Orchardown Rest 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 this key question was rated good overall, however, we identified a breach of Regulation 12 Safe Care and Treatment in relation to the management of accidents, incidents and safeguarding concerns. At this assessment the rating has remained good and the breach has been met. This meant people were safe and protected from avoidable harm.

This service scored 69 (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.
The Registered Manager (RM) was open and honest about challenges and improvement they had identified and how these had been implemented. Staff were supported and involved in improvements and opportunities to learn and improve were shared. For example, following an incident the RM had identified that completed documentation had not included all relevant information. The manager had spoken to staff to ensure that improvements were made.
Relatives told us they were kept informed of any accidents or incidents which occurred and felt communication was good. The RM completed analysis of accident and incidents to identify any trends and themes to identify any learning which could be taken forward.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The RM and staff understood the importance of working with other agencies to provide joined up care for people. The service worked with other health care professionals including GP’s, district nurses, Speech and language therapy (SALT) chiropodist and other specialists involved in people’s care. A relative told us, “When [relatives name] went into hospital staff would go and visit on their time off.” People were supported to attend appointments and family were involved to ensure people were able to attend with support if they needed it. For example, the service had a visiting optician, however if people were able to, they were supported to attend the local opticians in the town centre which was only a short walk from the service.
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The service had safeguarding policies in place and staff received safeguarding training. Improvements had been made to safeguarding processes since the previous inspection. We saw that accidents/incidents and wounds had been reported to the Local Authority (LA) and CQC when appropriate. The RM did identify 1 unexplained bruise which had not been clearly documented in the person’s daily records and a body map and incident form had not been completed. This was addressed promptly, and learning was taken forward to ensure staff were reminded of the correct process to ensure this was followed at all times. We were aware a fall had taken place on the first day of the inspection and saw this had been documented and appropriate actions taken. Staff demonstrated an understanding around mental capacity. Staff had previously received training and a refresher was due. The RM confirmed this had been arranged.
 

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. We identified some areas of risk assessment which needed to be reviewed to ensure all areas of environmental safety had been safely managed. However, prompt action by the RM meant risk was mitigated and people were kept safe. Some windows around the service did not have window restrictors which met the latest Health and Safety (HS) requirements. This was addressed promptly during the inspection.

Improvements had been made to care plans and risk assessments since the last inspection. However, further improvements were needed to ensure all identified risks were documented in more detail to ensure staff were aware of actions to take. For example, 1 person went out alone a number of times each day. On occasion they had returned later than expected and had previously had a fall whilst out. Although staff knew this person extremely well and were aware of actions to take should they not return to the home when expected, the risk assessment and care plan needed to include more information to demonstrate the level of oversight and risk management in place. People’s skin integrity was monitored, any issues identified were reported to the GP and/or district nurse. Staff needed to ensure that all healthcare visits were accurately documented and clearly recorded in people’s records as there was an over reliance on information being shared verbally or during handover which was not always recorded in care plans. Staff were able to tell us about any ongoing health issues and who was involved in people’s care which reduced the risk to people. The RM took prompt action when this was identified during the inspection.

People had Personal Emergency Evacuation Plans (PEEPS) in place to support safe evacuation in the event of a fire or emergency. Fire safety training had taken place, and the home had evacuation equipment to assist people if required.

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

The service was well maintained. People’s rooms were nicely decorated and updated when rooms became empty. Service checks were completed in house or by external professionals when appropriate to ensure people were safe. This included gas, electrical, water and equipment checks. We identified an environmental concern; however, this was addressed before the end of the inspection. Staff told us if they became aware of any concerns, these were recorded in a maintenance book and sorted out promptly.

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. At the previous inspection staffing levels were identified as a concern which had led to the RM and deputy covering kitchen duties. The home now also had designated kitchen and domestic staff. Staffing levels had also been reviewed at night to ensure two staff members were available in the event of an emergency. People we spoke with told us that staff were always available to assist them when they needed any help or support. We saw that staff spent time with people in communal areas joining in with people doing activities and stopping to chat with people.

Staff felt happy with the staffing numbers, 1 told us, “We work well as a team, there are enough staff on a shift to look after people it all works well.” Staff received regular training and competencies were being reviewed for people who administered medicines. The RM was looking at effective ways to maintain oversight of staff training. Staff had received mandatory training with further training sourced if needed. For example, if a person was diagnosed with a health need staff received training in this specific area. MCA training was out of date for staff, but this had been booked in the coming weeks. Staff told us, “The training is all good, every month something to do. Any time if you want to do anything extra [RM’s name] is really good at sourcing it.” Staff confirmed they had regular supervision and felt they had ample opportunity to discuss any issues or concern with the management.
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas of the service appeared clean and tidy and there were no noticeable odours around the building. People told us their rooms were kept clean. Personal Protective Equipment (PPE) was available for staff to use when required. We discussed with the RM that all bins used for clinical waste should be foot operated and they told us they would ensure these were updated.

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. However, some improvements were needed to medicine’s documentation.

Medicine Administration Records (MAR) charts were completed when a person had taken a medicine. Any declined or dropped medication was documented. For people who had prescribed ‘as required’ or PRN medicines we found that PRN protocols were not always in place, and some needed to be reviewed. For medicines which were only taken very infrequently, PRN protocols had not been completed. We also found that handwritten MAR charts had not been countersigned by 2 staff to ensure these had been documented correctly. Temperature checks had been completed for the medicine’s fridge and the room. However, we found some gaps which had not been followed up by management.

People told us they felt supported with their medicines. A person told us, “Staff do all my medicines, I don’t have to worry.” A relative told us, “I am very happy that all medications [relative] has to take each day are being administered correctly.” Staff responded promptly to requests for pain relief and ensured people took their medicines safely and demonstrated a good understanding of people’s medicines and how these should be taken. A person required soluble medicines or small tablets. When the pharmacy sent a different brand of tablet which were larger, staff discussed this with the person to ensure they understood why the medicine looked different and contacted the GP to see if the medicine could be replaced with the same brand the person had taken previously.People who wished to take their medicines independently had risk assessments in place for self-administration and had secure locked cupboards in their rooms to safely store their medicines.