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Inspection carried out on 17 January 2020

During a routine inspection

About the service

The Orchard is a residential care home providing accommodation with personal care for up to 14 people, some of whom are living with dementia. The accommodation is split across two floors within a modern, purpose-built building. At the time of our inspection, there were 11 people living at the home.

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

People were supported by staff who received training in how to identify and report potential abuse. Procedures were in place to identify and manage the risks to people. Staffing arrangements at the home meant there were enough staff with the right skills to safely meet people's care needs. People had support to take their medicines safely and as prescribed. Measures were in place to protect people from the risk of infections. The provider sought to learn from any accidents or incidents involving people who lived at the home.

Staff received training and ongoing management support to enable them to work safely and effectively. People were supported to maintain a balanced diet and to enjoy mealtimes at the home. Staff liaised with community healthcare professionals to ensure people’s health needs were monitored and met. 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.

Staff treated people in a respectful and caring manner. People and their relatives’ views about the service were encouraged and taken on board.

People’s care reflected their individual needs and requirements. People’s care plans were individual to them and followed by staff. People had support to participate in a range of social and recreational activities, and to pursue their interests. People and their relatives knew how to raise any concerns or complaints about the care provided, and were confident these would be acted on. People’s wishes and choices regarding their end-of-life care were assessed, so these could be addressed at the appropriate time.

The provider promoted an open and inclusive culture within the service. People and their relatives benefited from good communication with the registered manager and staff. Staff were well-supported by the registered manager and enthusiastic about people’s care. The provider had quality assurance systems and processes in place to enable them to monitor the quality and safety of people’s care. Staff worked collaboratively with the community health and social care professionals involved in people’s care.

Rating at last inspection and update

The last rating for this service was Requires improvement (report published 24 January 2019) and there were two 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 was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 6 December 2018

During a routine inspection

The inspection took place on 6 and 11 December 2018. The first day of our inspection visit was unannounced.

The Orchard 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 home is registered to provide accommodation with personal care for up to 14 people, some of whom are living with dementia. The accommodation is split across two floors within a modern, purpose-built building. At the time of our inspection, there were 9 people living at the home.

There was no registered manager in post at the time of our inspection. We met with the home’s manager who was in the process of applying to the Care Quality Commission to become registered manager. A registered manager is a person who has registered with CQC 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’s medicines were not always safely and appropriately managed. Electronic medicines records were not always accurate and up-to-date and guidance on the intended use of people’s ‘when required’ (PRN) medicines was not clear. In addition, the application of people's topical medication was not clearly recorded. Risk assessment and risk management procedures were not sufficiently robust or comprehensive, resulting in a lack of clear guidance for staff on how to keep people safe. The employment histories of prospective staff were not always explored in line with safe recruitment practice.

Staff training and staff supervision meetings had lapsed. Not all staff had completed the provider’s mandatory training or attended their annual refresher courses. People’s mental capacity assessments and best-interests decisions were not always decision-specific, and an application had not been made to renew one person’s DoLS authorisation as needed. The provider’s quality assurance systems and processes were not sufficiently effective. The manager lacked sufficient knowledge of the legal and regulatory requirements upon the provider.

Staff understood their individual responsibilities to report any form of abuse involving the people who lived at the home. The provider had safeguarding procedures in place designed to ensure any abuse concerns were reported externally and investigated. The staffing levels maintained at the home enabled staff to meet people’s needs safely. The provider had measures in place to protect people, staff and visitors from the risk of infections, including the use of appropriate personal protective equipment by staff.

Prior to people moving into the home, the management team met with them and, where appropriate, their relatives to assess whether their individual care and support needs could be effectively met by the service. People had access to the specialist care equipment they needed. Staff and management sought to avoid any form of discrimination in planning and delivering people’s care. New staff completed the provider's induction training to help them settle into their new roles at the home. People had the support they needed to maintain a balanced diet, and any associated needs and risks were assessed and managed. Staff helped people to seek professional medical advice and treatment if they were unwell. The design and decoration of the home reflected people’s needs.

Staff adopted a kind and caring approach towards their work, and had taken the time to get to know people well. People’s communication needs were assessed, and staff encouraged their involvement in decision-making that affected them. People were treated people with dignity and respect at all times, and staff and management took steps to protect their personal information.

People’s care and support re

Inspection carried out on 8 December 2017

During a routine inspection

This was an unannounced inspection visit carried out on the 8 December 2017, with a further announced visit on 12 December 2017.

The Orchard 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 care home accommodates 14 people in one adapted building. At the time of our inspection there were 9 older people living there.

There was no registered manager in post 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. The current home manager told us they were in the process of applying for registration with CQC.

This service was first registered with CQC in December 2016, and therefore had not been previously inspected.

The provider had systems in place to monitor the quality of care people received. Staff spoken with had a good understanding of people’s care needs. Risk assessments were in place and care plans had mostly been updated to ensure they reflected people’s current care and support needs.

People together with their relatives told us they or their family members were safe living at The Orchard care home. Staff were able to tell us of the risks people faced and the action they took to support them and keep them safe.

People and relatives consistently told us there were sufficient numbers of staff available to meet their needs. The provider followed safe recruitment practices that ensured those staff who were providing care were suitable to be working at the home.

There were suitable arrangements in place for the safe management and administration of medicines.

Staff spoke favourably about the training and support they received.

People had access to healthcare professionals to make sure they received effective treatment to meet their specific needs.

People’s dietary requirements were assessed and appropriate care plans and risk assessment were in place.

Staff treated people with respect and promoted their independence. Staff actively involved people and their relatives in decisions about their care

People felt comfortable raising any concerns or complaints with staff or the management team and believed they would be listened to.

There was an open and inclusive culture within the home. People and staff felt that the manager was approachable and supportive.