Archived: Orchard House

Updated 28 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

One inspector completed this unannounced inspection on 17 January 2017. Before our inspection we reviewed the information we held about the home, including previous inspection reports and notifications of incidents the provider had sent to us since the last inspection. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with five people and two relatives to gain their views of the home. We observed care and support being delivered by staff in communal areas of the home. We spoke with one member of care staff, two senior care workers and the registered provider.

We looked at the care plans and associated records for five people. We reviewed the medicine administration records for 15 people and we looked at a range of records relating to the management of the service including; records of complaints, accidents and incidents, quality assurance documents, three staff recruitment file and policies and procedures.

Following our visit we received feedback from two groups of health and social care professionals who regularly visit the service and support people there.

Updated 28 February 2017

This unannounced inspection took place on 16 January 2017.

Orchard House provides accommodation and care for up to 15 people who live with mental health conditions including dementia. The home is a large converted property and accommodation is provided over two floors. Two stair lifts were in place to assist people to move between the floors of the home. There were 15 people living at the home at the time of our inspection.

The home is run by the registered provider as an individual. They are the person registered with the Care Quality Commission to manage the service. A ‘registered person’ has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Whilst staff were aware of the risks associated with people’s care and how to mitigate these, including those associated with some medicines, these were not always clearly documented.

Whilst incidents and accidents which occurred in the home were recorded there was no information on investigations completed following these incidents, any learning which came from these incidents or any patterns identified in these incidents. There was no information to show how this was shared with staff to prevent further recurrence in the home.

People received their medicines from staff that were appropriately trained; however some medicine administration records were not accurate.

People said they felt safe at the home. They were able to talk openly and honestly with staff and were sure any concerns or issues they had would be dealt with effectively. Staff knew people well and felt confident people would speak with them to raise any concerns. The registered provider and staff had a good awareness of how to safeguard people from abuse.

Whilst staff knew people very well and could identify how to meet each person’s needs, care records did not always contain accurate and up to date information on people’s needs.

There were sufficient staff to meet the needs of people. There was a very low turnover of staff and the stable staff group worked well together. With appropriate training and supervision processes in place, people were cared for by people who had the right skills and support to meet their needs.

Staff at the home had been guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked capacity to make some decisions. The Care Quality Commission monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider and staff had an understanding of the MCA and DoLS and when this needed to be implemented.

The atmosphere in the home was warm, calm and very friendly. Staff knew people well and demonstrated a high regard for each person as an individual.

People received nutritious and well-presented meals in line with their needs and preferences.

People had access to external health and social care professionals for support and treatment as was required. The home had good working relationships with other professionals including the local mental health team, community nurses, social workers and GPs. All health and social care professionals spoke very highly of staff in the service and the care they provided.

People had their needs assessed on admission to the home. The information gathered informed care plans which were discussed and agreed with people and their families. However care plans were not always kept up to date and did not always reflect the current needs of people and the care they received.

People had access to activities they requested and enjoyed. They were supported to maintain their independence through activities outside the home such as attending day centres and independent trips to the local shops and church.

The registered manager promoted an open and honest culture within the home where people were encouraged to voice their opinions and have these addressed. People and their relatives spoke highly of the registered provider and their staff.

The registered provider did not have a robust system of quality assurance in place to ensure the safety and welfare of people. There were no up to date audits on infection control, health and safety, medicines management or plans of care.

We found one repeat breach 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 the report.