Archived: Orchard House

Orchard House is a ‘care home’ registered to provide accommodation and personal care. The service is a neurological rehabilitation centre providing specialist community-based transitional rehabilitation for people with brain and spinal injuries, stroke, minimally conscious states, and a range of progressive neurological conditions. The service could support up to 11 people in one adapted building with communal areas. There were 10 people living at Orchard House at the time of the inspection.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met.

The provider did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. The management of medicines was not always safe. Not all staff were up to date with or had completed mandatory training. Staff did not receive regular supervisions, spot checks and team meetings were infrequent.

Staffing levels did not always support people to stay safe and well. Staff members did not always treat people with warmth, dignity and respect when interacting with people. People were not always supported to express their views using their preferred method of communication.

The service did not ensure that clear and consistent records were kept for people who used the service and the service management did not always inform CQC about notifiable incidents.

People, their families and friends did not feel that they were involved in the planning of their care. Care plans did not always contain information specific to people's needs or contain information on how to support people to manage any conditions they had, and in most cases up to date care plans were not in place. Staff were not provided with detailed guidance to follow when supporting people with complex needs.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Activities were limited and not all people using the service had access to available therapies.

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 outstanding (published 14 March 2019).

Why we inspected

We undertook a focused inspection of the key questions of safe and well-led to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safety of the service. These concerns were around up to date and accurate records and risk assessments not in place. There were also concerns about the effectiveness of the management in relation to governance by ensuring the service was safe and of a high quality. A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with other areas of the service, so we widened the scope of the inspection to become a comprehensive inspection which included all key questions.

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 changed from outstanding to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to good governance, person centred care, safe care and treatment, staffing, need for consent, safeguarding, duty of candour and fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service had a registered manager. 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.

At our last inspection we rated the service Good overall. At this inspection we found areas of the service had improved to Outstanding.

The leadership and management of Orchard House had made significant improvements since the last inspection. This was evidenced by high levels of satisfaction from people, relatives, staff and professionals. The registered manager had aspired to achieve a service that delivered exceptional care and support people in the service. The registered manager had continually thought of initiatives to make improvements to enhance people’s lives and those of the staff. The vision and values of the service were reflected in day to day practice and staff demonstrated the values, clearly showing a very person-centred service. The impact of this meant people felt valued and cared for and their feedback reflected this. The registered manager had sought to improve not only their own learning but provided opportunities for staff to develop and learn as well. This was reflected by staff comments about the manager and their effectiveness and how well supported they felt by the manager.

The effectiveness of the service had improved to Outstanding. The service had received re-accreditation with three domains rated excellent from a national organisation that specialised in promoting understanding in all aspects of head injury. Staff were trained to follow best practice and training in this specialist area and specific training was developed to enhance staff’s understanding of people’s conditions. Staff were provided with excellent support from their manager which meant staff could go on and support people well. The importance of food and fluids had been considered to ensure these provided choice and were palatable and enjoyable. Any risks associated with eating had been assessed and were managed in line with taking positive risks.

People’s needs were assessed in all areas of their life and information had been sought to inform people’s ongoing care. Current national guidance and advice was used to improve people’s health and social care. When people moved to the service they were well supported and at the time of discharge, arrangements were well organised to ensure the person had adequate ongoing facilities in place to meet their needs. People’s health was optimised with input from relevant professionals and relevant information recorded to inform other health services to ease communication. Where necessary, technology had been considered and put into place to enhance people’s outcomes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives repeatedly praised the kindness of staff. Everyone we spoke with praised the exceptional care that they received from the service. We were given numerous examples of times when staff had gone above and beyond people’s expectations to provide truly personalised care. Staff promoted positive values when working with people using kindness and respect continually. Equality, diversity and human rights were well embedded in the service and we saw examples of the registered manager ensuring these were meaningful and respected in practice.

Relatives also felt supported by the service and were appreciative of this. People and their relatives recognised and appreciated these efforts which allowed them to receive their support in a way that made them feel individual and cared for.

The service was truly person centred. People and their relatives described how responsive staff had been to their needs. All levels of the service demonstrated a strong commitment to providing a personalised and holistic service. The registered manager and staff showed a commitment to ensure people’s quality of life was optimised and provided emotional support. Staff had gone the extra mile in ensuring the people maintained and experienced interests and activities that were important to them. People were treated as individuals when considering recording any preferences or wishes at end of life. Respect was given when a decision not to discuss this was made.

People were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified. Where risks to people had been identified assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicine as prescribed.

We told the provider to take action and they sent an action plan detailing the actions they would take to improve. During this inspection we found improvements had been made.

Orchard House is registered to provide accommodation and personal care for up to nine adults with acquired brain injury, stroke and other neurological conditions. They provide rehabilitation services within a community setting. At the time of our inspection the service had seven residents.

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 told us they felt safe. Staff had received regular training to make sure they maintained their knowledge in relation to recognising and reporting safety concerns. People received their medicines as prescribed. Staff carried out appropriate checks before administering medicines. Records were accurately maintained and all medicines were stored safely and securely. Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

People were supported by staff that had the knowledge and skills to effectively care for them. Staff had received the training and support they required to ensure people received good care. The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) which governs decision-making on behalf of adults who may not be able to make particular decisions themselves. People’s capacity to make decisions was regularly assessed.

People were provided with food and drink that was freshly prepared and presented nicely. People we spoke with told us they enjoyed the food and had choices about what they ate.

People spoke highly of the care they received. Staff understood the needs of people and provided care with kindness and compassion. Staff spent time with people and treated people with dignity and respect.

People’s care was planned ensuring that people were treated as individuals. People had been involved in developing their care plans and reviewing these. People were encouraged to be involved in activities and to take part in activities that assisted their rehabilitation, such as swimming and physiotherapy.

People in the service knew the registered manager and spoke to them openly and with confidence. The service had systems to assess the quality of the service provided in the home. These systems ensured people were protected against the risks of unsafe or inappropriate care. All staff spoke positively about the support they received from the registered manager. Staff told us they were approachable and supportive. The service worked with other professionals to ensure people in the service received the optimal input in their rehabilitation.