Archived: The Orchard Nursing Home

The Orchards Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 63 people in one adapted building over three floors. At the time of the inspection there were 36 people living there. This was because parts of the home were going through refurbishment.

The service had a manager who was not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The manager had submitted an application to register and this was in progress.

There were systems in place to monitor the quality of the home. However, they had not identified all of the areas that required improvement that we found on inspection. The service was making good progress in regards to an action plan in place to ensure a good quality service was provided and sustained. People and staff were positive about the running of the home which included the new manager and staff were proud about what they had achieved.

Most people were supported in a safe way. However, some people did not always receive appropriate pressure care.

There were sufficient staff to meet people’s needs, however, feedback was mixed. We found that staff were recruited safely. Staff knew how to recognise and report any risks to people’s safety and medicines were managed safely.

People were supported by staff who had received updates to their training and people were supported in accordance with the principles of the Mental Capacity Act 2005. People were supported by staff with respect and kindness and confidentiality was promoted in most cases. However further development was needed to ensure people’s dignity was always promoted.

People gave mixed views about the food, however, most were positive. We sampled the food and food that it was tasty and looked appetising.

People had regular access to health and social care professionals. The design of the building on the two refurbished units was well throughout and made for a pleasant environment. The second floor was still waiting to be refurbished.

People were involved in the planning of their care and most people received care in a person centred way.

People told us that they enjoyed the activities provided, however, these needed further development to ensure they reflected and met people’s individual hobbies and interests. Some feedback was that activities did not meet everyone’s needs.

People’s feedback was sought to help make changes in the service and there was a complaint’s process which people and their relatives knew how to use.

The Orchard Nursing Home provides accommodation for up to 63 older people, including people living with dementia. At the time of the inspection there were 40 people living there.

The service had a manager who was not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The manager told us that the provider was recruiting for a permanent registered manager.

People’s medicines were not always managed safely and staff needed further development in relation to fire safety procedures. There were also mixed views about staffing. Staff were recruited safely, however, references needed to be consistently verified. There were audits completed but these did not identify all of the issues found on inspection. The service has been rated requires improvement and been in breach of regulations for 20 months.

People’s care needs were not always met in a person centred way and care plans were not always reflective of people’s current needs. People felt that the activities needed further improvement.

People were supported by staff who knew how to recognise and report concerns about their safety. Individual risks were assessed and accidents were reviewed and the kitchen was adhering to safe working practice. People were supported by trained staff and staff told us that they felt more supported.

People were supported to eat and drink and there was regular access to health and social care professionals. This included the appropriate referrals.

People were treated with dignity and respect. They told us that staff were kind. People and their relatives had their involvement in care planning improved and confidentiality was maintained.

People’s feedback was sought and complaints were responded to.

There was a clearer management structure in place and people and staff told us they had seen some improvements. Systems in place had improved communication in the home.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Orchard Nursing Home provides accommodation and nursing care for up to 63 older people, including people living with dementia. At the time of the inspection there were 47 people living there.

The service had a manager who had applied to be registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The application was in progress.

People’s medicines were not managed safely and safe food hygiene practice was not consistently followed. People were not always protected from harm and views on staffing were mixed. However we found staff were recruited safely.

Quality assurance systems were not always effective and the management team needed to develop systems to ensure people’s voice was sought and heard consistently. There had not been sufficient improvement in the systems in place to ensure breaches of regulation were resolved and the service people received was consistent.

There was a new management structure being implemented which included two deputy managers who would be available seven days a week. People were supported by staff who were trained and supported. People had their consent sought and the staff worked in accordance with the principles of the mental capacity act. There was a variety of meals and support with eating and drinking as needed and people had access to health and social care professionals.

People were treated with dignity and respect and they were positive about the staff who supported them. People and their relatives where appropriate, were involved in planning their care. Confidentiality was generally promoted, however, at times staff spoke openly about people in public areas. People did not always receive activities that took account of hobbies, interests, likes and dislikes and this was an area that required improvement.

People told us care needs were met, however, at times there were issues in relation to accessing the toilet or getting off the toilet. People’s care plans were clear and up to date and complaints that the manager received were responded to.

The Orchard Nursing Home is registered to provide accommodation for up to 63 people. The home provides support with personal care and nursing care for older people, some of whom live with dementia. At the time of the inspection there were 51 people living there.

The service had a manager who was not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The manager had started their application by applying for checks with the Disclosure and Barring service (DBS).

We found that unexplained bruises and injuries were not always investigated or reported appropriately, and that staff did not always practise safe moving and handling techniques. We also saw that records relating to pressure care management were inconsistent and not always completed. Staffing deployment and organisation needed to be reviewed. However, people were supported by staff who were recruited safely and medicines were managed safely.

Although we observed some positive interactions with people and staff, people were not always treated with dignity and respect. We also found that privacy was not always promoted.

Management systems were not used consistently or fully embedded throughout the service. While there had been some improvements in regards to the management of the service, there still remained areas that needed to be addressed.

The Orchard Nursing Home provides accommodation, care, nursing and support for up to 63 older people, some of whom are living with dementia. At this inspection 41 people were living at the service.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People’s medicines were not always recorded accurately and staff knowledge in regards to safeguarding needed to be improved and unexplained injuries needed to be reported. People’s individual risks were assessed and mitigated where possible.

People’s dignity was not always respected and attention to the smaller details was not always considered. The activity programme in the home had reduced and consideration had not been made on how care staff could supplement activities for people.

The systems and leadership put into place needed more time to allow them to embed and develop further. People, relatives and staff were positive about the changes to the management and leadership in the home.

People were supported by sufficient numbers of staff who were recruited through a robust process. Staff had received training and supervision and told us they felt supported.

People had their consent sought and the service worked in accordance with the Mental Capacity Act. We found that people and their relatives were involved in planning their care but work was needed on how to ensure this was consistent and documented.

People enjoyed their food and had their nutritional needs assessed. People had access to health and social care professionals as needed.

People told us their care needs were met and their plans gave guidance to staff to meet their needs. We also found that confidentiality was promoted and that people knew how to make a complaint and were confident that manager would respond appropriately.

In relation to the areas they were not meeting the standards, you can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Orchard Nursing Home on our website at www.cqc.org.uk

The Orchard Nursing Home provides accommodation and personal care for up to 63 people. There were 43 people living at the home on the day of our inspection.

The service had a manager in post who had not yet registered with the Care Quality Commission (CQC) . A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The systems in place to monitor and review the service were not always effective. Although there had been improvements in regards to the management of the home, this was not always effective as there were some areas that still remained in breach of regulation.

People had been put at risk due to the process around removing bedrails when new beds were supplied. Although this was responded to promptly, there were a high number of falls and there remained some people without the equipment they needed to make them safe.

Staff had improved knowledge and awareness of individual risks. However, we noted that pressure reliving cushions were not always used when they were needed and one person’s fall risks were not consistently mitigated.

Medicines were not always managed safety. We saw improvements in regards to the records held. However, stock quantities were wrong and this was not detected by the auditing tool.

Staffing levels had improved and staff were recruited through an effective process. People, relatives and staff were positive about the calibre of new staff members. Staff received the appropriate training and supervision for their role.

People were supported to eat and drink sufficient amounts and staff made mealtimes an enjoyable experience. People’s care needs were met and their care plans were written with their involvement and included appropriate information to enable staff to support them safely.

People and their relatives were aware of how to give their feedback and make a complaint to the management. These were responded to appropriately.

The Orchard Nursing Home provides accommodation and personal care for up to 63 people older people, some of whom live with dementia. There were 50 people living at the service on the day of our inspection.

The service had recently been purchased by a new provider and the registered manager had resigned their position. This was the first inspection since the provider bought the home. The home had been managed during the transition period by a peripatetic manager employed by the provider but they had recently left the service. A peripatetic manager is a manager who moves between services owned by the same provider when they are without a registered manager. There was a newly appointed manager in post and the service had notified us of their intention to apply for their registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At the last inspection under the previous provider on 10 March 2015, the service was found to be meeting the required standards and was rated as Good. We carried out this inspection due to concerns raised with us about the welfare of people living at the service and found that the provider was not meeting the standards. We found there to be issues in regards to ensuring people received safe and appropriate care, staffing, management of medicines, complaints, communication, records and the management and leadership of in the home.

We found the service to be in breach of the Health and Social Care Act (Regulated Activities) 2014 Regulations. You can see what action we took at the back of our report.

The service was suffering severe staff vacancies and as a result was using a high level of agency staff. There were no systems in place or records available to ensure that in this period of difficulty staff could and were providing safe care to people. We saw many examples of people not receiving safe care.

There was limited leadership on the floors of the home and the permanent nurses who were responsible were expected to provide leadership with limited support and resources. The limited continuity of staff impacted on care delivery, maintenance of records, the management of medicines and people’s access to health care professionals.

People did not enjoy the food they were provided with and did not always receive the appropriate support with eating and drinking.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome. However, least restrictive options were not practised while these were pending and documentation did not support the needs of people and did not provide guidance to staff.

People and their relatives praised the permanent staff for their dedication in a difficult time and told us they were kind. Staff told us that agency staff were doing their best without guidance on how to work in the home.

responsive, safe, effective and well led? The inspection was carried out by one inspector over one day.

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm. We found that people who used the service were protected from the risk of harm. Staff who worked at the service were aware of people's individual needs and how to keep people safe. Staff members demonstrated that they knew how to support people safely and minimise risk. We saw records which evidenced that staff members had received training in the protection of vulnerable adults. Staff we spoke with were able to describe what constituted abuse and the process they followed if they needed to raise any concerns.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes

and promoted a good quality of life which was evidence-based where possible. We reviewed the care and support plans for four people who lived at the Orchard Nursing home. We found that the care plans contained appropriate person centred information to inform care staff how to support people in an individualised way. We saw that people had consented to the care they received.

Is the service caring?

By caring, we mean that staff involved and treated people with compassion, kindness,

We observed the staff to be caring and compassionate. Staff were observed spending quality time with people who used the service. We noted that staff knew the people they were supporting well, and were aware of people's abilities and needs. We observed the staff to be patient with people who used the service.

Is the service responsive?

By responsive, we mean that services were organised so that they met people's needs. We found the staff responded appropriately when required. We saw evidence that the staff were aware of how to respond to people both in a planned way and also in response to their needs when required.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care. This supported learning and innovation and promoted an open and fair culture.

We found that the Orchard Nursing home was well managed and staff confirmed they were well supported. Relatives of people who used the service spoke very positively about the standard of care and were complimentary about the management team at the Orchard Nursing home.

People who used the service and relatives we spoke with were mostly happy with the service they had received; however people and their relatives felt that the home did not have enough staff to always meet the needs of the people who used the service. We found that people's privacy and dignity was not always upheld. We found that records were not always updated, retained and were not securely stored. Risk assessments had not always been carried out and fluid charts were not always completed. Medication was not always given at the required time and without interruption. We found that people were not assisted in a timely manner as there were not enough staff to meet people's needs. We found that incidents that should have been reported to the Care Quality Commission (CQC) under Regulation 18 had not been reported. This lack of reporting may have compromised the health safety and wellbeing of people who used the service.