Orchid Homecare Ltd

Orchid Homecare Ltd is a domiciliary care agency. It provides personal care to adults living in their own homes, so they can live as independently as possible.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of this inspection 54 people were using the service, 43 of whom were receiving personal care. People had a variety of care and support needs including dementia, mental health and physical disabilities.

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

Since the last inspection, changes had been made within the management team both at provider and manager level. In addition, a new quality and compliance manager had been recruited.

At our last inspection we found the provider did not have robust systems in place to monitor the quality of service provided to people and to improve the service. This meant we found a number of areas where improvements were needed which had not been identified by the provider’s own quality monitoring systems. These included safeguarding training for all staff, the detail included on food and fluid charts, staff recruitment processes, the punctuality and consistency of staff, medicine record anomalies, inconsistencies in the use of PPE (personal protective equipment) and protecting people’s confidential data.

During this inspection we found improvements had been made in all these areas however, further work was required to address these fully, and to embed the changes that were being made by the new management team.

Despite our findings, the majority of people using the service and relatives were happy with the service they received and provided positive feedback. For example, one relative told us they would recommend the service to other people and described the service as, "A really caring, lovely company. Staff are very conscientious. It is an absolutely first-class company."

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 requires improvement (published 28 September 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Although we found improvements had been made at this inspection, not enough improvement had been made and the provider was still in breach of regulations. We found no evidence that people were at risk of harm. However, the provider needed to make further improvements. Please see the Safe and Well-Led sections of this full report for more detail.

Why we inspected

We undertook this targeted inspection to check whether the provider had met the requirements of the breach identified during our August 2020 inspection in relation to Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

This means the overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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

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.

Orchid Homecare Ltd is a domiciliary care agency. It provides personal care to adults living in their own homes, so they can live as independently as possible.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection 58 people were using the service, 56 of whom were receiving personal care. People had a variety of care and support needs including dementia, mental health and physical disabilities.

People’s experience of using this service:

The management and staff team as a whole had worked extremely hard to ensure people’s care and support needs were fully met during the ongoing Covid-19 pandemic and lockdown period. Unfortunately, changes made at the service to manage over this period had impacted on other areas of the service and we identified a number of improvements that were required.

There was no overall quality monitoring process that looked at all the areas we (CQC) look at when we inspect services. This meant we found areas requiring improvement during the inspection that the provider had not identified for themselves. This included: safeguarding training for all staff, the detail included on food and fluid charts, staff recruitment processes, the punctuality and consistency of staff, medicine record anomalies, inconsistencies in the use of PPE (personal protective equipment) and protecting people’s confidential data.

Despite our findings, the majority of people using the service and relatives were happy with the service they received and provided lots of positive feedback. One relative told us, “It’s outstanding care from the carers. They make [relative] smile, they always talk her through everything.” Another added, “[ would] definitely definitely recommend the service to a friend.”

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. Staff knew how to protect people and keep them safe. They had the right skills and knowledge to meet people’s needs, and people were generally happy with how they maintained good standards - in relation to infection control and hygiene.

There was strong leadership at the service and the provider demonstrated their willingness and commitment to learn lessons and improve the service where required. People and staff confirmed they were given opportunities to make suggestions and provide feedback about the service. They told us they felt listened to and feedback was responded to in a positive way.

Rating at last inspection:

The last rating for this service was Good (published 27 March 2018).

Why we inspected:

The inspection was prompted in part due to concerns received about safeguarding, the assessment process, medicines, consent, dignity and respect, infection control, records, staffing and recruitment. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of Safe and Well-Led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

This is the first time the service has been rated Requires Improvement.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, we have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. They have already taken action to address some of our findings and given assurances that appropriate action will be taken to address the remainder.

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

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Orchid Homecare Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, and younger disabled adults. Not everyone using Orchid Homecare Ltd receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We previously inspected the provider and rated them as requires improvement overall due to a breach of regulation. At the last inspection on 27 January 2017, we asked the provider to take action to make improvements to care plans. We asked the provider to complete an action plan to show what they would do and by when to improve the key question to at least good. At this inspection we found that care files were now clear and comprehensive and contained relevant health and personal information.

The service had a registered manager in place. 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 provider followed the local authority policy and guidance when dealing with safeguarding people from harm and the staff we spoke with demonstrated a good understanding of safeguarding issues.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service.

Staffing levels were sufficient to provide the level of care required.

Risk assessments were in place and were regularly reviewed and updated.

Cleanliness and infection control procedures were in place and followed by staff to minimise the risk of acquired infection.

Staff were trained to administer medicines safely and had undertaken further training to ensure they could deal with a number of health issues. Regular checks were undertaken to help ensure on-going competence in this area.

Staff demonstrated a good understanding of their roles and responsibilities. The service demonstrated a commitment to staff training, which was on-going and regular refreshers were undertaken.

Supervisions were undertaken regularly and considered important in offering an opportunity for discussion between staff and management.

The service was flexible and responsive to people's changing needs, desires and circumstances.

Confidentiality was respected and independence was promoted.

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

Communication with relatives was on-going throughout the duration of their relative's involvement with the service.

Comments and feedback was encouraged formally and informally and there was a complaints policy in place.

Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples.

A number of audits were undertaken to ensure processes were being followed.

Further information is in the detailed findings below.

This was the first comprehensive inspection carried out at Orchid Homecare Limited.

Orchid Homecare Limited is a domiciliary care agency providing a range of personal care and domestic support services for vulnerable people living in their own homes who may be unable to carry out these tasks for themselves. At the time of our inspection the service was providing personal care to 18 people.

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 and associated Regulations about how the service is run.

We found that where people’s needs had changed, the care plans had not always been updated in a timely manner to reflect the changes. This meant that staff did not always have up to date information on how to fully meet people’s needs.

Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. Staffing numbers were appropriate to keep people safe. There were safe recruitment practices in place and these were being followed to ensure staff employed were suitable for their role. Systems were in place to ensure that medicines were managed safely.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs. They were well supported by the registered manager and had regular one to one supervision and annual appraisals. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation. Where the service was responsible people were supported by staff to access food and drink of their choice to promote healthy eating. If required, staff supported people to access healthcare services.

People were treated with kindness and compassion by staff and had established positive and caring relationships with them. People were able to express their views and to be involved in making decisions in relation to their care and support needs. Staff ensured people’s privacy and dignity was promoted.

People’s needs were assessed prior to them receiving a service. This ensured the care provided would be appropriate and able to meet their needs. The service had a complaints procedure to enable people to raise a complaint if the need arose.

Staff were positive about the management and leadership at the service. A variety of audits were carried out, which were used to drive continuous improvement.