Orchard End

When we last visited the service we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was, at that inspection rated as inadequate.

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 questions of Safe, Effective, Caring, Responsive and Well led to at least good. At this inspection we found the provider was no longer in breach of regulations, but still required further improvements and these needed to be sustained over a period of time.

There was a registered manager in post who was available throughout the 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 person living at the service was protected from harm as the provider had robust processes in place to ensure their safety. Staff supporting the person were aware of their responsibilities in relation to protecting them from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

The risks to the person’s safety were clearly identified with measures in place to reduce these risks. The environment and essential equipment were well maintained and met the needs of the person who lived there.

The person was supported by well-trained and competent staff in sufficient numbers to keep them safe. Their medicines were managed safely and the person was protected from the risk of infection through good hygiene practices, and staff knowledge of reducing the risks of cross infection.

The person’s needs were assessed using evidence based tools and their rights were protected under the Equality Act. Staff were supported with appropriate training for their roles. The person was supported to maintain a healthy diet, with staff showing good knowledge of their nutritional needs.

The person received support to manage their health needs through well-developed links with local health professionals.

Staff sought consent from the person before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). The person was 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.

The person was treated with kindness and care by staff who supported them with respect and dignity. Staff developed positive relationships with the person in their care.

The person was able to maintain relationships with people who were important to them and relatives felt their views and opinions about their loved one’s care were listened to.

The care the person received was person centred and met their individual needs. However, when treatments had been changed for one of their health conditions the information had not been up dated in their care plan.

The person was supported to take part in a range of social activities to prevent isolation. There was a complaints procedure in place and the person knew who to complain to should they have any issues.

The service was well led, the registered manager was visible and supportive towards the person, their relatives and the staff who worked at the service. The quality assurance systems in place were used effectively to monitor the majority of aspects of care. The registered manager and provider responded positively to changes and used information to improve the service and care people received.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in post at the time of our inspection, the previous registered manager had left the service in July 2017. 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. There was a service manager in place during our inspection who had taken over responsibility for the day to day running of the service in late August 2017. However they were not registered with the CQC. The provider told us they would ensure a manager was registered with CQC. We will monitor this.

During this inspection we found that the service was not safe. People were not always protected from risks associated with their care and support. Where people needed support with behaviours that may put them or others at risk, there was not sufficiently detailed information for staff about how to support them safely. Systems to review and learn from accidents and incidents were not consistently effective and this meant we could not be assured that action was taken to protect people from harm. Action was not always taken to protect people from improper treatment or abuse. There were a number of safeguarding investigations underway at the time of our inspection visit following concerns being raised about possible abuse.

There were not always enough, adequately trained staff to provide care and support to people when they needed it. Staffing shortages meant people did not consistently receive the support they required. Temporary staff did not always have the necessary training to enable them to provide safe support. Safe recruitment practices were followed.

Medicines were not stored or managed safely. Staff did not always have the necessary training or competency to ensure safe medicines practices were followed and we were not assured that people received medicines when they needed them.

Where people lacked capacity to make choices and decisions, their rights under the Mental Capacity Act (2005) were not always respected. Some people had significant restrictions placed upon them, but a lack of formal capacity assessments meant we could not be assured these were in their best interests. Staff felt supported, but did not receive sufficient training to enable them carry out their duties effectively and meet people’s individual needs.

People were supported to attend health appointments. However, there was a risk that people may not receive appropriate support with specific health conditions as support plans did not contain enough information about people’s health needs and staff did not always have enough training. People were supported to have enough to eat and drink.

Some staff were kind and treated people with respect, however other staff were focused on tasks and had limited interaction with people who used the service. People were not supported to be as independent as possible. Staff did not consistently have an understanding of how people communicated and this had a negative impact on people who used the service. People’s right to privacy was not always respected.

People were at risk of receiving inconsistent and unsafe support as care plans did not provide an accurate or up to date description of people’s needs. There were not always a sufficient number of adequately skilled staff to ensure people were provided with the opportunity for meaningful activity.

People and their families knew how raise issues and concerns, however systems in place to monitor and respond to complaints were not effective and people did not have confidence in the provider to manage complaints appropriately.

The provider had not ensured staff had adequate skills and knowledge to provide specialist support to people with complex needs. Systems in place to monitor and improve the quality and safety of the service were not effective and this resulted in poor outcomes for people living at the home. Appropriate action was not taken to analyse and investigate incidents which posed a risk to the health and wellbeing of people who used the service. Swift action was not always taken in response to known issues. Relatives told us communication between them, the service and provider were poor. Staff felt supported and were able to express their views in relation to how the service was run.

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.