Orchard Views Residential Home

Orchard Views is a residential care home that provides accommodation and personal care for older people. The home can accommodate up to 40 people in one adapted building. At the time of this inspection there were 33 people using the service.

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

Since the last inspection there had been changes in the management team and the service had a new manager. The previous registered manager had left the service 2 months ago and the provider had recently appointed a new manager to oversee improvements at the service.

The new manager was in the process of submitting an application to register themselves as the new manager of Orchard Views. We are currently assessing this application.

The service had improved since the previous inspection. The nominated individual and manager gave assurance these improvements would continue and be further embedded, to ensure there was a continuous approach to improving care, quality assurance systems and the environment.

There had been improvements to ensure risks identified with people's health, medical and care needs had been assessed and documented. The provider’s governance systems had improved to ensure people continued to receive good quality and safe care. Improvements had been made to ensure medicines were managed safely although some staff’s competency checks needed updating. Appropriate health and safety checks to the buildings and premises were carried out and people were protected against the risk and spread of infection.

Some actions recommended in the services fire risk assessment, which was completed in March 2023 had not been completed and required attention.

The home was clean, but areas of the home looked ‘tired’ and required refurbishment and redecoration.

People were safeguarded from the risk of abuse. Risks in relation to people's care were identified and detailed information about how risks could be mitigated. People were protected from the risk and spread of infections. Accidents and incidents were recorded and analysed to identify any trends or patterns. This helped to mitigate future risks and ensured lessons were learned. The provider had a safe recruitment process which assisted them in recruiting suitable staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Throughout the inspection we observed staff interacting with people in a caring and considerate way. We saw staff gaining people's consent prior to carrying out care tasks. People we spoke with were complimentary about the care and support they received.

Recommendation

We have made a recommendation about the provider implementing a more structured system to gather feedback from people and relatives on how the service was being run or what could be done better to drive improvements.

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 requires improvement (published 18 February 2022). Although we saw improvements had been made, the service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

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.

You can see what action we have asked the provider to take in the full report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Orchard Views is a residential care home that provides accommodation and personal care for older people. The home can accommodate up to 40 people in one adapted building. At the time of this inspection there were 31 people using the service.

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

At the last inspection some of the provider’s governance systems required improvement to ensure people continued to receive good quality and safe care. At this inspection we found the providers governance and quality assurance systems needed further improvements.

Medicines were not always managed safely which placed people at risk of harm. Staff did not receive competency checks on their performance and abilities to ensure they carried out their roles and responsibilities safely. Risks associated with people's care were identified but were not managed in a way that kept people safe.

Appropriate health and safety checks to the buildings and premises had not been carried out, placing people at risk of harm. People were not always protected by the risk and spread of infection.

The provider had a recruitment process in place which showed staff were recruited safely. The provider had systems in place to safeguard people from the risks associated with abuse. Staff were knowledgeable about how to safeguard people.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 December 2019).

Why we inspected

We received concerns in relation to quality assurance systems, the management of the service and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 the provider needs to make improvement. Please see the safe and well-led questions in this report.

You can see what action we have asked the provider to take at the end of this full report.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, assessing risk, infection control and governance.

Follow up

We will request an action plan for 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.

Orchard Views is a residential care home that provides accommodation and personal care for older people. The home can accommodate up to 40 people in one adapted building. At the time of this inspection there were 37 people using the service.

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

People were happy with the care they received at Orchard Views. People felt safe and well-treated by staff. People told us staff were kind and caring and it was clear staff knew people well. People were treated with dignity and respect and their independence was promoted. Although people were happy with the care they received, some people told us they did not have enough to do to keep them occupied each day. We have made a recommendation about the development of activity provision in the home.

The provider had completed the refurbishment of people’s bedrooms, since the last inspection. Further refurbishments were underway during this inspection. The refurbishment of the whole building had progressed slowly, however people and staff were pleased these works were being completed.

Risks to people were assessed and minimised, to help them remain safe from avoidable harm. People were supported by staff who received a range of training to ensure they had the right skills and experience to carry out their roles effectively. Staff supported people to maintain their health and they sought support and advice from health professionals, when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. People told us staff responded to them quickly if they needed any support and if they had any concerns, they would not hesitate to raise them with staff.

Some of the provider’s governance systems required improvement to ensure people continued to receive good quality and safe care.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 23 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

This comprehensive inspection took place on 18 October 2018 and was unannounced. This meant the staff working at the home and the people living at the home did not know we were visiting.

At our last inspection on 22 and 23 August 2017 the service’s overall rating was ‘Requires Improvement’. We saw work was required to improve the general environment of the service and staff training. One of the directors told us they hoped to complete all the redecoration and refurbishment of people’s rooms within six months.

At this inspection we saw the system in place to ensure staff received relevant training had improved. However, we saw sufficient action had not been taken to improve the general environment within the service. The director told us that more than 50% of the programme of refurbishment had been completed since the last inspection. We saw the main and side conservatory areas were not available for people to use. We also saw that people had limited access to the outside space. The overall rating of the service remains as “Requires Improvement”.

Following the inspection the director sent us an environmental improvement plan with a timeframe for completion. We recommend the registered provider monitors progress against plans to improve the service and take appropriate action without delay where progress is not achieved as expected.

There was a registered manager at the service. 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 who lived at Orchard View told us they felt safe and staff provided them with the support they needed.

Staff were aware of their responsibility to protect people from harm or abuse.

Medicines were managed safely at the service.

All the people and relatives we spoke with did not express any concerns about the staffing levels at the service. Our observations during the inspection told us that people’s needs were being met in a timely manner and we did not note any lengthy wait for a call bell to be responded to.

All the people and relatives we spoke with made very positive comments about the care provided and the staff.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food. Preferences and dietary needs were being met.

There were robust recruitment procedures in place so people were cared for by suitably qualified staff who had been assessed as safe to work with people.

Staff underwent an induction and shadowing period prior to commencing work, and had regular updates to their training to ensure they had the skills and knowledge to carry out their roles.

Staff we spoke with felt supported and received supervisions and appraisals regularly.

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

Care plans were detailed and were reviewed regularly.

People were treated with dignity and respect, and their privacy was protected.

There were end of life care arrangements in place to ensure people had a comfortable and dignified death.

People and relatives spoken with were confident in reporting concerns to the registered manager and staff, and felt they would be listened to.

We saw the service promoted people’s wellbeing by taking account of their needs including activities within the service and in the community.

We saw the registered providers quality assurance processes would benefit from being more systematic and methodical.

Further information is in the detailed findings below.

The inspection took place on 22 and 23 August 2017 and was unannounced on the first day, which meant no one related to the home knew we would be inspecting the service. The home was previously inspected in June 2016 when we judged the overall rating of the service to be ‘Requires Improvement’. We identified breaches of the following Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10 [Service users must be treated with dignity and respect] and Regulation 15 [Safety and Suitability of premises]. We asked the registered provider to submit an action plan outlining how they were going to address the shortfalls we found, which they did.

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

At this inspection we found that the provider had met the breaches in Regulation we highlighted at our last inspection. Improvements had been made to ensure the home was better maintained and met infection control guidelines. However, further work was required to improve the general environment of the home and staff training. We saw the registered provider had a detailed action plan that covered all the areas still needing attention, as well as plans for future improvements.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The home had a friendly atmosphere which people described as welcoming. Everyone we spoke with told us Orchard Views was a friendly, caring and safe place to live.

Throughout our inspection we saw staff supporting people in an inclusive, kind, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. The people we spoke with made positive comments about how staff delivered care and said they were happy with the way the home was managed.

People told us they felt the home was a safe place to live. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made.

A structured recruitment process helped make sure staff were suitable to work with vulnerable people.

People received their medications safely from staff who had completed medication training.

Recruitment procedures were robust; thereby ensuring essential checks were completed prior to staff commencing employment. Staff told us they had received an induction when they commenced working at the home, but we found this had not always been documented.

People we spoke with told us they thought staff had the right skills and knowledge to support the people who lived at the home. However, training records failed to evidence that all staff had completed the expected refresher training in a timely manner. The registered manager had identified this and was in the process of arranging further training.

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

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. People told us they were happy with the meals provided.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support.

People had been involved in need assessments prior to moving into the home, as well as in planning their care. Care plans outlined peoples’ needs, risks associated with their care and their preferences.

The home employed an activities co-ordinator to facilitate social activities. People told us they had enjoyed the activities provided.

We saw the complaints policy was available to people who used and visited the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. Complaints received had been recorded and investigated appropriately.

There were systems in place to enable people to share their opinion of the service provided. This included meetings, surveys and reviews.

There was a quality assurance system in place so the registered provider could monitor how the home was operating. Systems identified the majority of the shortfalls we found during our visit, and actions plans were in place to address them. However, this needed embedding into practice.

The registered provider had not always submitted notifications to the commission in a timely manner. However, this has since been addressed.

Further information is in the detailed findings below.

Orchard Views is a purpose built care home registered to provide personal care and accommodation for up to 40 older people. On the day of our inspection there were 31 people living in the home.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Orchard Views took place on 8 August 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

People who used the service were happy and content. They told us they felt safe living at the home and that the care they received was good.

The environment at Orchard Views was very tired and worn. Refurbishment work was required to make the home more comfortable. Most areas of the home were clean and tidy. We found sluice rooms, some toilets and bathrooms were in need of cleaning and hand washing supplies were not in place. You can see what action we told the provider to take at the back of the full version of the report.

Staff were trained to give people their medicines in a safe way. Medicines were administered, stored and recorded as per recommended guidelines.

Risks to people had been identified and staff were aware of these and what needed to be done to help keep people safe.

The provider had a recruitment procedure which helped to keep people safe because necessary checks were completed before staff were allowed to work in the home.

Staff were aware of their responsibilities in keeping people safe and had received safeguarding adults training.

The registered manager provided training, supervision and appraisals to staff in a positive way which helped to improve their skills and knowledge.

Staff were caring and communicated well with people. People had been given the opportunity to talk about their wishes at the end of their life.

Some toilets had locks which did not work and a shower room was not fitted with a lock. This meant people’s privacy and dignity was not protected. You can see what action we told the provider to take at the back of the full version of the report.

People had care plans which had been written taking into consideration their personal choices and preferences. Where appropriate relatives, friends and healthcare professionals had been involved in compiling care plans.

A planned programme of social activities was not in place although staff did spend time with people chatting and socialising. An activity worker had been recruited and was due to start at the home within the next few weeks.

There were systems in place to check people’s needs were being met.

The registered manager was well respected by people who used the service, relatives, staff and healthcare professionals.

Orchard Views is a residential care home which was providing care and support to 39 people at the time of our inspection. As part of the inspection we spoke with five people who lived at the home, one member of staff, one relative and the home manager.

This was a follow up inspection to check that improvements had been made in the safety and suitability of premises.

On our previous inspection on 27 May 2014 we observed a number of concerns in relation to the building and environment.

The manager of Orchard Views submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We visited the service on 7 August 2014 to check that improvements had been made to the safety and suitability of the premises.

We found people were being cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. Improvements to the environment had been made which helped to ensure the safety of people living there. However the general appearance of the home was 'tired looking' and there remained areas of the home that required refurbishment and redecoration.

One relative told us, 'I have no complaints about this home. The staff are fabulous and although the building is old and needs refurbishment it's clean and safe and the care makes up for this.'

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and staff told us they understood their role in safeguarding the people they supported. Staff had received training in safeguarding to ensure people were protected from the risk of abuse. People who lived in the home said, 'I feel very safe here, everyone looks after me' and 'I'm very safe, there's no reason not to be.' One relative told us, 'I can go home at night and sleep knowing my family member is safe and well.'

Care and treatment was planned and delivered in a way that was intended to promote people's welfare. There were risk assessments in place with people's planned care. These gave details of how individual risks to a person could be removed or minimised.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Whilst undertaking a tour of the home we observed a number of concerns in relation to the building and environment. We saw the roof was leaking which had caused damage to the walls and floors on corridors. We also found hazardous substances which could pose a threat to people's health and welfare were left in unlocked bathrooms and sluice rooms. Other concerns were also identified regarding the general appearance of the home and work that needed to be completed to ensure people's privacy and dignity was maintained.

We have asked the provider to tell us what they are going to do to ensure people who use the service, staff and others are protected against the risks of unsafe or unsuitable premises.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People and their relatives said they had been involved in writing them and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

We found people were treated with respect and dignity by the staff. During our inspection we observed staff speaking with people who used the service in a friendly and caring way. We observed care and support was provided to people when requested. Care workers we spoke with demonstrated a good understanding of the people's needs and were able to give examples of how they promoted people's independence.

People we spoke with told us staff were, "lovely" and "marvellous." A relative said, 'I visit my family member every day and have only good things to say about how staff deal with people.'

Two visiting healthcare professionals told us they had good working relationships with managers and staff at the home. They said, 'staff know people well and if we ask for any action to be taken in order to improve a person's health this is taken on board by staff and actioned.'

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

Staff and a relative told us the care and support provided was flexible to the person's needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed. For example one person was requiring one to one support and this was being provided.

People were able to join in with a selection of activities. We observed staff treating people with kindness and helping them with their daily activities such as personal care and social activities. We saw staff spending time with people on a one to one basis and it was very evident that people enjoyed this.

People knew how to make a complaint if they were unhappy. One relative said, 'I have raised concerns with the manager and staff and they have listened and put it right."

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke with one visiting healthcare professional who told us, 'We work well with the staff. They inform us of any concerns and we resolve them together. There is always staff around to assist us if needed.'

Staff had regular meetings with the manager and were kept updated about any information they needed to know about the service. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information.

The service carried out a yearly 'Quality Assurance Survey'. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends, staff and healthcare professionals. This showed people had the opportunity to put their views across.

The service had a quality assurance system. Monthly and/or weekly audits were completed regarding such things as medication, care plans, the environment, staffing and infection control. We found an analysis report detailing the findings of the quality assurance survey had not been completed.

People received safe and appropriate care that met their needs and ensured their welfare. We saw that more activities had been provided for people including exercises, karaoke, dominoes and a game of 'memory box'. Relatives of people we spoke with were pleased with the quality of care their family member received. One relative said, 'personally, we think (our family member) is cared for well. They're safe and cared for and have always been clean. The staff have got real compassion.'

People were given their medicines when they needed them. People who were able were encouraged to manage their own medicines.

The service had quality checking systems in place to manage risks and assure the health, safety and welfare of people who received care.

We found that people's personal records were accurate and kept safe and confidential. This meant people were protected from the risks of unsafe or inappropriate care and treatment.

The planning and delivery of care was not being carried out in a way that met people's individual needs. The majority of people we spoke with felt they were 'looked after alright', but often staff were busy and they were asked to 'wait a minute'. Our discussions with some people living at the home identified the service did not promote their wellbeing by taking account of their day time activity needs.

People were not protected against the risks associated with the unsafe use and management of medicines, because appropriate arrangements were not in place for the obtaining, recording, handling, safe keeping and safe administration of medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were not protected from the risks of unsafe or inappropriate care and treatment due to a lack of an accurate record in respect of people's care and treatment, including information and documents in relation to the care and treatment provided to each person.

People experienced care, treatment and support that met their needs and protected their rights. Comments from people and their relatives included, 'everything's very good. Meals are ok. People and staff are ok, so what more do you want' and 'It's not the best looking of places, but the care is good. There always seems to be plenty of staff and they treat people well. The meals are really good. I always look at the menu board. Overall I'm very satisfied.' However, inaccurate records in respect of people's care, placed people at risk of unsafe or inappropriate care and treatment.

People were not protected against the risks associated with the unsafe use and management of medicines, because appropriate arrangements were not in place for the recording and safe keeping of medicines.

People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

Effective systems were not in place to identify and manage risks relating to the health, welfare and safety of people using the service, the information in records and the analysis of incidents that resulted in harm or had the potential to result in harm to people.