The Orchard Care Home

About the service

The Orchard Care Home is a residential care home providing personal nursing care to 5 at the time of the inspection. The service can support up to 6 people.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always supported to take their medicines in a safe way. People were not always supported by staff trained to meet their needs.

Right Care:

Poor risk management meant people were not always safe. Staff understood they had a responsibility to protect people from abuse but systems and processes in places meant incidents were not recorded or investigated appropriately. Staff were caring, people told us they were happy with the support they received from staff.

Right Culture:

Governance and management at the service was not effective which placed people at risk of living in an unsafe environment. The culture of the service was not always empowering or dignified for autistic people or people with a learning disability.

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

The last rating for this service was requires improvement (published 19 April 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviewed the culture and routines within the home to ensure they were supporting people in line with current guidance. At this inspection we found they had not made improvements.

Why we inspected

We received concerns in relation to the culture and management within the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement

We have identified breaches in relation to risk management, consent, staff training, culture and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to appoint a registered manager. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

About the service

The Orchard Care Home is a residential care home providing personal care to five people at the time of the inspection. The service can support up to six people.

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

The home did not have a manager in place. We found audits and quality monitoring systems were not effective. We found no evidence this had led to any harm.

We found a lack of understanding around current guidance for the use of personal protective equipment, in particular masks. Once we discussed this with the provider, they assured us all staff would be wearing masks in all areas of the home. The home was very clean, and people helped to maintain its cleanliness.

People were supported to take their prescribed medicines in their preferred way; however, we found a lack of guidance for staff around over the counter medicines such as painkillers. People said they felt safe at the home, and staff knew people’s individual needs and managed any potential risks well.

We found a lot of routines which were in place for all people, it was not evident they were in everybody’s individual best interests. It was not clear people always had a choice in certain things, for example we saw the use of “hygiene” books which were supposed to be completed to record what someone had worn but we saw them being completed several days in advance. We have made a recommendation about the routines within the home.

Records showed staff had not all completed relevant training. We have made a recommendation about staff training. People were supported with their eating and drinking needs. Relatives spoke positively about this support. However, we had concerns over the routines around these and the variety of food on offer. We have made a recommendation about eating and drinking.

Where people lacked capacity, best interest decisions were mostly in place. However, we were not assured the relevant legislation was always being followed. We have made a recommendation about making decisions on behalf of others.

Right Support

¿ The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including support to travel wherever they needed to go.

¿ Staff enabled people to access specialist health and social care support in the community.

Right Care

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

¿ People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

¿ People’s care, treatment and support plans reflected their range of needs

Right culture

¿ People were supported by a consistent staff team who knew them well.

¿ Routines in place meant we were not assured people were living empowered lives of their choosing.

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 good (published 20 February 2019).

Why we inspected

We received concerns in relation to the management of the service and support for people to make their own decisions. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We undertook this inspection to assess that 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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Orchard Care Home on our website at www.cqc.org.uk.

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.

A registered manager was present during the inspection. 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 2008 and associated Regulations about how the service is run.

At our last inspection on 1 December 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were supported by staff who understood the risks people could face and knew how to keep them safe. People were supported to minimise risk and promote their safety.

People were provided with their care and support when this was needed because there were enough staff to do so. People received the support they required to take their medicines at the time they needed these, although some improvements were needed in the records that were used for this. People were being protected from infection because safe practices were being followed.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and staff practices in the service supported this practice.

People were provided good nutritional support. Staff understood people’s healthcare needs and provided support to people in maintaining people’s health.

People were cared for and supported by staff who respected them and maintained their privacy and dignity. Where possible people were involved in planning their own care.

People received care that met their needs and they had activities they found meaningful. People were told in a way they understood how they could raise any complaints or concerns

People used a service that was responsive to their needs and views. They had confidence in the registered manager who was respected and supported by staff. There were some improvements needed to systems used to monitor the quality of the service and make improvements when needed.

Further information is in the detailed findings below.

People told us about what they did during the day and showed us activities that they were involved in. We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which enabled them to deliver appropriate and safe care.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment, induction and training systems were robust. The accommodation was appropriately designed, homely and suitable to meet the needs of the people living there.