Orchid Home Care Support Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and staff were encouraged and supported to raise concerns and people felt confident they could do this and would be treated with understanding, and would not be blamed, or treated negatively. A relative told us, “The manager keeps in contact with me; she visits [person] to make sure she is happy with everything.” A staff member said, “I feel confident and supported to speak up.”

Risks were not overlooked or ignored. The registered manager reviewed any accidents and incidents, they looked for themes or trends and agreed appropriate actions. We saw there had been no serious incidents or injuries since our last inspection. People’s risk assessments identified the action staff needed to take to keep people safe, and what to do in response to any incidents.

Any lessons learned from safety incidents or complaints were shared during staff meetings and in staff supervision meetings.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager ensured initial assessments were completed when people first began to use the service. Relatives told us they were involved in assessment discussions, one relative told us, “I am always involved with [person’s] care planning.”

The registered manager worked in partnership with other professionals to support people to access healthcare when they needed it. Care plans included relevant health and personal information to help inform care provision. People's needs and choices were clearly documented.

Some people told us they had family present who were involved in discussing their care needs when initially referred, and on occasion other professionals were also involved. A person told us, “I have a review every 6 months, [my relative] and the social worker also attend.” A second person said, “Me and the carers review my care plan every week, I have no complaints, they [staff] are doing a great job.”

The registered manager ensured arrangements were in place to support people who were transitioning in to or out of the service. Care and support were planned and organised with people, together with partners to ensure continuity. People’s views and those of partners and staff were listened to and considered. The registered manager considered whether the service could meet people’s needs, when first referred.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve it. The provider had systems in place to ensure people’s human rights were upheld, and they were protected from discrimination. The registered manager ensured staff had access to up-to-date safeguarding policies and procedures.

The provider maintained a deprivation of liberty policy in the community. This referred to situations where a person in a community setting, such as their own home is subject to restrictions on their freedom that amount to a deprivation of their liberty and is usually authorised by the court of protection. At the time of the inspection, no-one was subject to any such restrictions. Staff received safeguarding training which was relevant and at a suitable level for their role, and staff were up to date with safeguarding training.

There was a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners in a collaborative way. Records showed people were appropriately supported when they felt unsafe or raised a concern, and the registered manager had taken timely action to resolve any concerns raised; any individual staff concerns were also discussed in their supervision meetings with the registered manager.

Staff were encouraged to raise concerns and felt confident to do so. Staff had a good understanding of safeguarding and how to take appropriate action. Staff were able to outline indicators of abuse and the required actions if a safeguarding concern was identified.

People and most relatives did not raise any concerns about feeling unsafe and told us they were treated well and with respect. A person told us, “They [staff] take extra care of me and look after me well. They understand I have poor memory and make sure I have everything I need; I have been with them for many years.” A relative said, “The carers communicate with me and ring me straight away if they have any concerns; they go over and beyond.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks were assessed, and people and staff understood them. Risk assessments about care were person-centred, proportionate, and regularly reviewed with the person, where possible. We saw evidence of risk assessments for a wide range of areas, including the environment, medication, mobility, skin care, continence and catheter care. Each assessment had possible outcomes identified and the risk reduction measures needed and contained a good level of instruction and guidance for staff to follow.

People and relatives felt risks were managed well and staff were competent in supporting them. A relative told us, “[Person] is at risk from falling and has a walker and a wheelchair. [Person] has cream prescribed by the GP for pressure sores, the carers wash [person] twice a day and apply cream. [Person] has special cushions to sit on; the carers make sure [person] moves around and changes position.” Another relative said, “The carers are very safe, and they know what they are doing. I have every confidence with them; [person]is totally immobile. If [they] start to cough staff know to sit [them] up.”

The provider had policies for restrictive practice including restraint and physical interventions and for challenging behaviour. The registered manager told us no person was subject to any restrictive practice. Staff had time to read people’s information in full, to help them understand how best to support them to stay safe. The registered manager carried out regular spot checks of staff practice to ensure risks were being managed well and staff were following good practice guidance.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager explained how and when environmental risk assessments were completed; they told us before any care package started, they would go out to do an initial visit to people in their own home, to talk about the care and support people would like. As part of this process, they walked around the person’s home to complete an environmental risk assessment; our review of records confirmed this. There were no concerns raised by people and relatives around the safety of their environments.

The registered manager ensured people had individualised care plans regarding the environment which indicated any risks and how such risks could be mitigated or lessened. Areas assessed included the external pathways, fire precautions, flooring, furniture, sockets, appliances, lighting, stairs, any adaptations, the presence of gloves and aprons for staff, access to cut-off points for utility supplies and access to the property.

People had the equipment they needed, and rooms were adjusted to fit in with any equipment such as wheelchairs, hospital beds or hoists. Any equipment staff used to support people was maintained and serviced by the supplying organisation.

Risks in or around people’s homes, including the use of any equipment had been assessed, to help keep both people and staff safe. A person told us, “They [staff] are dead polite and welcoming. They always ask before they touch any of my stuff. They lock my door and post the keys through the letterbox. If I need to go out, they hold onto my arm, so I don’t fall.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There was a clear staffing structure in place and people had clearly defined roles. There was a consistent staff team in place, and it was clear the registered manager and deputy manager worked well together. Good systems were in place to induct and train staff and to ensure staff received regular supervision support and regular spot checks to provide further management oversight. One staff member told us, “My induction included shadowing, mandatory training, and introduction to policies. Training is ongoing and supports me in my role, and I can request additional training if needed. Staffing levels are generally safe, though sometimes (like mornings) can be busier. I receive regular supervision and feel supported by management.”

Staff were recruited safely with appropriate checks in place to assess the candidate's suitability to work with vulnerable adults. This included obtaining references, evidence of right to work and DBS checks. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had opportunities to learn, and any poor performance was managed appropriately.

Most staff had completed the relevant and necessary training for their roles within identified timescales, and any cancelled training was rescheduled for the following month. Staff were appropriately trained in supporting people with a learning disability and autistic people. People felt staff knew what they were doing and knew how to use any necessary equipment. A person told us, “I have breathing machines, and once a week they [staff] clean the pipes; they know what they are doing.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. People were protected as much as possible from the risk of infection because people’s homes and equipment were kept clean and hygienic.

The cleanliness of people’s homes was monitored to ensure standards were maintained and staff use of personal protective equipment (PPE) was observed by the registered manager as part of staff spot check visits. The provider felt adherence to strict guidelines on infection control was of paramount importance in ensuring the safety of both people and staff.

There was an up-to-date policy on the control of infection, (IPC) which staff could refer to if needed. Staff were trained in IPC and had access to PPE. People and relatives had no concerns over staff use of PPE and people said staff wore gloves, aprons and masks. Staff told us there was enough readily available PPE for their use.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. Medication risk assessments did not always identify the risks associated with the administration of some medicines, for example, for one person there were no fire risk assessments for the creams being administered, for another person there was no information about the need to give a medicine 30 minutes before food and other medicines. We determined no harm had occurred and the provider took immediate action to rectify this issue.

Staff used medicines administration records [MAR’s] to record the administration of medicines. The information recorded on MAR’s was not always sufficient to ensure the possible risks with administration were mitigated. Most MAR’s indicated people received their medicines as prescribed; however, the MARs were not always able to demonstrate time sensitive medicines were being administered at the correct times. We determined no harm had occurred and the provider took immediate action to rectify this issue. People’s allergies were being recorded on their MAR charts.

Additional information about the administration of medicines on a when required basis was present in the form of written protocols the information, included in these protocols was sufficient to inform staff when it was appropriate to support the administration of these medicines. Any errors with the administration of medicines were quickly identified and appropriate action was taken to ensure the safety of the person concerned. A person said, “They [staff] get my medication for me, they check it is the right ones, check it is the right time and check that I take it.”