Archived: Orchard Court Care Home

Updated 23 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 4 October 2016 and was unannounced. It was carried out by two inspectors and a specialist advisor (a registered nurse).

Before the inspection we reviewed the information we held about the service. This included statutory notifications (issues providers are legally required to notify us about) and other enquiries from and about the provider.

Some of the people living at the home were unable to fully express themselves; we therefore spent time observing care practices. To help us gain more information about people’s experiences we used a Short Observation Framework for inspection (SOFI). A SOFI is an observational tool used to help us collect evidence about the experience of people who use services, especially where people may not be able to fully describe these experiences themselves because of cognitive or other problems. We looked at the care records of the people we had observed through the SOFI.

During the inspection we spoke with six people who lived there, four relatives, the managing director, three regional managers and six members of staff. We looked at records relating to the care and services provided. These included recruitment records, staff training records, daily handover records, staff rotas, menus, care plans, and records relating to quality monitoring and improvement.

Updated 23 November 2016

This inspection was unannounced and took place on 4 October 2016.

Orchard Court is registered to provide accommodation with nursing and personal care for up to 44 people. The home was purpose built and the accommodation was arranged over one level. The home is situated in a quiet residential area and has ample parking space.

At the time of the inspection there were 20 people living at the home although not all were able to engage in conversations with us due to their dementia or mental health problems. People had a range of complex nursing care and support needs.

The service did not have a registered manager, however there was a deputy manager. A registered manager is a person who has registered with the Care Quality Commission 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.

On the day of the inspection the home was being managed by a regional manager who was supported by a managing director. The managing director informed us there would be a regional manager supporting the deputy manager and staff at all times in the absence of a registered manager. Plans were in place to establish a new registered manager.

At the last inspection on 12 March 2015, we found there were breaches of legal requirements and the service was rated Requires Improvement. This was because some procedures and processes were not in place to make sure people were protected. For example, local safeguarding policies and procedures were not always being followed. Systems to assess, monitor and improve the quality and safety of the service were not effective enough. Systems and checks were not in place to monitor the cleanliness of the environment. The provider had submitted an action plan telling us how they intended to improve.

At this inspection we found, although the provider had followed their action plan and made improvements, some risks still remained. People and their relatives said they felt safe however we found areas that require improvements. For example people who required support with eating and drinking, to keep them safe, had been assessed by the speech and language team (SALT). However, the guidelines within the care plans were not always being followed. We also found whilst there were a number of audits and checks being carried out they had not been effective at identifying the issues found at this inspection.

The provider had however made improvements regarding infection control and there were effective systems and checks to monitor the cleanliness of the home. Cleaning schedules were being followed and checks were completed.

The provider had also made improvements to ensure people had access to call for assistance when required. People had call bells and on the day of inspection, the bells were answered promptly. However some people felt they still had to wait a while to be supported with personal care requirements.

People's needs were assessed prior to moving to the home to ensure the service could provide the necessary care and support. Each person had a comprehensive care plan based on their assessed needs. Care plans provided the necessary information for staff to enable them to respond to people's individual needs. People and their relatives told us they had been involved in the assessment and review of care following admission to the home. People’s risks were assessed and recorded and had a review date set, this ensured that assessments were current and accurately reflected the needs of the person.

People were supported by sufficient numbers of staff. The managing director told us they adjusted the staffing levels to meet the needs of people living at Orchard Court, for example a dependency check was completed at the home on a daily basis. They said “Staff sign in to the home through a key system, this will alert me if there are insufficient staff to support. I will authorise agency if I feel the skill mix of staff is wrong or if staff would be unable to support people safely.” People felt they were supported by staff who they knew and who knew them.

Recruitment procedures were in place and staff underwent pre-employment checks before starting work with the service. New members of staff received an induction which included shadowing experienced staff before working independently. One member of staff said, “My induction was good I felt very supported by all my colleagues”, “I have done e learning and mandatory training, I understand about safeguarding I would know what to do if I needed to”.

Staff received training to ensure they had the knowledge and skills to provide effective care in line with current best practices. This included mandatory training, such as: safeguarding, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, first aid, infection control, fire safety, moving and handling, and understanding dementia. Person specific training was also provided to meet people's individual needs, including dementia, person centred care, and communication.

Throughout our inspection staff showed kindness and consideration to people. When staff went into any room where people were they acknowledged people. Staff had a good rapport with people and were seen to be friendly.

Medicines were administered safely by staff who had received medication training. Safe procedures were followed when recording medicines and medicines administration records (MAR) were accurate and held dated photos of the person. Medication audits were completed and appropriate actions taken to monitor safe administration and storage.

People were able to take part in activities with minimum risks to themselves and others. The coordinator told us that they had plans for the service development including the recruitment of volunteers, further community involvement and the possibility of obtaining a mini bus for day trips.

Systems were in place for responding to people's concerns and complaints. People and relatives told us they knew how to complain and felt assured that staff would respond and take action to support them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.