Orchid House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Accidents and incidents were recorded and reviewed by the management team, and appropriate action was taken to mitigate risks to people. For example, 1 person who suffered a recent fall received input from external professionals to move rooms. This supported the person to mitigate risks and promote better mobility. On the day of our assessment we discussed with the registered manager, there was a lack of overarching monitoring in place, such as monitoring for themes and trends. However, staff knew people well, the service had a small number of people, meaning staff were aware of all incidents, and appropriate action was taken following incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People had pre- admission assessments in place, prior to people receiving care, this included detailed assessments from the local authority. People had hospital passports in place, which shared key details about people should they require hospital care. The provider was in the process of obtaining digital records, which would improve their ease of sharing records between services in the future.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People were safeguarded from the risk of abuse. The provider had clear systems and information available about how to keep people safe and how staff could whistle-blow on poor practice. Staff were trained in how to safeguard people, and told us they felt comfortable to report concerns to the management team. A staff member said, “Managers are great, good to talk to and easy to approach. Never had to report any concerns but I would and could do this if needed.” People told us they felt safe living at the service. A person said, “I like living here. If I was unhappy, I would talk to my key worker and the manager. I like and trust all the staff. They are kind and talk to me and make me laugh.”

 People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). At the time of our assessment, no one was required to have a DoLS authorisation in place. However, it was recognised there may be a decline in a person's capacity surrounding their finances. This was due to be discussed at an upcoming review with their social worker, and a care plan was in place detailing this.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks posed to people were assessed and mitigated. For example, a person who accessed the community independently had their risks assessed and associated care plans in place. Another person who was at risk of falls received input and equipment from professionals, which had recently increased their ability to mobilise following an injury. Where a person displayed incidents of distress, staff were trained about how to safely manage these, and staff made detailed records of their presentations and what had worked well.

The provider did not always detect and control potential risks in the care environment. Whilst most environmental checks were in place, to manage risks posed to people from the environment, some improvements were required to ensure the environment was kept safe on a day to basis. We found some unlocked hazardous cleaning materials, which may pose a risk to people, this was locked away immediately during our assessment. All appropriate equipment checks were in place such as electrical and fire safety equipment. People had personal evacuation plans in place. Legionella risk management systems were in place and staff undertook daily security checks of the environment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People were supported by enough staff, this included where people received 1:1 support. Staff were trained in a range of subjects to carry out their roles effectively, including training provided to staff relating to supporting people with a learning disability and/or autism. Staff were recruited safely, and all pre-employment checks were made prior to staff commencing work. Staff received an induction, probationary monitoring and regular supervisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff protected people from the risk of infection. Policies and procedures were in place and staff understood their responsibilities to promote safe infection control practices. The service was found to be clean and tidy, and kitchen areas contained appropriate equipment to ensure people were protected from the risk of infection relating to safe food practices.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The service had recently introduced a new system, which helped reduce the risks of medicines errors. Medicines audits had also recently been increased, which supported staff to recognise any concerns, this included a weekly check of medicines in stock. Medicines were stored appropriately, and medicines administration records (MAR’s) were completed by staff. Where people received 'as required' medicines, information was available to staff about when these should be given, these protocols could be further improved, by providing more detailed information and this was discussed with the registered manager on the day of our assessment. The service worked within the principles of Stop Over-Medication of People with a learning disability, autism or both, (STOMP), which aims to reduce the over prescribing of psychotropic mediations. Staff were trained and received competency assessments, staff also had knowledge checks in place, to ensure they remained competent to administer medicines to people.