Archived: Orchard House

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.

The provider sent us an action plan to say the home was compliant by 1 march 2014.

We spoke to a senior carer at the home during this visit and reviewed the cleanliness of the premises. We reviewed policies and procedures in place to support the management of infection control and we toured the premises. At this inspection we found that people were protected from the risk of infection because appropriate guidance had been followed and people were cared for in a clean, hygienic environment.

We looked at the care records of five of the fifteen people who lived at the home. We saw that people had discussed their plans of care with staff and these plans had been signed by people. We saw that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care was provided over two floors with single and double occupancy rooms available. People were able to personalise their rooms with their own possessions and could access their rooms whenever they chose.

We saw that clear person-centred care plans were in place to support people and we found that staff had a good awareness of people's needs. People told us that they had their care discussed and agreed with them or their representative; however, we found that this had not been documented.

We found that the provider did not have clear processes in place to ensure that staff could support best interest decisions when a person was unable to identify their choice or provide consent.

We observed that staff treated people in a kind and gentle manner respecting their dignity at all times. People told us that they were very happy in the home and that the staff knew them very well. One person told us, 'The staff are wonderful and I couldn't wish for better care.'

We found that the provider did not have robust infection control procedures in place to ensure that people were protected from the risk of infection.

People who used the service were very positive and agreed that they were treated with respect and been involved in their care planning. Each resident spoken to commented that they were happy to live at Orchard House and that the food was very good. One resident said "it was always fresh" and "fantastic."

People we spoke with told us that they had good relationships with staff and they "felt safe" as staff were always checking on them. People made positive comments about the staff saying that they were always approachable and the provider was "very hands on." People told us that they were involved in regular activities and that relatives were encouraged to be involved as far as possible.

We also spoke to three members of staff who were on duty. They told us about the level of care they provided to identify the residents of Orchard House by reading care plans. They told us about the support they received from management and training to enable them to provide good quality of care.

We found that there were systems in place to monitor the quality of the service.