Archived: Ormidale House

At the last inspection in June 2017, the service was rated as Requires Improvement with two breach in regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-Led to at least good.

At the last inspection in June 2017, we asked the provider to take action to make improvements for the safety of the premises and their governance systems. We found the action had been completed regarding the safety of the premises, however the providers governance systems were ineffective.

At this inspection we found the service was inadequate overall, and in the key questions safe, effective and well-led. The inspection identified six breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

Ormidale House accommodates 10 people in one adapted building over two floors. There were eight people living at the home on the day of our visit.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found the provider had not always ensured they adopted this approach, as care and support was not always person-centred, planned, proactive and coordinated.

People who lived at Ormidale House have varied and complex needs. The provider was not clear in who they provided support to. The provider was set to support people with a learning disability, however we found older people living with dementia and people with complex mental health needs also lived in the home which was not in-line with the provider’s statement of purpose.

There was a registered manager working at the home at the time of our inspection. 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.

Where risks to people’s health were identified people had not been adequately assessed or reviewed to understand if the support in place was adequate. The guidance given to staff was not based on best practice nor had the registered manager sought help from external healthcare professionals to ensure the right support was being offered. This put people at potential harm of unsafe care and treatment. There were not sufficient staffing levels in place to keep people safe from harm and to support people safely in the community. People’s medication was managed in a safe way; however checks and reviews of people’s medicines were inconsistent.

People had not had proper assessments of their care. People, their relatives and professionals had not been involved in the planning of the care to ensure this was consistently being delivered in the right way. The registered manager had not followed the principles of The Mental Capacity Act 2005 (MCA) and could not demonstrate that care and support was being offered in people’s best interests. The registered manager did not recognise when they were restricting people and had not understood the role and responsibilities in accordance with this. The registered manager had not made any Deprivation of Liberty Safeguards (DoLS) application to the Local Authority to ensure the care was being provided in a legalised way.

Staff received online training. The provider had plans in place to check staff’s competence and understanding, however these had not been implemented at the time of our inspection. Staff had not always received training that was specific to people’s care needs. We found people continued not to be supported to eat a healthy balanced diet. Some people had diagnoses of obesity and the provider could not demonstrate how they had adequately support people, particularly given that we had identified this as an area of concern at our last inspection. We found that people had access to healthcare professionals when they became unwell or had an accident; however we found people were not supported to access healthcare services for on-going physical and mental health conditions.

Staff completed all tasks within the home which took them away from their caring role. People were not always supported to go on outings as there were insufficient staff to always support them. People’s care and support was not always delivered in a respectful way and we identified areas which compromised people’s dignity.

People did not always receive care that was responsive to their individual needs and people continued to not be supported to maintain their interests and hobbies. Information on how to raise complaints was provided to people in an easy read format, and people and relatives knew how to make a complaint if they needed to.

People and staff felt the registered manager was supportive. There continued to be ineffective systems in place to ensure the service was delivering good quality care. The provider did not understand their responsibilities in ensuring they were meeting the legal requirements and did not have a robust systems in place to identify areas for improvement. The providers had not been able to assure themselves their staff team were delivering good quality care to people.

The provider is registered to accommodate and deliver personal care for up to 11 people. Eight people lived at the home at the time of our inspection. People who lived there had a learning disability, or an associated need. Some people had a physical disability.

A manager was registered with us as is required by law and was involved in our inspection. 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.

Risks to the premises had not been identified or managed which potentially placed people at risk of accidents and injury. We found insufficient numbers of staff were provided to meet people’s full needs. Medicine systems required some further improvement to promote safety. Safe recruitment processes were in place. People were safeguarded from the risk of abuse.

Weight monitoring processes were not always in place to determine if people were at risk of malnutrition, obesity or to detect an early onset of ill health. A range of health and social care services were accessed to assess people’s health and welfare needs. People were provided with food and drinks that they liked. Staff had received induction training when they started to work at the home. Staff had one to one supervision with the registered manager and told us that they felt supported. Staff had received the training that they required for their job role. Staff ensured that people were supported in a non- restrictive way. Staff sought people’s consent before they provided care and support.

The individual staff who supported people had a kind and caring approach and treated people with dignity and respect. People were supported to maintain their independence where possible. Visiting times were open and flexible to enable people to have regular contact with their family and friends.

Complaints procedures were available in a user friendly format. People had been given the opportunity to feedback on the service they received. Due to staffing levels activities available for people were limited. Although people and their relatives were involved in the planning and review of their care. Reviews were not undertaken regularly.

Quality monitoring and audits had failed to identify that there were numerous premises issues. These were potentially placing people at risk of injury. People and their relatives told us that the support provided within the service was good. The registered manager and provider were visible within the service and people were aware of who they were.

You can see what action we told the provider to take at the back of this report.

The summary is based on our observations during the inspection, discussions with people who lived at the home, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found;

Is the service safe?

All people we asked told us they felt safe. All people that we asked told us that they had not seen anything of concern. One person told us, 'The staff are lovely here. They do not shout or anything'.

Staff we spoke with had a basic knowledge of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. We were told by the registered manager that there had been no need to date for an application to be made to the local authority regarding a DoLS issue.

We found that some systems were in place to maintain safety and reduce risks. We saw that equipment was available to promote the independence and safety of people who lived there. We also saw certificates to confirm that the firefighting appliances were serviced regularly to ensure that they were safe to use and fit for purpose.

We found that recruitment processes were adequate which prevented unsuitable staff working there and reduced the risk of harm and abuse to the people who lived there.

We determined that management of day to day risks and safety needed greater diligence. This included the specific monitoring of one person's health condition. We found that one person was not being weighed although it was highlighted in their care plan that they should be to prevent health risks. The registered manager and provider told us that they would address those issues immediately.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was safe.

Is the service effective?

All of the people we spoke with confirmed that they were happy to live there. They told us that the service provided met their needs. One person said, 'I am happy here. I like it'.

All staff we spoke with told us that they felt that the people who lived there were well cared for and were safe. One staff member said, 'We provide good care and the people are happy'.

We found that systems were in place to ensure that people could select food and drink which was nutritious and varied. We saw that the meals provided were well presented attractive and in sufficient quantity. One person said, 'The food is very good'.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The care records showed how they wanted to be supported and people told us they could choose how this support was provided.

We found that staff received on-going support from senior staff to ensure they carried out their role effectively.

Arrangements were in place to request heath, social and medical support to help keep people well.

We found that the provider had processes and systems in place to meet the requirements of the law in relation to ensure that the service was effective.

Is the service caring?

All of the people with were complimentary about the staff. They described them as being, 'Wonderful', and 'Kind'. One person who lived there said, 'The staff are friendly and kind'.

We spent some time in communal areas observing interactions between staff and the people who lived there. We saw that staff showed people respect and promoted their dignity. We also saw that staff showed patience when supporting people.

We saw that care was provided with kindness and compassion. People told us that they could make choices about how they wanted to be supported, and that staff listened to what they had to say.

The staff knew the care and support needs of people well enough to ensure individual personal care was provided.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was caring.

Is the service responsive?

We found that meetings were held regularly so that the people who lived there had the opportunity to raise any issues. This showed that the provider was willing to listen to the views of the people who lived there to improve the overall service provision.

We found that the provider had taken note of the findings from our previous inspection and had taken action to address issues to improve, for example, providing higher night staffing levels and the regular servicing of equipment. Those improvements had been sustained.

The people who lived there were supported to take part in a range of recreational activities in the home and the community which were organised in line with their preferences.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was responsive.

Is the service well led?

There was a registered manager at the home who was aware of their legal responsibilities. The provider visited the home regularly to monitor how it was being run.

The staff were confident they could raise any concern about poor practice in the home and these would be addressed to ensure people were protected from harm.

Plans and systems were in place to ensure people knew how to act in the event of any emergency to keep people safe.

The staffing was organised to ensure people's needs were met and support was available for any appointments and activities.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was well led.

No one knew we would be inspecting that day. During our inspection we spoke with two people who lived there, three staff, and the manager. One person said, 'The staff helped me to get up this morning. That was good because I could not stand very well'. Another person said, 'I like it here'.

We found that systems and processes had been implemented to ensure that equipment was in good working order to prevent risk to the people who lived there.

We found that systems were more robust to ensure that the service was being run in the best interests of the people who lived there.

People who lived at the home told us positive things about their experiences. One person said "I have lived her for a long time and I am still happy living here'. Another person said "It is good here ".

Because some of the people living at the home had complex needs not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of these people which included observation. We spent time sitting in communal areas to observe the care that people received. We saw good interactions between the staff and people who live at the home and we saw that people were given choices. We saw that people were at ease with the staff.

We saw that people's needs had been assessed by a range of health professionals including specialist doctors, the dietician, and the optician. This meant that people's health care needs had been monitored and met.

We found that adequate attention had not been given to ensuring that fire prevention and other equipment had been maintained and serviced. This meant that people had been placed at risk from potentially faulty equipment.

Night staffing levels had been improved upon so that people's choices were being better respected and the staff and people living there were safer.

We found that staff had received training and had support from management. This meant that staff had been given the support and knowledge that had helped them to look after the people in their care.

We saw that there were some systems in place to monitor how the home is run to improve the quality of life of the people living there. However, these processes needed to be improved upon to prevent any risks to the people living there.