Archived: Orchard House

An adult social care inspector carried out this inspection. The focus of the inspection was to look at how the provider had addressed the previous concerns and to use this information to answer two key questions: is the service caring and is the service safe?

At the time of this inspection the service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. Prior to this inspection the provider had informed CQC that the Registered Manager had left the service and that they were in the process of recruiting a new manager to this post. The provider had also advised CQC of their arrangements to manage the service during this time.

People who used the service had complex care needs relating to their learning disability and Autism. Although we spoke to some of the people who used the service the feedback from people about their experiences of the service was limited. Although people were busy during the day and some spent time in their bedrooms we were able to join people for lunch and spend time observing the care and support being provided within the communal parts of the home.

Below is a summary of what we found. The summary describes what staff and relatives told us, what we observed and the records we looked at.

Is the service caring?

People were supported by caring and attentive staff. We saw that staff were patient and responded promptly and appropriately to people's needs and requests. For example one staff member was supporting a person to prepare lunch. We heard the person being supported asking a question about their meal a number of times. The staff member providing support answered the person's questions clearly and patiently, repeating the answer as many times as the person requested.

We saw that staff had a good understanding of people's communication methods. We observed staff using their skills and knowledge of people they supported to respond to changes in mood and behaviour. We saw one staff member supported one person to consider other conversations when discussions they were having could cause them distress. This awareness and understanding helped diffuse potentially difficult situations and helped maintain a happy and calm atmosphere for everyone in the home.

A relative we spoke with said, 'Staff are good at considering people's privacy and dignity' and 'The care being provided has improved, and the staff working in the home now really want to make a difference'

Staff we spoke to said that they felt that opportunities for people had improved as the changes within the service had become more settled and as staffing levels had improved. One staff member said 'I think staff are clearer about the needs of people in relation to staffing levels, staff are more confident to support people to develop their independence and to take risks', and ' We are trying to get people out and about, doing things they enjoy'. On the day of the inspection we saw that people had the opportunity to go out to local shops and the beach. We spoke to the manager of the day centre, which was also located on the site. He told us that people had the opportunity to partake in a programme of activities such as cooking and computer skills, and that part of the day centre programme also included accessing opportunities in and around the local community.

Is the service safe?

People were cared for in a service that safeguarded and promoted their rights, dignity and independence.

Staff told us and we saw that each person had a personal care support plan within their records. This plan detailed how the person needed to be supported with daily personal care tasks, such as washing and dressing. As well as describing the person's skills and needs the plan also included information about encouraging independence and respecting the person's privacy. This told us that care was provided in a way that people respected people's choices, independence and privacy.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. Through discussion with staff and records it was evident that people were involved and included where possible in discussions about any restrictions on their freedom and rights. We saw the minutes of a recent meeting for one person, which looked at the person's rights in relation to accessing parts of the service, such as the kitchen area. The minutes of the meeting demonstrated that the rights and choices of the individual had been taken into account as well as the need to involve the person in these discussions in a way that was appropriate and that they could understand.

The home's record keeping systems ensured that people were protected from the risks of unsafe or inappropriate care and treatment.

We saw an example of the new filing system for one person, which included a main support file and a separate file for all health information. One of the main files we looked at was well organised and contained clear and up to date information about the person concerned and their care arrangements. The support plan provided staff with clear guidelines about how the person needed and preferred to be supported as well as information about risks and how these should be managed. This ensured that care was delivered safely and in a way that met people's needs.

During this inspection we found that there was not a registered manager in place at present. We were able to speak with the newly appointed acting manager during our visit.

During this inspection we found that consideration had been given to ensuring that people’s privacy and dignity was protected. A policy had been put in place to ensure that the rights of all people were considered when visitors were in the service. Systems were in place to ensure that people’s dignity was preserved should they display behaviours that impacted on others.

Care planning did not evidence that people had opportunities to choose or access community activities and develop their independence in a way that met their needs or that were appropriate to their age and ability.

Plans were in place to ensure that staffing levels were sufficient and met people’s needs.

Staff said that they felt supported by management and had opportunities to discuss issues about their role and changes within the service.

Although there had been some improvement with the records relating to people’s support needs, some other records in the home were duplicated and lacked purpose and quality.

We saw that care plans had been developed for people with specific health care needs and staff had received updated training to ensure that they had the skills to support and monitor people with health needs relating to epilepsy. Some improvements were still required in the care planning and review process to ensure that staff had sufficient information to support people in a way they needed and preferred.

Behaviour support plans had been updated and staff we spoke to and observed had a good understanding of these guidelines. Other agencies we spoke to said that there had been improvement in the way staff managed behaviours that occurred within the service.

Risk assessments were in place for individuals and staff supported people to be as independent as possible whilst ensuring that they remained safe.

Staff had received updated training in relation to the protection and safety of people using the service. This training had included discussion about the types of abuse, which could occur as well as the procedures staff needed to follow to ensure that people using the service were protected and remained safe.

Staff we spoke to said that they had more opportunities to reflect on their practice and to consider less restrictive and appropriate ways of managing people’s behaviours.

We saw that where possible people were supported to make daily choices.

Some of the support arrangements in place for individuals had not always taken into account the rights, privacy and dignity of all people using the service.

Support plans did not in all cases reflect the complex care needs of some people using the service. The care planning and review process did not demonstrate that the service responded promptly and with urgency to changing needs and concerning information.

Some of the staff did not feel sufficiently supported and trained to ensure that people within the service were protected.

Although staff worked hard to support and keep people safe, inconsistencies in the way that people's behaviours were managed and restrictions within the environment did not ensure that people were protected from excessive use of seclusion and restraint.

Staff were not always available in sufficient numbers to meet people's assessed needs.

We found that some support records did not give staff clear and up to date information about people's needs. Incident reports did not in all cases provide a clear audit trail of what had occurred or the action taken.

We saw that improvements had been made in the planning and delivery of care. Records were organised and contained clear and up to date information about people's needs. Training had been provided to ensure that staff managed incidents of behaviour in a way that was appropriate and safe.

We saw that sufficient staffing levels were in place to meet people's needs and to keep people safe. We saw people laughing and smiling and able to move around their environment with minimal restrictions.

Staff we spoke to said that morale within the service had generally improved and that they felt supported to fulfil their role. However, the induction process for new staff was not robust and did not ensure that all new staff were supported and sufficiently prepared to fulfil their role.

The quality assurance process for the service had been improved and it was evident that the service was actively seeking the advice and guidance from a range of internal and external agencies to ensure that people's care needs were met.

People were involved in the running of the home and supported to make decisions about their care and support needs. People were unable to comment in detail about their care due to their autism. However people said "yes" when asked if they were happy, if they liked the staff and if they liked using a computer.

People saw healthcare professionals regularly or when needed. Staff were friendly and respected people's rights. There were not enough staff on duty to support people when they were distressed/anxious or to meet people's social needs and enable active participation in the community. The staff had received some training to enable them to carry out their roles competently but felt unsupported by the management team through a lack of supervision and perceived lack of staff meetings.

The arrangements in place to protect people against the risk of any form of control or restraint being unlawful or otherwise excessive were not robust as they did not include consultation and agreement from external health/social care professionals.

The home did not have an effective quality monitoring system in place to ensure people's safety and welfare.