The Old Orchard Care Home

About the service

The Old Orchard is a residential care home registered to provide personal and nursing care for up to 5 people. The service provides support to people who have learning disabilities and/or autistic people. Nursing care was not being provided at this care home. At the time of our inspection there were 5 people using the service.

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

Right Support

Not enough staff were deployed to meet people’s assessed needs for 1:1 support or to support people to follow their interests and take part in activities outside of the care home. The service gave people care and support in a safe, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community.

People were not always supported to have maximum choice and control of their lives. Limitations in staffing levels prevented that. Within the care home, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People’s care plans did not always accurately reflect their specific care needs in respect of modified diets, which were important to mitigate people’s risks of choking on food. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

The provider had not taken action to ensure people received the level of staff support they were assessed as requiring. Staff knew and understood people well, and wanted to enable people to live their life as they wished, but were limited by the provider’s staffing levels. The provider’s management arrangements also limited the registered manager’s ability to progress the improvements to the service which the provider had identified as being necessary. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity.

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 Good (published 5 July 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

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

Enforcement

We have identified breaches of regulations in relation to staffing levels, person-centred care, and the provider’s quality monitoring processes at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service:

The Old Orchard Care Home is a care home that provides personal care for up to five people. The accommodation was on one level in a purpose-built building which provided individual bedrooms with ensuite bathrooms and a communal lounge, kitchen and dining area. At the time of the inspection there were five people using the service.

People’s experience of using this service:

People received care from flexible staff who had received training to ensure people were protected from harm. Risk assessments had been completed to ensure all aspects of people’s daily life which had been reviewed and measures put in place to reduce the risk of harm. Staff knew the importance of following the guidance provided. Medicines were managed safely to ensure people received medicines to support their pain control or long-term condition. The home was cleaned to a standard to reduce the risk of infection. Any incidents which had occurred had been reviewed and lessons were learnt, to reduce the risk of the incident reoccurring.

Staff had received training for their role and there were opportunities for staff to progress. Care was provided using the latest best practice, to ensure people’s needs were supported. People’s dietary needs had been met and their health care monitored to ensure any required appointment or referrals had been made. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The environment had been designed to meet each person’s needs and they were able to personalise their space.

Staff provided care which was respectful and ensured each person’s dignity was maintained. Relationships had been established and people’s wishes were followed using a range of communication methods. Relatives were made welcome and people could access advocates if required.

Care plans were detailed and covered all aspects of people’s care. These included specific aspects of care which were important to the individual. There were opportunities for people to enjoy regular activities or spontaneous new experiences. When care was provided the person had an opportunity to choose the gender they preferred for their care. The provider was developing end of life care plans which would reflect aspects important to the individual.

There was a complaints policy, and any concerns had been recorded and responded to. There was a new auditing tool which covered all aspects of the service. It was used to follow up any accidents, incidents or actions following an audit. This reflected ongoing quality improvements.

People’s views were considered through family contacts and understanding of people’s needs, to ensure the service was meeting their needs. Staff felt supported by the provider and local management in delivering care to people.

Partnerships had been developed and there were opportunities for improvements to continue to improve the service. Notification had been provided following any events. There was an open atmosphere which created a warm homely environment.

Rating at last inspection:

The last rating for this service was good (published 11 March 2016). 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: This was a planned inspection based on the registration with us.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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