Orchid Lawns

Updated 10 August 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors.

Service and service type

Orchid Lawns is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a new manager who became registered with the Care Quality Commission during the inspection period. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, Healthwatch England and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with nine relatives about their experience of the care provided. We spoke with 10 members of staff including the registered manager, senior care workers, care workers, housekeeping staff and the chef. We used observation as a way of observing care to help us understand the experiences of people who could not talk with us.

We reviewed a range of records. This included three people’s full care records, multiple medication records and aspects of a further seven people’s risk assessments and specific care plans. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two health and/or social care professionals who regularly visit the service.

Updated 10 August 2021

About the service

Orchid Lawns is a residential care home service with nursing, providing accommodation for older people, who may be living with dementia and/or who require nursing or personal care. At the time of our inspection, Orchid Lawns was supporting 11 people, many with complex needs and advanced dementia. The service is registered to support up to 24 people.

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

Safeguarding incidents were not always acted upon, nor always reported to the Care Quality Commission or the local authority safeguarding team without delay. This meant people were at risk of not receiving all external support to ensure they were safe.

The registered manager had introduced new ways of working and systems that improved the quality of care. Some of these were still being fully implemented but meant people’s experiences of the care had improved..

People were being supported by a staff team who understood their needs and preferences and treated them with kindness and patience.

Staff received training to ensure they had the right knowledge and skills to safely support people and know the right processes to follow in emergencies. However, this was not followed through in practice in all cases.

Staff ensured people had access to all health professionals when required. Follow up actions were not always recorded but were now being monitored.

People were being kept safe from the risks of COVID-19 as staff were following all current government guidance for infection prevention and control. Visitors were supported to follow the correct processes.

There were sufficient staffing levels to meet people’s needs and manage risks which meant people did not have to wait for support.

People were supported to eat and drink and had a choice of food and drink options. People who required additional support to eat and drink or who had specialist diets were given the support they needed, and all guidance was being followed correctly.

People were given choices of how they wished to spend their time on an individual basis although group activities were also an option.

People were supported to maintain relationship with their relatives and friends. Staff supported communication between them.

People were administered their medicines safely.

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.

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 inadequate (published 11 January 2021) and there were multiple 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 were now only in breach of one regulation, no longer in breach of all regulations except one.

Not enough improvement had been made in regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 and the provider was still in breach of this regulation.

This service has been in Special Measures since 11 January 2021. During this inspection the provider demonstrated that enough improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and in part due to concerns received about a failure to report allegations of abuse. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvement, but people were not at risk of harm from this concern.

The provider had reflected on lessons learnt in relation to allegations or poor care and failure to report. They had implemented new systems and staff practices to ensure all concerns could be identified early and acted on.

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.

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 a breach in relation to failing to report incidents without delay. Please see the action we have told the provider to take at the end of this report.

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