Orchard Lodge

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

The service could show how they met the principles of Right support, right care, right culture.

People lead confident, inclusive and empowered lives where they were in control and could focus on areas of importance to them. The ethos, values, attitudes and behaviours of the management and staff provided support in the way each person preferred and enabled them to make meaningful choices.

The needs and quality of life of people formed the basis of the culture at the service. Staff undertook their role in making sure that people were always put first with enthusiasm. They provided care that was genuinely person centred and directed by each person.

The leadership of the service had worked hard to create a learning culture. Staff felt valued and empowered through inclusion in the development of people's care to suggest improvements and question poor practice. There was a transparent and open and honest culture between people, those important to them, staff and leaders. They all felt confident to raise concerns and complaints with a view to improving outcomes for people.

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’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.

• People were protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People were supported to be independent and had control over their own lives. Their human rights were upheld.

• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.

• People’s risks were assessed regularly in a person-centred way, people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

• People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

• People made choices and took part in meaningful activities which were part of their planned care and support. Staff supported them to maintain independence and promote choice.

• People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.

• People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice. Staff regularly evaluated the quality of support given, involving the person, their families and other professionals as appropriate.

• People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

• People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

• Where people were at risk of placement breakdown, or had recently been discharged from hospital, there was clear support plans and reviews to try to prevent hospital admission. Staff worked well with other services and professionals to prevent readmission or admission to hospital.

• People were supported by staff who understood best practice in relation to learning disability and/or autism. Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve the service.

Our last inspection found a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities). This inspection found the provider had systems in place that were robust enough to demonstrate safety was effectively managed.

Why we inspected

This was a planned inspection based on the previous rating. We undertook this inspection to provide assurance that the service is applying the principles of Right support right care right culture.

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Orchard Lodge is a is a six-bedded residential care home that was providing personal care to six people who have a learning disability, physical disability and/or autism at the time of the inspection. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

A registered manager was not in post. However, there was a newly appointed manager in post who was in the process of submitting an application to the Care Quality Commission (CQC).

Health and safety checks and actions were not always completed. We found that there was a delay to the completion of required maintenance and there were outstanding actions from audits where maintenance requests had been submitted to the provider. Environmental risks were mostly assessed and monitored. However, we observed that the reviews for environmental risks lacked sufficient detail. People mostly received their medicines safely in line with their preferences and by staff who knew them well. However, the medicines systems in place were not always as effective as they could have been. We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed.

Accidents and incidents were documented and investigated with action taken to prevent a reoccurrence. There were appropriate policies and systems in place to protect people from abuse. There were sufficient staff to meet people's needs and keep them safe. Staff files contained the information required to aid safe recruitment decisions. Staff had regular support and supervision.

People were supported to have choice and control of their lives. Staff demonstrated an understanding and awareness of mental capacity and best interests’ decisions and supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, records did not always fully reflect this and the manager had plans in place to address this.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There was a strong emphasis on the importance of training and induction. Staff received training that enabled them to meet the needs of people living at the service. The manager was prioritising training compliance for the staff team to bring it in-line with the provider’s policies and procedures. The provider ensured staff had access to best practice guidance to support good outcomes for

people. People were supported with personalised menu planning and personalised bedrooms. The home worked with other organisations to ensure they delivered joined-up care.

People and their relatives were positive about the quality of care and support people received. We saw a warm and caring approach by staff with positive and kind interactions between staff and people. We observed staff responding proactively and sensitively to people and people were offered opportunities to be involved in reviews, but this was not always consistent. There was a strong focus on building and maintaining people's independence. We saw people being supported using their preferred communication methods and staff demonstrated an awareness and understanding of people's needs. We observed that some people were being supported to work towards achieving identified goals.

Care plans were detailed, person centred, and goal orientated with a focus on achieving outcomes. People’s daily records of care were up to date and showed care was being provided in accordance with people’s needs. People had access to a range of activities. People's communication needs were identified, recorded and highlighted in care plans. We saw people had personalised communication support plans. The manager was pro-active in ensuring they were visible within the home and operated an open-door policy.

The provider mostly had robust quality assurance procedures and systems to help drive ongoing improvements within the home. However, we observed a lack of consistency in their completion within the home. Staff were encouraged to regularly feedback about the service delivery and share ideas and suggestions on how the service could be improved. Extensive policies and procedures were in place to aid the smooth running of the service. People, their relatives and staff were positive about the new manager and felt listened to.

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 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to governance; systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at risk of harm. This was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 Lodge provides long term accommodation to six adults who have a learning disability, autism and/or a physical disability. At the time of our visit there were six people living at Orchard Lodge.

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. The registered manager was experienced in the care of people with a learning disability.

At our last inspection, carried out on 13 June 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection the service was rated requires improvement.

The concerns were; the lack of personalised risk assessments and care plans meant that people were at risk and not enough action had been taken to mitigate any risks. There was a lack of response in updating people’s individualised needs and risks in their care plans and records that would help staff to monitor people’s health and wellbeing. Whilst there was a monitoring tool and an audit system in place there were concerns about poor record keeping, and the quality assurance system had not identified these concerns, so were not effective. There was a lack of records for person centred care as the lack of good governance meant that the service was not responsive to changes. The provider did not send us an action plan this was because the manager left after the inspection. However at this inspection we found the provider had taken action and was now compliant with the regulations.

Where people had communication needs, staff were aware of how to communicate with people to ensure they could express themselves and make choices. People mainly used body language, gestures or sounds to communicate, some people could use a few key words to communicate their needs.

There were sufficient staff to keep people safe. There were recruitment practices in place to help ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People's medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records.

Care plans were clearly written showing the support people needed. Risk assessments were in place for a variety of tasks such as personal care, use of equipment, health, and the environment and they were updated as needed. The registered manager ensured that actions had been taken after incidents and accidents occurred to prevent a reoccurrence.

People's human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Staff were heard to ask people’s consent before they provided care.

Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink.

People's weights were monitored on a regular basis to ensure they remained healthy. People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was an induction programme in place which included staff undertaking the Care Certificate. Staff were supported in their work and received regular supervision.

Positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

People's choices and views were respected by staff. Staff and the registered manager knew people's choices and preferences. People's privacy and dignity were respected.

People received a personalised service. Care and support was person-centred and care plans contained sufficient detail for staff to support people effectively. People were supported to develop their independence. People took part in a variety of activities supported by staff.

The provider listened to staff and relative's views. There was a complaints procedure in place. There had been no complaints since the last inspection.

Servicing and maintenance checks were carried out by staff which helped protect people who used the service from injuries caused by equipment. Where there had been accidents these had been recorded and where necessary investigated.

The management promoted an open and person centred culture. Staff told us they felt supported by the manager. Staff were motivated and aware of their responsibilities.

There was a quality assurance system in place which meant that the service was able to review and improve.

Orchard Lodge is a care home that does not provide nursing. It provides support for up to six people, with learning and physical disabilities and behaviour which challenges. At the time of our inspection there were five people living at the home. Orchard Road where the home is situated is a quiet residential road near Havant town centre.

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.

Risk associated with people’s needs had not always been assessed and plans had not always been developed. Some care plans were generic and not personalised.

People told us, and our observations indicated, that they enjoyed living at the home. Staff understood people's needs and preferences well. Whilst staff knew people well, it was not possible to see how staff had involved people and/or their relatives in looking at their support needs and risks associated with those needs. We have made a recommendation about this.

Observations demonstrated people’s consent was sought before staff provided support. Staff and the manager demonstrated a good understanding of the Mental Capacity Act 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made applications for people and there were two authorised DoLS in place.

We found that staff received a good level of training; the provider's own records evidenced this, as did our observations and the staff we spoke with.

Staff demonstrated a good understanding of safeguarding people at risk. They were confident any concerns raised would be acted upon by management and knew what action to take if they were not.

Medicines were mostly managed safely, with some record keeping issues around creams and lotions. We have made a recommendation about this.

Recruitment checks had been carried out and staff received an induction when they first started work which helped them to understand their roles and responsibilities. It was not clear whether the provider ensured there were enough staff to meet people’s needs as staffing was variable.

People and their relatives knew how to make a complaint and these were managed in line with the provider’s policy. Meetings were held weekly to gather people’s views and surveys were sent out yearly to assess and monitor the quality of the service.

There were systems in place to ensure people's safety by monitoring the service provided however they were not fully effective and had not recognised all the issues we found.

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

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service told us.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw systems were in place to help ensure the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.

The registered manager was responsible for arranging staff rotas and took people's care needs into account when making decisions about numbers, qualifications, skills and experience of staff required. This helped ensure that people's needs were met.

Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it. This meant people could access additional support when they required it.

People's health and care needs were assessed with them as much as possible and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that care plans reflected people's current needs and wishes.

People's needs were taken into account with appropriate signage. The layout of the service enabled people to move freely and safely around the home. The premises had been sensitively adapted to meet the needs of people who lived there.

Is the service caring?

People were supported by kind and attentive staff. One person was able to tell us the staff were "Kind" to them. We saw staff were patient and gave encouragement when they supported people. Staff engaged and involved people in decision making processes and went about their duties in a relaxed and unhurried and manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had a wide range of daily activities available to them both inside and outside of the home.

Details of the complaints procedure was clearly displayed in written and pictorial format and easily accessible to everyone. We saw there was a complaints log and entries had been recorded in detail and actioned appropriately. We saw there was a comments and suggestions log freely available for people to use. We saw positive comments about the service had been made. This showed us people were happy with the service they received.

Is the service well led?

People who used the service, their relatives, friends and other professionals involved with the service completed a service satisfaction survey twice a year. Comments and ideas were listened to and acted upon in a timely manner.

The service worked well with other agencies and services to help ensure people received their care in a cohesive manner.

The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes which were in place. This helped to ensure people received a good quality service.

We observed staff supporting people and their privacy and dignity was respected. We saw that staff knocked on people's doors before entering and took time to explain to people what they were doing. We saw that people and staff got on well together and there was a friendly atmosphere in the home throughout our visit.

We spoke with the registered manager, the deputy manager, a senior support worker and two members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.

We found that appropriate checks were carried out before staff began work at Orchard Lodge. The provider, Dolphin Homes Limited operated a robust recruitment process.

We saw that Orchard Lodge had an effective system to regularly assess and monitor the quality of service that people receive.

We did however speak with two relatives of people and they told us that they were very happy with the care and support their relatives received.

Relatives said that they were involved in their relatives care and were kept informed of relevant changes to their care needs.

Relatives told us that they were aware of how to make a complaint and told us that they were confident that any concerns would be quickly resolved.

We also spoke with two members of staff. They said that they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were very supportive and approachable.