Background to this inspection
Updated
14 May 2021
Background to this inspection
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out over two days, one inspector attending on day one, and two inspectors on day two.
Service and service type
The Orchards is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection-
We spoke with one person who used the service, three relatives, two care staff, two team leaders, the chef, the cleaner, the registered manager and the provider.
We reviewed a range of records. This included four peoples care records and multiple medication records. We looked at four staff files in relation to recruitment and induction. A variety of records relating to the management of the service, policies and procedures were also reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.
Updated
14 May 2021
About the service
The Orchards is a residential care home providing personal care to up to 21 people aged 65 and over, including people living with dementia. There were 14 people living at the service at the time of inspection.
The care home accommodates people in one adapted building which has been extended over the years and is set over two floors.
People’s experience of using this service and what we found
People at The Orchards did not receive a safe, effective and well led service. We identified concerns relating to people’s safety which included poor oversight of fire safety issues by the provider. A lack of training and guidance for staff on how to support people in the event of a fire, and insufficient staffing levels during the night. This put people at significant risk of harm.
The provider did not ensure staff’s competencies were checked in relation to training received. We have made a recommendation about this.
The provider had no oversight of the safety and quality of the service. Quality assurance systems were not established and operated effectively to ensure compliance with regulations. The premises were not well maintained, and areas were not fit for purpose. This included decoration and furnishings of the premises.
Medicines were not managed safely. Staff did not always have guidance to ensure they administered ‘as and when required’ medicines to people safely. Night staff had not been trained to carry out medicine administration.
Robust systems were not in place to monitor accidents and incidents which placed people at increased risk of harm. Systems did not give clear guidance to staff when to seek medical advice following an accident or incident. We have made a recommendation about this.
Safeguarding concerns had not been reported by staff and management. The registered manager was not clear of their role and responsibility in relation to safeguarding people.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; policies and systems in the service did not support this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This inspection was prompted by serious concerns we received about the service in relation to care management, staff support and training and poor condition of the premises.
We have found evidence that the provider needs to make improvements. Please see safe, effective and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Orchards Care Home on our website at www.cqc.org.uk
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 fire safety, management of medicines, staff training and support, failing to operate effective monitoring systems to improve the quality and safety of the service, poor record keeping, notifications of incidents, and safeguarding people from risk of harm.
Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.