5 April 2022
During a routine inspection
About the service
Little Orchard is a residential care home providing accommodation and personal care to up to six people. The service provides support to younger people who have learning and / or physical disabilities or autism. At the time of our inspection there were four people using the service. Little Orchard accommodates four people on the ground floor of the premises and there are two vacant rooms on the first floor. The premises are in a converted house in a village location and has a large garden and ample communal areas where people could gather should they want to. Plans are in place to refurbish areas of the service that need updating.
People’s experience of using this service and what we found
People were not consistently protected from risks of harm due to care plans not always being followed, care records not being reviewed or audited and equipment settings not being checked for accuracy.
People were supported by staff trained in safeguarding who would report concerns should they have any. Risks were assessed, and actions taken to minimise residual risks of harm. The management of medicines was mostly effective however we have made a recommendation to improve safety.
We had a concern about use of personal protective equipment that was addressed immediately by the registered manager. We have also made a recommendation about infection prevention and control. The premises were clean, and the provider was following current guidance on visiting care homes.
We were concerned at some staff members communication skills as they were not fluent in English which was the main language of people using the service. We have made a recommendation about this.
Staff were safely recruited and completed an induction before commencing in post.
People’s needs were assessed and developed into clear and informative care plans covering all aspects of peoples care and well-being. Staff participated in regular supervision one-to one meetings and staff meetings. There was a wide range of training some face to face and some online.
People were supported to eat and drink meals prepared according to their taste and needs. Appropriate referrals to SaLTs and the dietician were made and concerns about people’s weight and appetite raised with the GP.
The premises were accessible and met people’s needs however there were refurbishments planned to enhance peoples experience of living there.
The registered manager had an understanding of the MCA and ensured decisions were made in line with this. Staff also understood people’s communication well and could interpret body language and gestures.
People were at ease with staff and staff were clearly fond of people using the service. There were mostly kind and caring interactions throughout the inspection. Staff respected people’s privacy.
People had communication plans in place and details of these were included in their hospital passports. A recent development was an individual newsletter mainly featuring photos of people being produced for people to share with friends and relatives.
There were some activities taking place and people had activities planners. These were not clear and needed additional details to inform peoples and staff what would be happening.
The registered manager had worked hard to improve relationships with relatives. There had been no recent complaints raised.
There were some end of life care plans in place which were detailed and person centred considering not just the person but their relatives as well.
The registered manager had been in post for around eight months and had made significant improvements to aspects of the service. There were some concerns about the oversight of records, and audits were not always effective.
The service demonstrated how it was meeting the principles of Right support, right care, right culture.
Right Support
When possible, people were supported to make choices in their daily lives and to participate in activities that were fulfilling. People had personalised rooms and the provider was working to incorporate more sensory aspects into the service. People accessed the community taking local walks, using the local pool for swimming, and accessing a local day service provider. People were referred to appropriate health and social care professionals to enhance their well-being.
Right Care
We saw kind interactions between staff and people, and staff were familiar with people’s communication needs. People’s wishes were considered as well as needs, and sessions such as swimming and bowling arranged so people could join in their chosen activities.
Right culture
Relatives were involved in developing peoples care plans and advise was also sought from health and social care professionals to inform planning. There were long service staff working at Little Orchard who knew people well and who provided consistent care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We carried out this scheduled, unannounced inspection as the service had been newly registered under a different provider and to assess that the service was applying the principles of Right support right care right culture. 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.
Enforcement
We have identified a breach in relation to how the provider set up and maintained equipment, and a lack of oversight of records at Little Orchard. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.