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
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.