Archived: C & V Orchard Residential Limited

At this inspection the team inspected the service against two of the five questions we ask about services: Is the service well led and is the service safe. This is because the service was not meeting some legal requirements. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At our September 2017 inspection we gave the location a rating of ‘inadequate’ and entered it into special measures. We identified seven breaches of the Health and Social Care Act (HSCA) 2008 and one breach of the Care Quality Commission (Registration) 2009. At this inspection we found the provider continued to be in breach of the HSCA regulations. You can see what action we told the provider to take at the back of the full version of the report.

C & V Residential Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates people in one adapted building. C & V Residential Limited accommodates 32 people, some were living with dementia. At the time of the inspection there were 22 people living at the home.

The home currently has a registered manager in place. 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.

People did not have their needs met in a timely manner because there were not enough staff nor were they effectively deployed across the home. Staff did not have the skills and knowledge to meet people’s needs effectively. People were not protected from the risk of harm because staff did not understand how to manage people’s individual risks to keep them safe. People did not always receive their medicines as prescribed and people’s nutritional needs were not always being met. The recruitment system operated by the provider needed to be improved to ensure staff were suitable to work with the people living at the home.

Staff had not received adequate training nor had their competencies checked to ensure care provided to people was safe and effective. The care people received was not always responsive to their own individual needs. People had mixed views about whether the service was well led. People were not protected by a quality assurance system that identified areas of improvement needed to ensure people received safe effective care. The provider continued to fail to recognise and improve the quality of care being provided to people. Staff did not have effective leadership which meant people were not protected from risks to their health, safety and well-being.

The overall rating for this service is ‘Inadequate’ and the service remains 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. If there is not enough improvement so there is still a rating of inadequate for any key questions 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.

At our September 2017 inspection we gave the location a rating of ‘inadequate’ and entered it into special measures. We identified a number of breaches of regulations and the Commission made a decision to exercise its urgent enforcement powers by way of Section 31 of the Health and Social Care Act 2008, in the form of issuing a Notice of Decision to restrict any further admissions to the home including service users who may require to use the service for respite care. We also required people’s risk assessments to be updated and reflective of people’s needs along with assuring adequate numbers of qualified trained staff were deployed effectively across the home. On the basis that service users may be exposed to the risk of harm.

C & V Residential Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates people in one adapted building. C & V Residential Limited accommodates 32 people, some were living with dementia. At the time of the inspection there were 25 people living at the home.

The home currently has a registered manager in place. 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.

People did not always have their needs met in a timely manner. Staff did not always have the skills and knowledge to meet people’s needs effectively nor were they well deployed. People were not protected from the risk of harm or potential abuse as the management team and provider were not managing safeguarding concerns appropriately. Staff did not understand how to manage people’s individual risks to keep people safe. People received their medicines as prescribed.

People were not protected by a quality assurance system that identified areas of improvement needed to ensure people received safe care. The provider failed to recognise and improve the quality of care being provided to people. Staff did not have effective leadership which meant people were not protected from risks to their health, safety and well-being.

During the September 2017 inspection we identified seven breaches of the Health and Social Care Act 2008 and one breach of the Care Quality Commission (Registration) 2009. At this inspection we found the provider continued to be in breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service remains 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. If there is not enough improvement so there is still a rating of inadequate for any key questions 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.

C & V Orchard Residential Limited provides accommodation and personal care for up to 32 older people, some were living with dementia. The home currently has a registered manager in place. 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.

Staff did not understand how to manage people’s individual risks to keep people safe. People were not protected from the risk of harm because staff did not use safe techniques to move people safely. People were not protected from harm because the registered manager had failed to take appropriate action when people sustained injuries. People did not always have their needs met, as there was not enough staff to meet people’s needs. People were not protected from the risk of abuse because staff did not always recognise potential abuse; which meant incidents were not investigated and reported to the local authority. Medicines were not always available to people so their well-being was promoted.

People did not receive support from staff that had the knowledge and skills to support people safely. People were not always supported in a way that protected them from unlawful restrictions. Principles of the Mental Capacity Act had not been followed because staff did not have the knowledge or understanding of how to apply the principles in care practice. Staff did not always make sure people had enough to eat and drink. Staff did not always follow the guidance given by health care professionals to maintain people’s health needs.

Staff did not always treat people with respect and ensure their dignity. Staff did not have time to spend with people and missed opportunities for interaction. Staff were focused on tasks and people did not receive care that was responsive to their individual needs. People were not involved in making choices about their care and support needs. Staff did not always understand people’s needs and preferences. People were not supported to access hobbies and activities and enabled to choose how they spent their time. People knew how to complain and processes were in place to manage concerns and complaints.

The registered manager and provider had failed to monitor the quality and effectiveness of the service provided to people. Staff did not have effective leadership and support and as a result, people were not protected from risks to their health and wellbeing. The provider had failed to notify us of events as required by law. The culture of the home was not open and transparent.

During this inspection we identified seven breaches of the Health and Social Care Act 2008 and one breach of the Care Quality Commission (Registration) 2009. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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. If there is not enough improvement so there is still a rating of inadequate for any key questions 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.

C & V Orchard Residential Ltd is a residential home providing accommodation and personal care for up to 32 older people. At the time of the inspection there were 27 people living at the home.

Some people living at the home have dementia or additional health needs such as mental health, physical disability, sensory impairment, learning disabilities or autistic spectrum disorder.

It is a requirement that the home has a registered manager in post. There was a registered manager in post. 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.

People told us they felt safe living at the home. Staff we spoke with understood their responsibility in keeping people safe from the risk of abuse or harm and said they would report any concerns to the registered manager. People did not always receive support from sufficient numbers of staff, which meant their needs were not met in a timely manner.

Risks to people’s health and welfare were assessed and action taken to minimise these risks. Improvements had been made in medicine management however people’s medicines were not always clearly recorded.

People were asked for their consent before support was provided. Assessments had been carried out around people’s capacity to make certain decisions. Staff and the managers knew how to obtain consent from people if they lacked capacity to make decisions around their own care.

Mealtimes were not always a positive experience for all. People had adequate to eat and drink and had access to healthcare professionals when required.

People said their choices were not always respected because staff did not always have enough time to spend with people. People’s dignity was not always promoted and maintained. People told us staff were kind and caring. Care was planned to meet people’s individual needs and preferences. People told us there were not enough leisure activities and people were not always encouraged to follow their interests or hobbies. People and their relatives knew how to complain and there were processes in place to manage concerns and complaints.

People told us staff were approachable. Quality assurance systems were not effective and failed to ensure that issues identified at the last inspection had been addressed or that improvements made had been sustained. The systems in place had not identified the areas of concern we found during the inspection.

During this inspection 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 the report.

C & V Orchard Residential Ltd is a residential home providing accommodation and personal care for up to 32 older people. At the time of the inspection there were 28 people living at the home.

Some people living at the home have dementia or additional health needs such as mental health, physical disability, sensory impairment, learning disabilities or autistic spectrum disorder. It is a requirement that the home has a registered manager in post. There was a registered manager in post. 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.

People told us they felt safe living at the home. Staff we spoke with understood their responsibility in keeping people safe from the risk of abuse or harm and said they would report any concerns to the registered manager. People told us there were enough staff to support their needs at the home. However, there were times when staff were not able to meet people’s needs in a timely manner. Risks to people’s health and welfare were assessed and equipment was available for staff to use. People received their medicines as prescribed. However, we found systems used to manage medicines needed to be improved. People were asked for their consent before support was provided. Appropriate assessments had been carried out around people’s capacity to make certain decisions. Although not all staff knew those people who were safeguarded by an authorised DoLS. People’s dietary and nutritional needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when required.

People told us staff were kind and caring. Staff understood people’s needs and choices. Staff respected people’s dignity and privacy when supporting them and providing care. People and their relatives had been involved in the development of their care plans. Care was planned to meet people’s individual needs and preferences. People were supported to maintain their interests as far as possible.

People told us they found the staff and registered manager approachable and would feel comfortable to raise any complaint or concern should they need to. People considered the home to be well-managed. Whilst there were systems in place to monitor and improve the quality of the service provided; we found some of the audits were not robust enough to identify and address areas of concern we found during the inspection.

We were told about interim management plans in place. We saw that the acting manager was at the home from Monday to Friday. We were told that a registered manager from another home attended twice weekly. The owner of the home told us they attended regularly to ensure that the acting manager received the necessary support to perform their role.

Previously, we completed an inspection in November 2013, where we found the provider was not meeting requirements for outcome 5: Meeting nutritional needs and outcome 21: records.

We completed a follow up inspection in March 2014, where we found the provider was not meeting requirements for outcome 5: meeting nutritional needs and outcome 16: Assessing and monitoring the quality of service provision. We found the provider was also not meeting requirements for outcome 21: records. We issued a warning notice due to previous concerns in this area and the potential negative impact on people who used the service. We found that improvements were needed in these areas.

After the inspection, the provider sent us an action plan. This told us the action the provider would take to make the necessary improvements and by what date.

At this inspection we checked whether required improvements had been made since the last inspection. We also completed a combined scheduled inspection and looked at other essential standards of care.

We found that the provider had made the necessary improvements with respect to meeting people's nutritional needs.

We found that improvements had been made to audits identified at the last visit.

We found that the provider had made improvements to record keeping at the home and had met the requirements of the warning notice.

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with five people who used the service and three visiting relatives involved with their care and a visiting professional. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

All of the people we spoke with told us they felt safe. We found that safeguarding procedures were in place at the home to safeguard vulnerable people.

We found that policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) were in place. This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no applications had needed to be made.

We saw that risk management plans were up-to-date and staff said they received updates when people's needs changed. People were not put at unnecessary risk. Policies and procedures were in place to make sure staff had information they needed so that unsafe practice was identified and people were protected.

We found that the home could benefit from a scheme of refurbishment. We found that repairs were required to floors and carpets which could present a safety risk to people who lived in the home. We found that these shortfalls had not been recorded in the home's maintenance audits.

Is the service effective?

We found that people had an individual care plan which set out their care needs. Assessments included people's needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of whom visited the home. People told us that staff referred them to GPs when they needed it. One person told us: 'When I need a doctor they [staff] are straight on to it'.

This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

We spoke with five people who used the service and three relatives of people who were not able to speak directly to us. We asked them for their opinions about the staff that supported them. One person told us: 'The girls are very nice' and another person told us: 'They are very good people. Some lack a little patience'.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Not all of the people we spoke with told us that they felt their rights, privacy and dignity were always respected by care staff.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We looked at examples of investigations which had been completed in line with the complaints policy. We saw that complaints were investigated and action taken as necessary. We found that systems were in place to make sure that the managers and staff learned from complaints. This reduces the risks to people and helps the service to continually improve.

People who used the service and their relatives told us they could talk to management about any concerns they had and they would be dealt with. People received surveys every three months to give feedback to the service about care they received. We saw and were told by people who used the service, that where shortfalls or concerns were raised, they were dealt with by the home.

We found from discussions with a visiting district nurse and with the managers, that there was a need for improved communication to ensure that managers captured concerns and acted on information to improve the quality of service provided.

Is the service well-led?

We found that the service had a quality assurance system in place. We found that in some areas improvements were needed to ensure the quality of the service continuously improved.

We saw that people's personal care records, and other records kept in the home, were accurate, complete and fit for purpose.

We have asked the provider to tell us what they are going to do to make the necessary improvements in relation to consideration and respect for people who use the service and the safety and suitability of premises.

After the inspection, the provider sent us an action plan. This told us the action the provider would take to meet the requirements of the regulations.

At this follow up inspection we checked whether improvements had been made to address the issues identified.

We spoke with the acting manager and provider. The provider told us that the registered manager for the home had been absent since April 2013. They had sent us a notification of the registered manager's intended absence. They told us the acting manager was supported by the provider and the registered manager of another home, who visited three times a week.

At this follow up inspection we reviewed two care plans and records kept by the provider.

We found that improvements were required to food and fluid records to ensure people's nutritional needs were monitored effectively. We have decided it is appropriate to take enforcement action for this under Regulation 20: Records.

We found that improvements had not been adequately made to ensure appropriate records were kept to protect people from the risk of unsafe or inappropriate care.

We found that the provider did not have an effective system in place to manage risks to the health, safety and welfare of people using the service.

People were supported to have their personal care needs met. People were dressed in an individual style that reflected their age and gender. People saw the GP when they were ill and had eye and dental check-ups. People had the opportunity to take part in some activities.

People's nutritional needs were assessed and were regularly reviewed. People were offered a choice of food and drinks. People were provided with support to have their meals. Some people needed to have their food and drink monitored. These records were not always fully completed.

The provider was making sure that care staff were suitable to work with vulnerable people. The home was completing the necessary checks before care staff started working at the home.

The home had a complaints procedure. Relatives told us that the home took action when they raised any concerns.

The home's record keeping needed to improve. People's care records and records required for the effective running of the home were not adequately completed.

At the last inspection we found that the service had some systems in place to monitor and evaluate the service. However the quality monitoring systems they had did not provide assurance that people would be protected from risk.

We completed an unannounced responsive review to look at how things had improved since the last inspection. This meant that the provider and the staff did not know we were coming.

During our visit we spoke with the registered manager about changes and improvements that had been made at the home.

Having spoken with the registered manager and reviewed evidence provided we found that the provider was compliant as they had an effective system to regularly assess and monitor the quality of service that people received.

We also spoke with people living at the service about whether they liked living at the home.

One person living at the home told us, 'The staff are very nice here'.

We spoke to a relative who told us, 'I find the home very good. The staff are very friendly and very helpful'.

The majority of the people living at the home, due to the nature of their needs, were unable to tell us their opinions about the home. We used other methods to better understand their opinions, to include surveys completed by their relatives and observations of care delivery.

Staff we spoke with told us they enjoyed working at the home and received appropriate training to undertake their work competently. They also told us they received appropriate support from the management team.

We looked at six key outcomes to establish whether people were involved and participated in the service they received; whether care was provided appropriately; whether the service could adequately ensure people's safety within the home; whether there were adequate infection control measures in place; whether there were sufficient staffing levels and whether there was a system for ensuring ongoing quality assurance within the home.

We found that C & V Orchard Residential Limited was compliant in five key outcomes and non-compliant with respect to quality assurance systems within the home.