Orchard Lea

Orchard Lea is a care home registered to provide nursing and personal care for up to 37 people, some of which were living with dementia and/or a physical disability. The premises comprise of a two-storey building with a passenger lifts to access the second floor. At the time of the inspection, 21 people were living at the service. Although the service is registered to provide nursing care, no-one was in receipt of this regulated activity at the time of inspection. We were not able to inspect this regulated activity as a result.

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

Improvements had been made since the last inspection and two previous breaches had been met in relation to good governance and notifications required by CQC.

There were improved systems in place to check the quality and safety of the service. Effective quality assurance and monitoring systems had been embedded and were used to identify shortfalls and drive improvements.

At the last inspection some environmental risks had not been proactively managed in relation to hot water temperatures. We found improvements and action had been taken to address this risk. Personal emergency evacuation plans (PEEPS) had not been reviewed or updated at the last inspection to include all people living at the service. At this inspection PEEPs were all up to date with information to assist people when evacuating the building.

At the last inspection, some staff had not received core training to ensure they worked safely with people. At this inspection we found staff received training and support needed to carry out their role effectively.

Everyone we spoke with said they felt safe. Comments included, “It is very nice here. Everyone is very pleasant” and “Yes, I am safe and happy.” People were protected from harm and abuse as staff understood how to report any concerns. Risk assessments were completed and contained strategies to reduce potential harm. Medicines were safely managed.

Staff had enough time to deliver a good standard of care without rushing people. The registered manager followed safe recruitment processes to ensure staff recruited were suitable for their roles.

People’s needs were assessed prior to moving to the service to confirm their needs and preferences could be met. People enjoyed the food and there was always a choice.

The service worked well with health care professionals to provide timely care to people to ensure their health was maintained. These included GPs, speech and language therapists; occupational therapist and the mental health team. Feedback from professionals included, “This is one of the better homes we know…” and “We have no concerns whatsoever. They have been brilliant”.

The service promoted a positive and inclusive culture for people. People described a happy atmosphere. Comments included, “I think they look after you and accommodate you…I can’t think of anything to improve” and “It is first class. I have never seen anything to cause any concern at all”.

People using the service and relatives described the registered manager as approachable and all said they would feel confident to raise any issues or concerns. People and their relatives were asked for their views about the care and support provided. Where suggestions were made, action was being taken.

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 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 requires improvement (published 24 December 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of safe, effective and well-led which contain those requirements. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

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

People living at the service, and their relatives, shared positive comments and experiences of the service with us. They told us the service was safe and staff were particularly praised for their kind and considerate approach. However, we found improvements were required.

Although there were quality assurance systems in place, including audits and checks, the registered provider did not always consistently assess, monitor and improve the quality and safety of the services provided. They had not identified the shortfalls we found at this inspection. For example, issues relating to staff training; safe water temperatures and personal evacuation plans.

The registered provider had failed to notify the Care Quality Commission (CQC) of reportable events. This meant we could not check that appropriate action had been taken to ensure people were safe.

The service had experienced staffing difficulties with recruitment and sickness absence. However, existing staff or occasional agency were used to cover shortfalls and the provider was advertising for staff. We have made a recommendation in relation to the deployment of staff.

We identified that staff training was needed in some areas. The registered manager sent us additional information following the inspection showing staff training was being addressed.

Whilst action had been taken by the registered provider to make the environment dementia friendly, further improvement could be made. We have recommended the provider review current dementia research and good practice and make changes to create a more dementia friendly environment.

People had limited opportunities to enjoy meaningful and stimulating activities. We have recommended advice and guidance is sought to ensure people have a variety of suitably stimulating and meaningful activities to occupy them.

People were safe as risks associated with their health and support needs had been identified and arrangements were in place to reduce known risks. Staff were aware of their responsible to safeguard people from abuse or neglect. People told us staff treated them very well and no concerns were raised with us. Professionals met with during the inspection confirmed they had not witnessed any practice which caused concern. People’s medicines were safely managed. People were protected from the risk of infection and the service was clean and generally odour free.

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.

People enjoyed a varied and nutritious diet, and all were complimentary about the quality of food provided. The service worked in partnership with health and social care professionals to ensure people’s individual needs were met. Professionals described good working relationships with the registered manager and staff.

Without exception, people and their relatives described a very caring and compassionate staff team. People’s independence was promoted, and the service worked with other professionals to achieve this.

People benefited from planned personalised care that valued them as individuals. Staff enabled people to choose what they wanted to do throughout the day.

At the end of their lives people were supported to remain at the service (when this was their wish), in familiar surroundings, supported by their family and staff who knew them well.

People and their relatives knew how to raise a complaint or concern and were confident the service would take appropriate action if they did complain. People’s suggestions had been acted upon demonstrating their views were taken seriously.

There was an open culture, led by the registered manager who was described by staff and people as being approachable and supportive. The registered manager was very passionate about delivering a person-centred service and was committed to ensuring improvements were made.

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

Rating at last inspection (and update)

This service was registered with us on 10 October 2018 and this is the first inspection.

Why we inspected

This was a planned inspection.

We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We found no evidence during this inspection that people had been harmed from the concerns we identified. Please see the relevant sections of this full report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.