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Archived: The Orchards Care Home

Overall: Inadequate read more about inspection ratings

1 Wilmer Drive, Heaton, Bradford, West Yorkshire, BD9 4AR (01274) 547086

Provided and run by:
Baybury Limited

All Inspections

27 April 2016

During a routine inspection

This inspection took place over two days on 27 April and 3 May 2016 and was unannounced. The inspection was carried out to see if any improvements had been made since September 2015 when the home had been placed in 'Special Measures' by the Care Quality Commission. This was due to the service being in breach of a number of regulations for which the Commission took enforcement action.

The Orchards Care Home provides residential care (not nursing) for up to 22 older people. At the time of our inspection there were 14 people living at the home. The person registered as manager for the service was also the provider. They had little presence in the home and therefore management duties are undertaken by an acting manager who intended to apply to the Commission to be the registered manager. 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.

People told us they felt safe and staff knew what to do if they thought someone was at risk. However we found issues which could mean people were not safe. Medicines were not managed safely and people had not always been receiving their medicines as prescribed. Staff recruitment procedures had not been followed which meant some staff working at the home had not been subject to checks on their background; this included criminal record checks. There were not enough staff available at all times to make sure people were safe and not all staff were up to date with necessary training. Checks on the safety of the environment were not up to date and we found environmental issues which could put people at risk of harm.

People told us they were well cared for. Staff appeared to know people well and we saw some caring interactions between staff and people living at the home. People told us the food was good and our observations confirmed this. People received the nutrition they needed to maintain their health.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was working in line with these requirements.

We found staff were not always respectful of people's confidentiality, privacy and dignity needs. Not all communal toilets and bathrooms had locking mechanisms and much of the furniture available to people was stained and dirty. Private records were not stored securely.

We found improvements had been made to care plans since our last inspection although care records did not always reflect a person centred approach.

People had access to healthcare services such as GP, district nurse and dieticians. We saw these services were accessed in a timely manner.

People were able to engage in activities although time for this was restricted by staff having to attend to other duties.

There was a system in place for people to make complaints and we saw complaints were managed and responded to.

We found the systems for auditing the quality and safety within the home were ineffective which meant issues which could affect people’s safety and wellbeing had not been identified or addressed.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

24 September 2015

During a routine inspection

The Orchards Care Home is a large three storey converted house with a garden situated about three miles from Bradford city centre. The home provides care without nursing to a maximum of 22 people.

This was an unannounced inspection which took place on 24 September 2015. On the date of the inspection there were 17 people living in the home.

A registered manager was in place. 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. However the registered manager was not in day to day charge of the service. The home lacked adequate management and leadership with a lack of supernumerary time allocated to the running of the service. We found this had a significant impact on the quality of the service.

In October 2014 we found a number of breaches of regulation, when we returned in April 2015 we found improvements had been made. However since the last inspection in April 2015 care quality had slipped again. This should have been prevented through strong leadership and management of the service. There were inadequate checking and auditing systems in place to ensure robust documentation was maintained, medication safely administered and to ensure staffing levels were safe. On the day of the inspection the registered manager confirmed they had appointed a new home manager who would work supernumerary which would allow them to address the issues identified during the inspection.

People told us they felt safe and secure in the home and did not raise any concerns over their safety. Staff had a basic understanding of safeguarding but were unable to tell us how to raise an alert with the safeguarding authority.

Incidents and accidents had not always been investigated to keep people safe. This increased the chance that incidents would reoccur.

Medicines were not managed safely. People did not receive their medicines as prescribed and staff did not demonstrate an adequate knowledge of the medicines they were administrating. Record keeping of medicine stock levels were poor, meaning there was a lack of accountability for medicines stored in the home.

Safe recruitment processes were not in place as key information relating to staff character and qualifications was missing.

We found people experienced delays in care and support as staffing levels were not adequate both during the day and at night. The registered manager told us they recognised staffing levels were not sufficient and would ensure increases were made promptly once new staff started.

People reported the food in the home was good and said there was sufficient choice. However we found nutritional risks were not always well managed. A lack of action had been taken to mitigate the risks of malnutrition to one person who used the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had made a number of DoLS applications where it suspected it was depriving people of their liberty and was awaiting feedback from the supervisory body.

We observed care and found people were treated with dignity and respect by staff. People and their relatives told us that staff were always kind and treated them well.

A system was in place to ensure people knew how to complain and ensure any complaints were responded to. However documentation demonstrating follow up and learning from complaints was not always present.

There was a lack of activities provided in the home. Despite an activities schedule being in place we saw it was not followed and we observed staff did not have time to engage in activities with people who used the service.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe."

30 April 2015

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of this service on October 8 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this unannounced focused inspection on 30 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Orchards Care Home on our website at www.cqc.org.uk

A registered manager was in place. ‘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.’ However as both the home manager and registered manager had other responsibilities outside of the service, we were concerned about the lack of consistent management support to the home.

Improvements had been made to the medicine management system, for example medicines were now stored appropriately and risk assessment documentation put in place. However, there were still some inconsistencies in the way medication support was documented. For example the reasons people did not take their medicines was not always robustly documented.

Risks to people’s health, safety and welfare were appropriately managed with risk assessments now relevant to people’s needs and were kept up-to-date. Incidents were recorded and investigated to help keep people safe.

Improvements had been made to key safety aspects of the service. Disabled access had been installed and fire and trip hazards reduced. A range of safety checks were undertaken to ensure the premise was safe. The décor was tired in some areas of the home. For example some areas had damaged and scuffed door frames, and some wallpaper was peeling from the walls.

We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and care plan documentation showed care was planned to take into account people’s choices and preferences. Staff had a mixed understanding of The Mental Capacity Act (MCA) and DoLS and we found some staff were overdue training updates in this area.

A new approach to care planning had been introduced by the home manager and we found this was a significant improvement. Documentation demonstrated people’s needs had been assessed with appropriate plans of care put in place to help provide effective and responsive care. Some care plans could have contained more specific information to each individual.

Documentation detailing the care people received had been much improved and provided evidence people’s needs were being met. We observed care and saw people were treated appropriately and care was delivered in line with existing plans of care.

Significant improvements had been made to the service demonstrating that management had been effective in driving changes. A range of audits were undertaken and we saw evidence these were regularly identifying issues. We saw the service used these to drive further improvement. For example, new care plan documentation had been put in place following the results of one audit.

8 October 2014

During a routine inspection

The Orchards Care Home provides accommodation and personal care for up to 24 older people at any one time. The home is spread over three floors and set in its own grounds.  On the date of the inspection, 8 October 2014, 16 people were living in the service. 

At the last inspection in December 2013 the home met all the regulations we looked at.

A registered manager was in place.  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 and associated Regulations about how the service is run. There was also a newly appointed home manager in place.  We learnt through discussions with the two managers that the new home manager (referred to as the home manager in this report) who was responsible for day to day running of the home, was going to apply to take over the role of registered manager.

We found medicines were not appropriately managed. People did not always receive their medicines at the times they needed them or in a safe way. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The premises were not managed safely. There was no disabled access in or out of the building, which put people who used wheelchairs at risk. We found some light bulbs were not working and the fire escape was partially blocked with storage. This meant people were being put at risk should they need to leave the building in an emergency. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People told us they received good quality care from staff who knew how to care for them.  We found staff were knowledgeable about the people living in the home. People spoke positively about the food on offer and we found there was a good choice of meals available.  

People’s needs were not always fully assessed. Care plan documentation showed people’s needs were assessed prior to admission and a number of care plans were put in place to guide staff. However, work was required to make sure care plans consistently reflected people’s current needs. Appropriate care was not consistently delivered such as checking people’s weights in line with the requirements of their care plans. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People and their relatives said the home provided good quality care and staff were kind and considerate. People described the atmosphere in the home as pleasant and, “Like a family” and said staff and management listened to and respected them. We found staff were caring and treated people with dignity and respect, provided companionship as well as assisting with care tasks.

People’s capacity was not assessed under the Mental Capacity Act 2005. (MCA) We found care records did not consider people’s capacity to make decisions for themselves which meant there was a risk their rights were not protected.  The home had not met the requirements of the Mental Capacity Act Deprivation of Liberty Safeguards (DoLS). Restrictions on people’s liberties had not been considered despite the home restricting people’s access out of the building. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Effective systems were in place to manage complaints. People reported that the home manager listened to any concerns they had and were confident they would take appropriate action.

The home manager had a clear plan in place to make improvements to the home and had identified some of the issues we found during the inspection.  Staff told us the service had improved since the home manager had started with a number of positive initiatives having been put in place.  We saw several improvements had been made which demonstrated to us the home manager was committed to developing the service. Further work was required to quality assurance systems and systems designed to seek feedback from people who used this service; to ensure the quality of care was consistently monitored to drive further improvement. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Improvements were required to some of the documentation used by the home namely the completion of records detailing people’s daily lives and the completion of handover records.  This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

9 December 2013

During an inspection looking at part of the service

We spoke with five people who used the service. They all told us they were happy in the home and did not raise any concerns with us. For example, one person told us they liked the food and the choice of activities available. One person told us they were cold, but a member of staff quickly responded and ensured they were provided with a blanket.

Care plan documentation showed people's needs had been assessed and care plans had been written to enable staff to deliver appropriate care.

We saw some good interactions between staff and people who used the service. We saw staff encouraged people to be involved in activities such as singing and puzzle games.

We found the provider had systems in place to ensure deaths were notified to the Care Quality Commission (CQC) without delay.

23 July 2013

During an inspection looking at part of the service

We spoke with one person who used the service who told us they were 'happy' at the home.

We spoke with three staff members. Two of them told us they thought people who used the service received good quality care from the provider. However a third staffmember told us they thought the standard of care was "not great" as there was not enough for people to do and there was no specialised care for people with Dementia.

Since the last inspection, we found the ratio of staff to people who used the service had risen. We judged there were now enough staff to meet people's needs.

However, we found the provider had failed to carry out assessments of people's needs around falls prevention, behavioural management and diabetes. This put people at risk of receiving care and treatment that was inappropriate to their needs.

We also found there had been five incidents which had affected the health, safety and welfare of people who lived at The Orchards Care Home which had not been reported to the Care Quality Commission (CQC).

3 April 2013

During a routine inspection

During the inspection we had the opportunity to speak with three people who used the service. They told us they were happy with the home. One person told us 'They ask me what I want to eat here.' Another person told us 'They are nice here.'

We saw evidence people's wishes and choices had been included in the planning of their care and staff understood the process to obtain consent from those without capacity.

We found staff displayed a caring attitude towards people in the home. However we found people were not always protected against the risks of receiving care or treatment which was inappropriate as some key care records were missing and information was not always recorded.

We found the home was well decorated and maintained with a homely feel. One person told us 'I like my room.'

We found the provider had a robust recruitment procedure in place which ensured staff were suitably qualified and had undertaken the required checks.

However we found there was not always a suitable number of staff to ensure the health, safety and welfare of people who used the service.

19 April 2012

During an inspection in response to concerns

People using the service had complex needs that meant they were not able to tell us their experiences. We were able to speak with three people and they told us that they were happy with the care they received. One person told us "They look after me, they are good."

We observed care delivered for appropriately three hours and saw that the staff were friendly and kind and constantly offered help and support to people. We observed the positive way they explained their actions when they offered support or help with personal care and asked people for their preference and consent. We observed that people were being appropriately supported with their medications by staff and the staff were attentive and appropriately monitoring the communal areas.

Relatives told us that "The staff are great with mum, I have no qualms" and "the home is always clean and mum is always clean and cared for" and "They visit in the morning as their mum liked to go to bed early and the staff support this."