The Orchards Residential Home

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• 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 changed to good.

This meant people were safe and protected from avoidable harm.

At the previous assessment, the service was in breach of legal regulation in relation to the ways people’s medicines were managed safely at the service. At this assessment, the provider was no longer in breach.

This service scored 75 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

At our last assessment falls recording lacked detail. During this assessment we found leaders had analysed falls and produced audits showing times that people are most likely to experience a fall and what measures could be put in place to mitigate these.

Staff analysed audits and changed their ways of working with people. For example, the provider focused on early intervention when people showed signs of distress. This helped to reduce incidents across the service. This meant staff were able to learn to and improve care for people.

Incidents and accidents were recorded and reviewed by the management team to ensure actions were implemented. We looked at several incidents and found the provider had supported people involved and a lessons learnt exercise had been completed. For example, additional training was provided by the service to help staff support a person to speak to their relative. This prevented the person becoming anxious. This ensured continuous improvement and development.

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.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

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

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 made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At our last assessment, we found medicines were not managed safely and there was confusion over medicines being administered covertly. Leaders had undertaken an investigation and sought confirmation from GPs. During this inspection, leaders evidenced the origin of these shortfalls and produced learning from this. The new manager and deputy manager had also ensured all staff were re-trained and observed with medicines competencies. Liquid medicines had opened dates on them, controlled drugs were stored securely and there was minimal overstock in medication cupboards. Leaders told us they had developed medicine management in a more person centred way, this included people’s allergies being documented. We saw detailed risk assessments and medicines that were taken when required guidance for all people.

People told us staff provided good support for them to take their medicines. Comments included: “Staff know when I take my medicines and what I take, I trust them” and “I always receive my medicine on time”. Staff had completed training in the safe management of medicines and leaders regularly observed their practice. Managers told us medicines audits and competency spot checks were completed to support people to take their medicines safely. We observed medication administered in a kind and person centred way. For example 1 person was asked how they would like to take their medicine. Visiting professionals told us “I have not had any concerns around medicines for people for a number of months now”.

People were supported to have regular reviews of their medicines with their GP. Changes in medicines were listed on the provider’s medication audits.

Leaders undertook monthly medication reviews of all people. These reviews contained analysis of patterns and trends from the previous month. These trends were then discussed with staff and measures to support people with medication were explored. For example, several people sometimes refused their medication. Staff discussed this concern and developed a way of supporting the person differently by explaining why medicines had been prescribed and what the impact of not taking them could be. People told us this made them feel comfortable around staff and that they felt staff “Worked with them in their best interests”.

Medicines errors were appropriately recorded and escalated in line with the provider’s policies and procedures. Each person had a comprehensive medicines risk assessment, along with body maps for emollient application and clear guidelines to support safe administration. Medicine Administration Records (MAR) showed all prescribed medicines, including topical creams, were administered as required. This ensured people received the correct medicines at the right time, promoting safe care delivery.