Archived: Orchard House

Updated 18 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 24 and 30 January 2018. The first day of the inspection was unannounced, which meant no one knew we would be visiting the service. The second day was announced to ensure the registered manager and provider were available to speak with. The membership of the inspection team consisted of one adult social care inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection, we reviewed the information we held about the service. This included correspondence we had received and notifications submitted by the service. A notification must be sent to the Care Quality Commission every time a significant incident has taken place, for example, where a person who uses the service experiences a serious injury.

We gathered information from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information was reviewed and used to assist with our inspection.

Before the inspection, the provider had not been asked to complete a Provider Information Return (PIR) due to the rescheduling of the inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

We used a number of different methods to help us understand the experiences of people who used the service. We spent time observing the daily life in the service including the care and support being delivered. We spoke with nine people living at the service, one relative, the registered manager, the registered provider (the owner), a team leader, a senior support worker and a care staff member. We looked round different areas of the service; the communal areas, bathroom, toilets, and some people’s bedrooms. We reviewed a range of records including, three people’s care records, three staff files, medication administration records, incident records and other records relating to the management of the service.

Updated 18 July 2018

This inspection took place on the 24 and 30 January 2018. The first day of the inspection was unannounced. This meant staff and the registered provider did not know we would be visiting. Orchard House is a residential care home and provides support to adults with a learning disability and/or autistic spectrum disorder. The service can accommodate up to ten people. At the time of the inspection nine people were living at the service. People in this care home receive accommodation and personal care as part of their contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Orchard House is two terraced houses that have been converted into one building.

At this inspection we found six breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating of the service is ‘Inadequate’ and the service is 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, and if there is not enough improvement so there is still a rating of inadequate for any key question 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.”

There was a registered manager employed 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 we spoke with told us they felt ‘safe’ and did not express any worries or concerns.

Although people told us they felt safe, we found the premises and equipment were not clean or properly maintained. We also saw the premises would be challenging for people who had poor and decreasing mobility. The fire officer had also visited the service in November 2017 and asked the registered provider to make a range of improvements to make the service safer. The registered provider was still in the process of making these improvements.

We found the registered provider had not ensured that staff received regular safeguarding refresher training to ensure they had an understanding of their responsibilities to protect people from harm. At the time of the inspection the registered manager was liaising with the local authority in regards to providing staff training.

We found the arrangements in place for people who had monies managed by the service needed to be improved to protect people from financial abuse.

We saw the service’s recruitment procedures needed to be more robust to ensure people were cared for by staff who had been assessed as safe to work with people.

We did not receive any concerns from people or staff about the staffing levels at the service. However, a few people living at the service had complex needs and restricted mobility. The service only provided a staff sleep in service at night, which meant people’s wellbeing was not checked during the night. Neither did the service have a call bell system in place so that those people could summon for assistance if required. The registered manager told us they would provide people with restricted mobility with a wireless bell in their room so they could call for assistance from staff. During the inspection we saw the staffing levels in place could not ensure the people with poor mobility were supervised and monitored to an adequate level to ensure they were safe.

Medicines were managed safely at the service. However, we saw the storage of medicines required improvement to ensure they were stored appropriately and within a safe temperature range.

People had individual risk assessments for such things as deterioration in skin condition. We saw that some people’s risk assessments would benefit from being more detailed on the measures being taken to reduce their risk.

The service had a process in place for staff to record accidents and untoward occurrences. The registered manager told us the occurrences were monitored to identify any trends and prevent recurrences where possible.

People we spoke with told us they were satisfied with the quality of care they had received. Some people living at the service communicated with us by using signs and gestures to confirm they were satisfied with the care they had been provided. However, our findings during the inspection showed some of the routines at the inspection did not uphold people’s dignity and did not respect their human rights. For example, the routine of telling people they had to go to their room when medication was being administered. The registered manager told us this medication routine would be stopped.

We received mixed views from people about staff working at the service. People’s comments included, “Most of the staff are alright, they look after me,” “I get on with most staff,” “One staff member is less friendly than the others” and “The staff are great, you can have a real laugh with them and they care for us so well.”

We saw there was a lack of understanding at the service in regards to supporting people’s autonomy and independence in all aspects of their care and that people needed to be supported to the maximum extent. We saw people could be supported to be more involved in their community and have goals and aspirations. People could be supported to have more control over their monies.

People we spoke with made positive comments about the quality of the food provided and told us their preference and dietary needs were accommodated.

The service had not ensured staff had undertaken training which was regularly updated to ensure they had the skills and knowledge to support people effectively. For example, some staff required their first aid training to be updated. We saw staff had not undertaken any training about supporting people with learning disabilities.

The registered manager had recently reviewed people’s care plans. The care records showed people were provided with support from a range of health professionals to maintain their health. We saw the service had a good working relationship with the local GP and district nurses.

We saw the activities provided could be improved for people so they were provided with a range of leisure opportunities in the service and within the community.

The service had not received any complaints since the last inspection. People we spoke with felt if they had any concerns or complaints they would be listened to. However, we saw that people would benefit from being invited to express their views about the care and support in a range of accessible ways.

In our discussions with the registered manager we saw they cared about the people living at the service and had developed a trusting relationship with them. However, we found the culture of the service did not always question some of the practices at the service and the leadership did not drive improvement.

We found some of the quality assurance procedures in place to cover all aspects of the running of the service required improvement.