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Archived: The Orangery Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 25 November 2017

This inspection took place on 30 August 2017 and was announced.

The Orangery Extra Care Scheme is a domiciliary care service and is registered to provide personal care. Care is provided to people living in their own home in The Orangery and Marlborough House, two Extra Care Schemes each managed by a housing association. Both provide accommodation for people over 60 years of age and care and support can be provided to people with a physical disability or learning disability, people with a sensory loss, for example hearing or sight loss and people with mental health problems or living with dementia. Twenty four hour care, seven days a week is provided with on-site care staff and with an emergency call facility. Additional services provided include organised social activities, a café, and a hairdressing salon. At The Orangery there is also a restaurant (for main meals). Around 90 people across both sites were receiving a service, of those 56 received support with the regulated activity of personal care.

This is the first inspection since the service was registered with the Care Quality Commission (CQC). On the day of our inspection, there was not 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 had left and there had been a period of interim management arrangements. A new manager had just been recruited. The CQC had not received an application for the new manager to register for the service.

People and staff told us it had been a difficult period with a number of staff changes including senior staff and difficulties in recruiting care staff. One person told us, “There’s quite a turnover of girls I’m afraid.” Another person told us, “It is a very tight ship; they are always short of carers.” There were vacancies of care staff and in the senior management team, which we were told were being recruited to. People were cared for by staff who had not always been recruited through a safe recruitment procedure. We found regular auditing by senior staff in the service to ensure the quality of the service had not been completed or regularly maintained and embedded in the running of the service. People had been able to feedback on the care and support they had received. However, it was not evident how this had been used to inform and improve the service provided. Where the provider and local authority had audited the service, action plans to address the issues had not been drawn up, and it was not clear any actions which had not been taken or planned to address issues highlighted through the audits to be addressed. There was no evidence of how the provider monitored or analysed the information received to look for any emerging trends or make improvements to the service provided. These are areas in need of improvement.

Care staff received a five day induction and essential training to ensure they have the knowledge and skills to meet people’s care needs. Care staff told us they felt well supported. However, care staff had not always received regular supervision and appraisal in one to one meetings in order for them to discuss their role, training needs and share any information or concerns. One member of staff told us, “I haven’t had supervision since I started, or an appraisal.” Spot checks, which included arriving at times when the senior staff were there to observe the standard of care and to obtain feedback from the person using the service, had not always been completed. Staff meetings had not been maintained. These are areas in need of improvement.

Consent was sought from people with regard to the care that was delivered. All staff understood about people’s capacity to consent to care and had a

Inspection areas

Safe

Requires improvement

Updated 25 November 2017

The service was not consistently safe.

People were not cared for by staff who had always been recruited through safe procedures. There had been difficulties in recruiting care staff and a number of staff changes including senior staff, which had affected the consistency of care staff providing the service.

People had individual assessments of potential risks to their health and welfare. However, the system to ensure these were regularly reviewed and paperwork fully completed had not been maintained.

Procedures were in place for the administration of medicines. However, records of when medicines had been administered had not always been completed as needed.

Effective

Requires improvement

Updated 25 November 2017

The service was not consistently effective.

Care staff had an understanding around obtaining consent from people, and had attended training on the Mental Capacity Act 2005 (MCA). However, supporting documentation had not been completed.

There was a comprehensive training plan in place. Care staff had the skills and knowledge to meet people�s needs. Care staff had a good understanding of peoples care and support needs. However, systems to ensure care staff received supervision and appraisal had not been maintained.

Where required, care staff supported people to eat and drink and maintain a healthy diet.

Caring

Good

Updated 25 November 2017

The service was caring.

Care staff involved and treated people with compassion, kindness, and respect. People told us care staff provided care that ensured their privacy and dignity was respected.

People were pleased with the care and support they received. They felt their individual needs were met and understood by care staff.

Responsive

Requires improvement

Updated 25 November 2017

The service was not consistently responsive.

People had been assessed and their care and support needs identified. Care and support plans were in place. However, there was a lack of consistency in the recording and systems to ensure these were regularly reviewed had not been fully maintained.

The views of people were welcomed, and people knew how to make a complaint if they were unhappy with the service provided. They knew who to speak with if they had any concerns.

Well-led

Requires improvement

Updated 25 November 2017

The service was not consistently well led.

There had not been a registered manager for the service, which had led to a period of interim management arrangements. There had been a number of staff changes.

This had been a significant period of change which staff and people were working through.

Systems were not fully in place to audit and quality assure the care provided.

The leadership and management promoted a caring and inclusive culture. Staff told us the management was approachable and very supportive.