Archived: Orchard Manor Limited

Orchard Manor provides accommodation for up to 34 people who require personal care. At the time of our inspection there were 32 people living at the home.

At our last comprehensive inspection visit in November 2016 we rated the service as 'requires improvement' in all the areas we inspected. We found the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people’s rights were not protected through the effective application of the Mental Capacity Act (2005). The provider was in breach of Regulation 12 regarding safe care and treatment because the management of medicines was not safe. In addition the provider was in breach of Regulation 17 relating to the governance of the service. The provider did not have effective systems in place to assess, monitor and improve the quality and safety of the service and had not maintained accurate complete and contemporaneous records in respect of each service user. After our inspection in November 2016 the registered provider sent us an action plan to show how they would meet the legal requirements of the regulations.

We undertook this unannounced inspection on 10, 11 and 17 October 2017 to check the registered provider had followed their own action plan and to monitor their compliance with the legal requirements of the regulations. During this inspection we found widespread and significant shortfalls in the service; which meant people had experienced harm and or had been exposed to the risk of harm. The required improvements had not been made and the service had deteriorated significantly. We asked the registered provider to take immediate action to ensure the safety of people who had been identified as at high and extreme risk of harm. During day one of our inspection we alerted the Local Authority about the serious safeguarding concerns identified. The local authority attended the service following our escalation and a number of health and social care professionals visited the home to carry out reviews. The Local Authority shared our concerns and provided the home with a team of staff to increase their staffing levels to ensure people were kept safe whilst we considered what further action to take.

There was not a registered manager in place and the home was being managed by an acting 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.

At this inspection in October 2017 we found serious concerns about the safety of the service. People were at risk of and at times had been subjected to unsafe and inadequate care and support. Risks to people relating to the management of people’s physical and mental healthcare needs were not always identified, recorded and known to staff. Staff lacked knowledge of those at risk of choking and measures were not in place to minimise this risk. Skin integrity was poorly managed placing people at risk of injures. Clinical observations which could indicate health concerns were not understood and acted upon. People were not protected from harm due to staff not recognising and reporting safeguarding incidents to the local authority. People were at risk of injury due to unsafe moving and handling practices, poor maintenance of equipment and a lack of suitable equipment.

The home was dirty and smelt offensive. The systems in place to ensure good infection control and prevention and the cleanliness of the environment were not adequate. Infection control practices were reviewed by an infection control nurse and found to be unacceptable. There were insufficient staff numbers available to meet people’s needs safely and in a timely manner. We could not be confident people always received their medicines as prescribed.

People were not supported by sufficient number of care staff who had the training, skills and knowledge to support them effectively. People were not supported in a way that protected them from unlawful restrictions. People did not have their rights upheld and protected due to poor understanding and implementation of the Mental Capacity Act.

People did not have their food and fluids intake managed safely when it had been identified that they were of risk of malnutrition and dehydration. Some people did have contact with healthcare professionals to maintain their health, however, staff had not always identified when healthcare support was required and subsequently throughout our inspection we found people whose healthcare needs had not been met. Sometimes people did not receive the appropriate health interventions when needed.

People did not have their privacy and dignity respected and were not always treated compassionately. We found occasions where people were in a distressed, anxious or unkempt state and the inspection team had to intervene. People were not involved in making decisions and choices about their care and support. Staff did not have time to build meaningful

relationships with people. Some language and daily records used by staff to describe people and their care needs was not dignified. People’s individual cultural and language needs were not met and valued.

People did not receive personalised care which met their needs. The majority of care plans did not reflect people’s current needs, and they were not an accurate or helpful tool for staff providing care. Staff did not know what people’s needs were and how support should be provided. People had not received the opportunity to undertake any range of interesting and stimulating activities that they enjoyed. People did not feel that their concerns and complaints were listened to.

Leadership within the home was woefully inadequate and had failed to ensure positive outcomes for people who lived there. People had been placed at risk of significant harm and many had experienced avoidable harm. The registered provider systems in place failed to ensure people received the care and support they needed and had failed to monitor the quality of the service and ensure people were protected from harm. In addition the registered provider had failed to notify us of events as required by law.

The overall rating for this service was 'Inadequate' and the service was therefore placed into 'Special measures'. Services in special measures are kept under review. Following the inspection we took urgent action to cancel the registration of the provider as people were exposed to ongoing risk of harm and the provider failed to make sufficient and timely improvements. At the time of the publication of this report, our action had been completed and there were no longer any people living at the service.

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in place however they had not been at the home for a number of months and the home was being managed by the 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.

Improvements were needed to the management of medicines to ensure people received their medicines as prescribed. People told us they felt safe and were happy with the support they received from staff. Staff could identify signs of potential abuse and were able to explain what actions they would take to keep people safe. Risks to people were not updated when people’s needs changed and guidance was not available for staff to refer to. People did not always receive support from sufficient numbers of staff which meant on occasions people’s needs were not met in a timely manner.

People were asked for their consent before care and support was provided by staff. Information relating to any restrictions of people’s rights and freedoms were not available. People told us staff had the skills to meet their needs. However training for some staff was not up to date. People told us they had sufficient to eat and drink and had access to healthcare professionals when they needed.

People told us staff were caring but did not always have time to spend with them. Care records were not reflective of people’s needs or risks. People told us there were not enough leisure opportunities and people were not supported to follow any interests or hobbies. People told us their dignity and privacy was maintained and respected by staff. People were confident if they had any concerns or complaints, they would be listened to and the matter resolved.

Staff understood their roles and responsibilities. Quality systems in place to monitor care provided were not effective. Improvements identified at the last inspection had not been implemented.

We found three breaches of the HSCA 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was 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 said they felt safe within the home and were happy with the care they received. Staff knew how to report any concerns and were aware of the provider’s procedure for reporting any issues around people’s safety. People were not always protected from the risk of harm because risk’s had not been clearly identified and managed.

There were sufficient staff on duty to meet the care and support needs of people. People received their medicines as prescribed and appropriate records were kept when medicines were administered.

Some staff were not knowledgeable about the requirements and their responsibilities in relation to the Mental Capacity Act 2005. Assessments of people’s capacity to consent and records of decision had not been completed. People were at risk of having their rights and freedom restricted. Staff did not always ensure they sought people’s consent before providing care.

Staff had received training but not all staff had the skills and knowledge to support people’s specific care needs.

People were supported to have sufficient to eat and drink. However mealtimes were not a positive experience for everyone living at the home. People were supported to access other healthcare professionals to ensure that their healthcare needs were met.

People felt staff were kind and caring however, people’s independence was not fully promoted. People were supported to maintain their interests as far as possible. Care plans were mainly centred around providing for people’s personal care needs. Some plans did not include details of people’s likes, preferences and specific detail for staff to provide individualised care and support.

People were confident if they had any concerns or complaints, they would be listened to and the matter resolved.

People told us the staff; provider and registered manager were approachable. The provider had audit systems to record incidents and accidents. However, we found that there were no processes in place to identify and monitor trends that would improve the quality of care people received.

You can see what action we told the provider to take at the back of the full version of this report.

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

At this inspection we checked whether required improvements had been made to care and welfare issues identified at the last inspection.

During this follow up inspection, we spoke with the registered manager and reviewed three people's care plans.

We found that the provider was now compliant. Care and treatment was planned and delivered in a way that ensured people's safety and welfare.

People told us they were quite happy living at the home. They told us they could make decisions about their life. We saw that people were supported to have their personal care needs met and saw the doctor when they were ill. Some areas of need were not assessed and some plans of care were not fully up to date.

People were provided with a varied menu and they had a choice of meals. People that needed help to eat received the support they needed. People's nutritional needs were assessed and monitored.

The premises were safe for the people that lived there. Some areas of the home would benefit from redecoration.

The provider's recruitment procedures made sure that care workers were suitable to provide care to vulnerable people. All the required checks were completed.

A complaints procedure was available to people that lived at the home. The provider listened to people and acted upon concerns.

We completed an inspection on 17th April 2012 where four key outcomes were inspected. The service was found to be compliant with all four outcomes.

We needed to complete a second visit to ensure that overall five outcomes had been inspected at this home as part of their scheduled annual inspection.

We looked at outcome12 to establish whether requirements relating to workers were effectively implemented within the home.

One staff member told us, 'We get support when we need it from the manager. We get a lot of training and are always reminded when training needs updating'.

We found that Orchard Manor Limited had effective recruitment and selection procedures in place and that appropriate checks were undertaken before staff began work.

Staff we spoke with told us they had appropriate training to undertake their work competently and had a good level of support from the management team.

We found that Orchard Manor Limited was compliant in this outcome area.