The Orchards

The Orchards is a care home providing personal and nursing care. It is registered to provide care and accommodation to up to 45 people. The home specialises in the care of older people, people with complex healthcare needs and people living with dementia. At the time of our inspection there were 39 people living at the home and one person receiving respite care.

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

People lived in a home where the provider and registered manager led by example to create a homely, welcoming and fun environment which valued each person as an individual.

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 felt safe at the home and with the staff who supported them. Staff knew how to raise concerns and were confident they would be listened to.

People received their medicines safely from staff who had received specific training and had their competency assessed to make sure their practice remained safe.

An inclusive ethos was promoted which meant people were able to share their views, raise concerns and follow their own routines. This all helped people to remain in control of the support they received and their day to day lives.

Staff had an excellent knowledge of the people they cared for which enabled them to provide person centred care. People and visitors told us they were very happy with the care they received. Individual care was monitored and reviewed to make sure the care people received evolved as their needs and wishes changed.

People could be confident that at the end of their lives they would receive kind and compassionate care. Staff had the skills and experience to make sure people were comfortable and received dignified care at the end of their lives.

People told us they thought staff went the extra mile to support them. This was demonstrated in the support provided which included numerous examples of special events staff arranged for people.

People had access to a wide range of activities and social stimulation in accordance with their wishes and abilities. The home hosted social events which enabled people to continue to be valued members of their families and local community.

People were cared for by staff who felt well supported and proud to work at the home. The staff team were welcoming and friendly which created a happy atmosphere for people to live in.

People lived in a home where quality monitoring, learning and continuous improvement were embedded into the day to day running of the home. People’s views and wellbeing were central to all quality monitoring processes.

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 7 April 2018.)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We received information which raised concerns about how risk was managed at the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has not changed from Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Orchards on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The Orchards is care home with nursing for older people. 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 we looked at both during this inspection.

The Orchards provides accommodation and nursing care for up to 44 older people in a purpose built building across two floors. It has special facilities for people who require end of life care or have problems associated with dementia. At the time of our inspection there were 32 people living at the service.

There was a registered manager in post. 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.

People living at the home at the time of the inspection told us they felt safe. One person said, “I always feel safe staff look after me.” The provider had policies and procedures in place for safeguarding vulnerable adults. Staff understood how to recognise and report signs of abuse or mistreatment.

The provider had a health and safety committee that met three monthly to discuss any issues relating to the home. Each person had risk assessments in place. Staff assessed risks identified and took appropriate action to mitigate them. The provider had robust recruitment policies and procedures in place. There was enough staff to meet the needs of the people living at the home.

The provider had systems in place to manage medicines safely. There were suitable arrangements for storing and recording medicines that required extra security. Staff recorded room and fridge temperatures.

The provider protected people living at the home from infection. The home was visibly clean; communal areas and bedrooms smelt fresh and were in good condition. One person commented, “It’s always nice and clean.”

Staff knew how to report incidents and accidents. Records showed that staff had taken appropriate action where necessary and made changes to reduce the risk of a re-occurrence of an incident.

Staff had the skills, knowledge, and experience to deliver effective care and support. Mandatory training included safeguarding (adult and child protection), and Mental Capacity Act 2005.

The provider supported people to eat and drink enough to maintain a balanced diet. People who lived at the home told us they were very happy with the food provided. One person said; “There’s a good choice of food and you can have what you want” and, “The food is pretty good here.”

Staff discussed people’s care and support with them. People received personalised care. One person said, “They usually say, when would you like to get up.” Another person commented, “They ask me what I want to wear.” Staff worked in partnership with other professionals to ensure they effectively met people’s healthcare needs. One person living at the home told us, “They get the doctor to see you if you need it.”

The provider sought consent to care and treatment in line with legislation and guidance. When people moved to the home, staff assessed their capacity to consent and took appropriate steps if assessed the person as not having capacity to make a specific decision.

The provider ensured that staff treated people with kindness, respect, and compassion. Staff also offered emotional support when needed. People’s family members told us about the kindness and care provided by the staff, one relative said, “(The person) responds well to staff.”

Staff supported people to enjoy an active lifestyle according to their preferences. They had opportunities for meaningful occupation in accordance with their abilities and interests. The provider had a robust complaints procedure in place. People told us they would make a complaint if they were unhappy with any aspect of their care and support. One person told us, “There’s always someone to talk to. I have raised a few things in the past and they’ve always been sorted out.”

The leadership was visible and accessible. The registered manager had a clear understanding of the key values and focus of the service. One person’s family member commended the management for listening to their family member’s needs. Staff felt supported in their role. There were systems in place to communicate with staff. There were monitoring systems in place that reviewed matters such as infection control and care plans. People and their relatives had the opportunity to attend meetings to find out key information about the service and contribute their thoughts.

Further information is in the detailed findings below

There is a registered manager in post. 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 not available for the inspection. The quality and compliance manager acted on their behalf

At our last inspection of the service in October 2013 we did not identify any concerns with the care provided to people.

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people for example they had received training in diabetes care. However some staff said they would like to attend the dementia awareness training. The quality and compliance manager confirmed some staff had attended dementia awareness training and the course would be made available to the rest of the team. Records of staff training were not up to date and did not reflect the training carried out. Staff understood people’s needs and were able to explain to us how they would care for each person on a daily basis. One staff member said, “We have good handovers and the care plans have a lot of information.”

Before the inspection we received concerns that there were no activities taking place in the home. We spoke with one relative who said, “The programme is non-existent. That list is not followed.” The quality and compliance manager confirmed there was a full activities programme in place however due to both activities persons being on sick leave the activities had not been happening. Both staff members returned to work the week of the inspection and plans were in place to restart the programme and to add extra sessions. One person said, “I look forward to bingo on a Tuesday.” We observed the bingo take place with people enjoying the company and chat. One activities person said the home had a regular memory café which they hoped to extend to the community and the home had taken part in the Archie project when children from the local school had visited one day a month to talk with people in the home.

There were quality assurance systems in place to monitor care, staff development, accidents and incidents. However they had failed to identify that records maintained to evidence training and supervision had been carried out were not up to date. This was noted by the quality and compliance manager following their most recent audit visit they were in the process of rectifying this at the time of the inspection.

Before the inspection we received concerns that staffing levels were low in the home which may have impacted on the safety of people. Duty rosters showed people were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during the two days of our inspection. People told us the staff did listen to them and when they could took the time to sit down and chat. We observed very caring compassionate approaches to care. Staff said they had a good team who would help out when necessary.

People living at The Orchards told us they were happy with the care and support provided. They said the manager and staff were open and approachable and cared about their personal preferences. They confirmed staff kept them involved in decision making around their care. One person said, “I am very happy here I am looked after very well.” One relative said, “She is well cared for and comfortable, she’s so much happier.”

People living in the home told us they felt safe, one person said, “I feel as safe as I can be.” A relative said, “I feel happy when I leave knowing that she is safe.” Everybody was relaxed with staff and there was a friendly, cheerful atmosphere in the home.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care or a relevant representative. All care plans included an area where people could indicate they consented to care. Care workers had comprehensive information and guidance in care plans to deliver consistent care the way people preferred.

The organisation had a clear philosophy of care. Their statement of purpose said, They aimed to “promote the relief of people living in the UK who are disadvantaged by virtue of old age or by physical or mental disability.” Staff said they aimed to provide good quality care whilst respecting people’s preferences and maintaining independence as far as possible. One staff member said, “The centre of the care we provide are the service users, we must make sure we provide good quality care without forgetting dignity and respect.”

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff said they knew how to report any concerns. People who lived at the home said they would be comfortable to discuss any worries or concerns with the manager.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist on a regular basis. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

The service had a complaints policy and procedure which was available for people and visitors to view on the noticeboard. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

People’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

We spoke with three people who used the service and three relatives. All spoke very positively about The Orchards. One person said "It's lovely. I'm very comfortable". Another said "Everyone is very accommodating".

We observed that people's privacy and dignity were respected and that they were included in making decisions about their care. They were encouraged to be as independent as possible and their families were encouraged to spend time with them. There was a wide variety of activities to take part in and meals were varied and nutritious.

There was a team of skilled and committed staff who provided a sensitive and caring service. The staff were supported and managed effectively and were encouraged to update their skills and knowledge. They demonstrated a good understanding of the needs and wishes of the residents and created a friendly, safe and welcoming environment.