The Orchards

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders at the service 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 good practice. However, actions needed were not always evidenced to have been fully embedded and sustained. We fed this back to the provider and senior management team who reacted positively and were open about the actions they planned to take to drive the improvements needed.

We saw there was a reflective and positive learning culture in place where shortfalls, accidents, incidents, complaints and safeguarding were used to improve the quality of the service provided. A staff member explained to us the process that included reflective practice with leaders and other senior staff. They said they would, “Mention incident at 10 at 10 [daily senior staff meeting]. Process also includes [completing] incident forms; escalation alert to senior managers so they know one has been completed. [And] whether CQC need to be notified.”

Leaders and the staff team 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.

During this assessment we held a virtual meeting with the senior leadership team. They told us the improvements they would put in place following our findings. They confirmed they would undertake a ‘belt and braces’ review of their policy that set out how new people were managed admitted into the service. This included ensuring more detailed and consistent documentation around people’s health conditions and known risks to guide staff.

Staff contacted professionals such as GP’s, district nurses, speech and language therapists and physiotherapists when people needed additional support. Advice given from professionals guided staff on how people should be supported and monitored to help ensure their well-being. A person confirmed to us, “The doctor comes in on a [named day] and you can ask to see him if you need to.”

There was a multi-disciplinary team approach to try to ensure a smooth transition when people moved services. This included occasions when staff at The Orchards could no longer meet a person’s needs. A staff member told us how people’s needs were monitored, and where needed, this included involvement from the GP and other health professionals. This helped make sure that people were monitored to ensure they had access to services which met their needs.

Leaders and the staff team 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.

Staff had a good understanding of their responsibilities to keep people safe. There were effective systems in place to recognise, record and respond to information of concern. One staff member explained the formal process of raising concerns. They said, “[We] complete [an] incident form that then goes to management and they raise the safeguarding.” When asked where else they could raise concerns, they told us, “[We] can raise with [the] local authority and the CQC externally.”

Leaders and the staff team had requested legal authorisations, such as Deprivation of Liberty Safeguards, for people who were assessed to lack mental capacity. Decisions around these were made in people’s best interests and for their safety.

There were occasions where staff did not always work well with people to manage their known risks including risks around specific health conditions.

Whilst we found no evidence a person had come to harm, we identified there was a risk of harm to people’s well-being. This was in relation to safe management of a health condition and effective staff response. For example, we found 1 person had a health condition of diabetes and not all senior staff had received the required training to monitor and respond to this condition in line with the person’s care plan and health professional advice. This meant the person was at increased risk of harm and poor outcomes. Following immediate feedback during the assessment this was rectified by leaders at the service, but it is too soon to evidence that this will be fully sustained.

For people at risk of dehydration there were no records of individual fluid intake goal amounts to try to achieve to guide staff. This meant staff did not have guidance to work towards, nor a goal to compare people’s intake to. We therefore could not be assured reduced intake would be identified, or responsive action would be taken, if a person’s fluid intake was reduced.

Some people were at risk of malnutrition, and we found inconsistent information contained within their care plans. This meant staff did not have clear guidance in place on how to meet people’s nutritional needs and goals, which had placed them at risk of poor outcomes. For example, accurate records were not always present to identify if people, as required, had been given meals or drinks that were fortified to increase the nutritional value. Details and examples of these concerns were immediately fed back during this assessment. Once more, there was a positive response from the provider and senior management team. Actions were taken to resolve these concerns, but it is too soon to evidence that these improvements required to ensure safe care and treatment for people have been sustained.

Leaders and the staff team detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Robust systems were in place to make sure that equipment, fire safety and utilities safety checks took place and were scheduled in advance.

People were happy with the environment and the cleanliness of the service. A person told us, “I feel very safe here. They have got fences all round, I suppose people could get over them but then you have to get through 2 doors to get into the building. The staff will check on you when you are in your room as well, so I know I am alright here.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. During this assessment whilst in the main staff were trained, experienced and knowledgeable, we found a training gap around supporting people safely with a specific health condition. As such, this did increase the risk to people’s well-being. The provider and management team responded positively and quickly to this feedback. They organised the additional training required, and this took place during the assessment timeframe. However, it is too soon to evidence that this has been embedded and sustained.

The provider recruited staff safely. Processes ensured the necessary checks were completed prior to staff starting their employment. This included the provider obtaining employment references, proof of identity, and Disclosure and Barring Service (DBS) checks. These checks provided information including details and convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff were given development opportunities should they choose to pursue them and were supported with supervision.

Staff confirmed that in the main there were enough staff. However, some staff told us additional staff would be helpful during particularly busy times of the day. A staff member said, “I think in the mornings they need an extra [member of] staff, everyone wants to get up at the same time.”

People spoke highly of the staff team and most confirmed there were enough staff. One person told us, “They will always come to you really quickly if you need help. There is always someone around, I don’t think they are short of staff.” Whilst another person said, “At times it can take a while before someone comes to you, but it hasn’t caused me any problems.” During our assessment visits we observed enough staff to be responsive to people’s needs.

Leaders and the staff team assessed and managed the risk of infection. They detected and controlled the risk of it spreading. During our site visits we observed the service to be visibly clean and well maintained.

Audits and checks were in place to monitor the cleanliness of the service, and the effectiveness of the infection control measures in place. People were happy with the cleanliness of the environment. They said, “We have got some wonderful cleaners. All the staff are very particular about washing their hands.” And, “They are always cleaning, and they clean the door handles.”

Leaders and senior staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people when changes happened.

We observed staff supporting people to take their medicines in a kind and respectful way. People told us, “I always get my medication when I am supposed to. I know exactly what I am taking and why.”

Medicines were stored securely, and administration records showed people received their prescribed medicines as intended. Medicines audits were carried out monthly to check that people received their medicines safely.

Staff had received training, and their competence was assessed. A staff member confirmed to us, “[I] had a medicines competency last week.” Person-centred information to guide staff was in place for 'when required' (PRN) medicines, such as for pain relief.