Archived: Orchid House

Updated 24 January 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team:

The inspection was undertaken by two inspectors.

Service and service type:

Orchid House 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided

Notice of inspection: This comprehensive inspection was unannounced.

What we did before our inspection

We reviewed information we held about the service. This included the last inspection report, information received from local health and social care organisations, and statutory notifications. A notification is information about important events, which the provider is required to send us by law, such as, allegations of abuse and serious injuries. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke the assistant regional director, the registered manager, deputy, a manager who had just started working in the service and a positive behaviour support specialist. We also spoke with two members of staff. To help us assess how people's care needs were being met we reviewed four people’s complete records and referred to the other two records for information about risks. We also looked at the medicines records for all people, and a range of records relating to the running of the service. We carried out general observations of care and support and looked at the interactions between staff and people who used the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We emailed and heard back from a number of staff who work at the service. We contacted six people’s relatives and heard back from four with feedback about the service. After the inspection, we also spoke with the provider’s nominated individual who is responsible for supervising the management of the service on behalf of the provider.

Updated 24 January 2020

About the service

Orchid House is a residential care home that was providing personal care and support for six adults with learning disabilities and autism at the time of the inspection. The service is registered to support up to six people and accommodates five people in one building and one person in a self-contained annexe attached to the building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. However, we found the provider was not following these best practice guidelines in line with Registering the Right Support (RRS) to achieve effective outcomes.

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

People's relatives told us that they felt their family members were no longer receiving the consistent care they had prior to Choice Care Group (the ‘provider’) taking over the service in May 2019. This was, in part, due to the turnover of care staff, resulting in new members of staff who did not always have the experience to work with people’s complex needs. In addition, agency staff were being used to supplement the permanent staff.

The provider had not ensured that all staff had received the relevant learning and time to support people effectively and safely. The safe management of medicines was not always assured or delivered in line with the provider’s policy and procedures.

Improvements were needed to improve staff training in areas such as safeguarding, infection control, food safety and fire awareness. Not all staff felt they were receiving enough support from managers to ensure their roles and responsibilities were safely delivered. This was because there had been limited opportunities for one to one support meetings to discuss support they needed, in order for them to develop and improve.

People’s needs had not been regularly reviewed to ensure best practice guidance was used to achieve effective outcomes. Staff did not have the support in place to ensure they felt confident to deliver care to people with complex needs. People’s health need requirements, such as specialist health appointments, were not always known. This meant that the provider and registered manager did not have a good overview to manage people’s health conditions. People’s nutritional needs were not always being met to ensure their diet was healthy and adequate to maintain good health.

People were supported by staff that cared for them. However, the provider had not ensured that people were supported with consistent staffing in relation to their autism and other complex care needs. This meant that people were not always supported by staff that had the time to get to know them well and understand their care and support needs, wishes, choices and any associated risks.

People did not always have opportunities to pursue their interests and hobbies. People’s care needs had been recently reviewed and new care plans had been drawn up and were with families to review and comment where necessary.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. This was because people using the service did not receive consistent, planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The provider's quality assurance systems had not always effectively identified shortfalls in the quality of care when they acquired the service. Following a compliance visit, the local authority had identified a number of concerns. We noted some initial improvements to the quality and safety of the service were being actioned. These improvements at the service were not embedded at the time of this inspection.

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.

Relatives told us that improvements had been recently been made. This followed a number of reviews and meetings where they could discuss their concerns on areas discussed in this inspection report.

The provider was actively addressing the issues that had been raised during the inspection and demonstrated a willingness to work transparently and openly with all relevant external stakeholders and agencies.

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

Rating at last inspection:

The last rating for this service was Outstanding (published 15 December 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was brought forward because of concerns raised with the Care Quality Commission about the experience and training of staff. There was also concern about management of medicines. Concerns were also raised about leadership and quality monitoring at the service. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements.

We have identified four breaches in relation to person centred care, safe care and treatment, staffing and good governance at this inspection.

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

Follow up

Full information about CQC’s regulatory response to this inspection is added to the report after any representations and appeals have been concluded. 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.