and delivering care and support in a timely manner.

People who used the service were asked for their views about their care and treatment and they were acted on. The provider told us that they gained regular informal feedback from people who used the service.

People we spoke with told us that they liked living at the home and felt safe. Comments included "It's very nice here", "I wouldn't want to leave" and "I have no concerns".

People spoke highly of the staff and described them as "Caring" and "Lovely". People told us that they were happy with the care provided and said they were well looked after. During our inspection we saw that staff spoke to people in a respectful and caring way.

All of the people we spoke with said they liked the food and could choose to have something different if they didn't like what was on the menu. One person said "The food is very good" and "I'm always asked what I like".

We found that the home was warm and people looked comfortable. Staff told us that the equipment used in the home was in "Good working order" and they felt "Confident" using it.

Staff told us they felt "Supported" by their manager but would like staff meetings to be held regularly.