Archived: Orchid House

Updated 11 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors, a member of the CQC medicines team and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Orchid House 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.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. However, a new manager had been recruited and was in the process of applying to register with CQC.

Notice of inspection

This inspection was unannounced

What we did before inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We observed the care and support provided to all six people who lived at the service. We also spoke with five of these people and four relatives about their experience of the care provided.

We spoke with eleven members of staff including the manager, the group quality and compliance manager, a team leader and support workers.

We reviewed a range of records. This included six people’s care records and medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed too.

Updated 11 October 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Orchid House is registered with the Care Quality Commission (CQC) as a residential care home providing accommodation and personal care for up to six people with a learning disability and, or autistic spectrum disorder. At the time of the inspection six people were living at the service.

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

The service provided by staff did not always fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

¿The inspection highlighted that Orchid House was operating a non-traditional model of care. The provider told us in their view they were providing a hybrid and innovative model of care that enables people using the service to benefit from 24-hour supervision whilst maintaining their own tenancy. Traditional care homes would not have tenancy agreements in place and service users would not claim housing benefit or pay for their own food.

¿The provider did not support people to have the maximum possible choice, control and independence. From our discussions with the provider and the local authority, who fund people living at the service, it was clear that there was some confusion about the service provision in terms of what was being commissioned and what was being provided. During this inspection we have assessed the service being provided to people based on its registration status and our expectations of a registered care home.

¿People’s medicines were not always managed safely. Medication risk assessments did not describe in detail the support people needed with their medicines.

¿ People were expected to buy their own food. We found the amount people chose to spend on their grocery shopping varied. This placed them at risk of not having enough of the right food available to consistently promote healthy eating and the correct nutrition. Some people would not have the capacity to understand the benefits and importance of a balanced diet on their health and wellbeing.

¿ Not all staff who supported people with the preparation of food had been trained in safe food handling.

¿ Staff focused on people’s strengths and promoted what they could do. Staff supported people to achieve their day to day goals of developing life skills. People were supported by staff to pursue their interests whilst at home. Activities were planned during the week and two people living at the service were working voluntary. However, for people requiring support whilst in the community this was limited during certain times of day and the evenings due to staff availability.

¿ The service gave people care and support in a well-equipped, well-furnished and well-maintained environment that met their sensory and physical needs. However, we had concerns people had to contribute towards the cost of communal furniture, decoration, utilities, wi-fi and other building related costs as part of their regular rent and service charge payments.

¿ People were able to personalise their rooms. We observed elements of this in people’s bedrooms which reflected their hobbies and interests.

Right Care

¿ Not all staff had received training on how to recognise and report abuse. Those that had completed safeguarding training did not consistently know how to apply it. We had concerns about the way the service was operating and felt there were potential financial safeguarding implications for people living at the service. People were potentially in receipt of welfare benefits they may have not been entitled to. CQC referred this to the local authority for them to investigate.

¿ Not all staff had been appropriately trained to meet people’s needs and keep them safe when at home. For example, some staff had not been trained in First Aid and Fire Awareness. This could impact on people living in the home if there was a fire or someone had an accident.

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity.

¿ Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People were able to access the community, either with staff support, or independently. For example, people had part time jobs, another person performed at gigs and took part in conferences.

¿ Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. For example, accessing the community independently for shopping and the service had plans to support two people to self-administer their medication.

¿ People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. People spoke positively about how they had been supported to develop their life skills in various areas. For example, learning independent living skills such as cooking and preparing meals, cleaning their rooms, laundry, and budgeting, if this was required. The support people required was detailed in their care plans.

Right Culture

¿ The provider did not respect people’s rights. People living at the home did not have the protection provided by tenants’ rights despite signing a tenancy agreement. People were paying for aspects of their care and accommodation as if they were a tenant.

¿ Staff knew and understood people well and in the main were responsive, supporting their aspirations to live a quality life of their choosing. However, this was dependent on staff availability at certain times of the day.

¿ People and those important to them were involved in planning their care. Relatives were positive about the communication from staff and were happy with the care provided. The manager was in the process of updating all care and support records. One person said, “I have seen my care plans, the manager read it to me, and I signed it, and I am happy with it.”

¿ A new manager had been recruited at the service. Staff felt supported by the manager who they found approachable.

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

This service was registered with us on 2 February 2021 and this is the first inspection.

Why we inspected

We undertook this inspection to assess how well the service is 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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people from abuse, safe recruitment of staff, safe care and treatment, staffing, consent to care and overall management oversight of the service 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 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.