Orchard House Residential Care Home

Orchard House Residential Care Home is a residential care home without nursing, providing personal care for up to 33 older people including those living with dementia. At the time of the inspection 20 people were being supported. Orchard House has accommodation across two floors, in one adapted building.

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

Improvements had been made to the management of people's medicines so that they received their medication safely. Staff had received further training and had their competencies checked to ensure safe practice.

There was a new manager in post who was being supported by an outside consultant to drive improvements at the service. The provider's quality assurance systems and processes had been overhauled and improved to ensure they were more effective. This meant the registered manager and the provider had better oversight of the service. Many of these systems were newly implemented and needed time to become embedded into staff practice so they could be assessed for their effectiveness.

People received safe care and support and they told us they felt safe living at Orchard House. Staff understood safeguarding procedures and were confident in reporting any concerns. Risks to people's safety were assessed and well managed, and people’s care plans detailed current risks and individual needs.

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.

There were sufficient numbers of staff who were safely recruited to meet people's needs. Infection control measures were robustly followed, and staff had access to sufficient PPE.

People, relatives and staff were very positive about the new manager and the improvements that had been made at the service so far. Staff felt well supported and said the registered manager was open and approachable. The service worked in partnership with outside agencies.

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 Requires Improvement (published 15 November 2022) and there were 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.

Why we inspected

We undertook this focused inspection to check that the provider 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 of 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 changed to Good.

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 House is a residential care home without nursing, providing personal care for up to 33 older people including those living with dementia. At the time of the inspection 22 people were being supported.

Orchard House has accommodation across two floors, in one adapted building.

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

Systems in place to ensure the proper and safe management of medicines were not robust and did not ensure people received their medicines as prescribed.

Provider level quality assurance audits of the service to ensure oversight and safe care had not been effective in identifying areas for improvement and ensuring required improvements.

People felt safe living at Orchard House. Staff were trained in safeguarding and understood their responsibilities to protect people from harm.

Staff followed all necessary infection prevention measures. Staff wore appropriate personal protective equipment (PPE) and received training in infection prevention and control.

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.

Staff continued to work in partnership with health professionals involved in monitoring and providing care and treatment for people using the service.

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 Requires Improvement (published 11 March 2022)

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained Requires Improvement.

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

You can see what action we have asked the provider to take at the end of this full report.

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

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 medicines and the management and the governance systems at this inspection.

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 this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Orchard House is a residential care home providing care for older people with a diagnosis of dementia, mental health or physical disabilities. At the time of our inspection 26 were being supported at the service.

This home accommodates 33 people in 28 single and three shared rooms. It was purpose built and has a garden.

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

People had risk management plans in place, but these had not always been completed correctly and contained conflicting information.

We have made a recommendation about staff training in relation to risk management and how to complete risk assessments correctly.

Improvements had been made to the medication practices and procedures and to the systems in place to monitor the quality of the service.

There was an extensive use of agency workers to cover gaps in staffing numbers. The registered manager had an ongoing recruitment process in place and had recently recruited new staff members who were currently undergoing employment checks.

The systems in place to ensure lessons were learned when things went wrong had been improved. The registered manager had implemented a system to monitor incidents and accidents monthly so action could be taken to promote people’s safety.

Improvements had been made to the systems in place to keep people safe from avoidable harm. People we spoke with felt safe living at Orchard House.

Systems were in place to control and prevent the spread of infection. The service was clean and hygienic, and staff followed infection control and COVID-19 guidance and wore appropriate Personal Protective Equipment (PPE).

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 told us that staff were "very kind, caring and patient.” People and relatives knew how to complain and felt they would be listened to. The registered manager and staff worked with external professionals and referred people to healthcare professionals as required.

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 Requires Improvement (report published 30 June 2021) and there were two 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.

Why we inspected

We carried out an unannounced focused inspection of this service on 20 May 2021. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment and 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 remained Requires Improvement. This is based on the findings at this inspection.

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.

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

Follow up

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

Orchard House is a residential care home providing care for up to older 33 people with a diagnosis of dementia, mental health or physical disabilities. At the time of inspection 21 were being supported at the service.

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

Risks to people were not always mitigated. Some care plans and risk assessments held conflicting information within them. Some care plans did not contain enough information to ensure staff could support them safely.

Records of care tasks had not been completed, so we could not be assured that these needs had been met. For example, repositioning a person who was at risk of skin pressure damage or additional snacks or food being offered to a person at risk of malnutrition.

Medicines were not always managed safely or in line with best practice. We found missing information in people's medicine administration records (MAR).

Systems to ensure oversight and governance of the service required improvement. Audits had been completed but had not identified the concerns found on inspection. The registered manager implemented changes after the inspection to rectify some concerns.

Staff were recruited safely, and people told us that staff knew them well. We received mixed views on the staffing levels at the home.

The home appeared clean and tidy during the inspection. The outside space available to people had been designed to include a working tuck shop, bar and hairdressers. There was also a bus shelter, shop fronts and sensory lights.

People told us that staff were “nice and kind.” People and relatives knew how to complain and felt they would be listened to. The registered manager understood the duty of candour.

The registered manager and staff worked with external professionals and referred people to healthcare professionals as required.

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 16 December 2020)

Why we inspected

We received concerns in relation to staff training, staffing levels and use of personal protective equipment (PPE). As a result, we undertook a focused inspection to review the key questions of safe 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 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.

The overall rating for the service has changed from good 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 House 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 will continue to monitor the service.

We have identified breaches in relation to risk assessments, medicine management and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Orchard House Residential Care Home is a residential care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

People were supported by a staff group who had been trained in safeguarding and understood how to safeguard vulnerable adults from avoidable harm and neglect.

People’s individual risks were managed in a safe way and environmental risk assessments were completed appropriately.

The provider had enough staff with the right skills deployed to provide people with their commissioned care.

Medicines were safely managed. Medicines administration record (MAR) charts were accurately completed and medicines were safely administered. When people received their medicines ‘as and when required’ (PRN) the correct protocols were in place.

Comprehensive cleaning schedules were in place which supported staff to prevent and control infection.

The provider demonstrated that they learnt lessons when things went wrong and that they encouraged continuous improvements.

Quality control systems were effective in identifying issues within the service. When issues were identified during audits, the provider developed effective action plans to improve care and drive continuous learning.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

The provider and management team had good links with the local communities within which people lived.

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 29 November 2018).

Why we inspected

We received concerns in relation to negative interactions between people who use the service, manual handling practices and delays in seeking relevant medical intervention. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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.

The overall rating for the service has remained as good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard House Residential Care Home 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 House is registered to provide accommodation and personal care for up to 33 people. At the time of our inspection there were 24 people living in the home.

When we inspected on 28 September 2017 the service was rated as ‘Requires Improvement’. We found that some improvements were required under the headings of safety, effectiveness, caring, and well-led.

This inspection was unannounced on the 15 October 2018 with a second announced visit on 17 October to conclude the inspection. We found the service to be ‘Good’ The provider had taken timely and appropriate action to put things right and all the required improvements had been made and were sustained.

There was a registered manager but they had applied to voluntarily cancel their registration and were no longer working at the home. A new manager had been appointed and was in post. They were applying to register with the Care Quality Commission (CQC) when we inspected. A registered manager is a person who has registered with the 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.

The service met all relevant fundamental standards related to staff recruitment, training and the care people received. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation and adhered to good practice.

People’s care was regularly reviewed with them and staff were appropriately deployed throughout the home so that people received the timely support they needed. They were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. Staff were friendly, kind and compassionate. They had insight into people’s capabilities and aspirations as well as their dependencies and need for support. They respected people's diverse individual preferences for the way they liked to receive their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People that needed support to manage their medicines received this. People were supported to eat and drink whenever this was part of their agreed plan of care. They were provided with a nutritious diet that took into account their tastes and preferences. Their dietary needs were assessed and monitored and appropriate external healthcare professionals, such as the dietician, were consulted when needed. Where people needed physical assistance to eat and drink this was provided.

Whenever people reached the end of their life and could remain in the home with the support of healthcare professionals they received the care they needed to be kept comfortable and free from pain.

The provider and new manager led staff by example and enabled the staff team to deliver individualised care that achieved good outcomes for all people using the service.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and any improvements that were needed were acted upon.

There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong so that the quality of care across the service was improved.

People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assurance systems in place that were used to review all aspects of the service and drive improvements whenever needed.

People knew how to complain and were confident that if they had concerns these issues would be dealt with in a timely way.

There was a registered manager in post who was also the provider of the service. 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.

We inspected Orchard House in June 2015 and rated the service as ‘Good’, during this inspection we found that the service was rated as ‘Requires Improvement’.

Risks to people were not always managed appropriately by staff. People had plans of care outlining their known risks however; staff did not always take appropriate action in order to reduce the known risks to people.

Staff did not always apply the learning from their training effectively when providing people’s care. We observed that not all staff were confident or competent when supporting people with moving and handling.

People’s dignity and privacy was not always maintained by staff. We observed staff entering people’s bedrooms without knocking.

The provider needed to review people’s mealtime experience. We observed that people’s meal time experience was chaotic and took too long resulting in people becoming bored and not eating their main meal.

Staff did not receive supervision and appraisal to assess their competency in carrying out their duties.

The provider had not implemented or utilised a systematic approach to quality assurance. This had resulted in ongoing shortfalls in people’s care and support and a risk that further shortfalls would not be identified or acted upon.

People were supported by sufficient numbers of staff to provide their care and support. People could be assured that they would be supported to receive their prescribed medicines safely.

People were supported by a staff team that knew them well.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately. Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs.

People had detailed plans of care in place to guide staff in providing consistently personalised care and support according to people’s preferences. People’s feedback about the care they received was actively sought and acted upon.

The provider was visible throughout the home and was committed to improving the quality of care and support that people received.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

We saw that there was a policy for safeguarding adults. We looked at training records which showed that staff received safeguarding training as part of a planned training programme. We spoke with three members of staff about safeguarding. They were able to tell us about the safeguarding policy and explain how to protect people from the risk of abuse.

We saw that there were systems in place to monitor care records; medication; risk assessments and accidents and incidents. We saw that the manager had a programme of audits that she completed and that where issues were identified actions were taken to address these.

Although care plans contained most of the information that staff needed to provide appropriate care for people we found that some information was not included. We looked at assessments for seven people including nutrition assessments, pressure care assessments, mental health assessments and falls assessment. We saw that they were not being reviewed regularly.

We spoke with three staff. All had a good knowledge of people's care needs. We saw that staff treated people with respect and kindness. We spoke with three people who told us they were happy living at Orchard House.

Orchard House was registered for treatment of disease, disorder or injury as well as accommodation for persons who require personal care. As Orchard House is a care home without nursing this regulated activity was not being provided. We notified the nominated individual of this and asked that they review their registration to reflect the regulated activities being provided. This inspection did not include treatment of disease, disorder or injury.