Archived: Orchard House

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.

All of the people living at the home that we spoke with gave us positive feedback about the home. Some comments included 'I like everything about it. I want to stay here' and 'It's clean and up to scratch. The food is great.' We found that people's privacy, dignity and independence were respected.

All of the people using the service that we spoke with told us that the care and treatment in the home was good. One comment included 'I feel well looked after here.'

We found that the provider had taken steps to provide an environment that is suitably designed and adequately maintained.

We spoke with staff and we were told 'We feel like we are well supported' and 'really supported by the owners. We can call them anytime day or night if we need support.' People living at the home told us that they liked the staff and they were caring.

We found that the quality of care was monitored and safety maintained through effective incident reporting, audit and responding to complaints.

We spoke with two members of staff; they told us that they 'enjoyed working here.'

We looked at the care plans of three people who used the service. We saw that they were comprehensive and tailored to meet the needs of the individual. We saw that risk assessments had been carried out but there were no action plans to ascertain how the risks identified would be reduced.

We saw that there was a policy in place to protect the people in the home from abuse. We spoke with the staff and they told us they had received training in safeguarding.

The service operates within an old building and we saw that a lot of repair work needed to be done such as plastering and decorating. The inside of the house was in need of updating and cleaning throughout. The owner of the home and the manager of the service told us that they were aware of this and had plans to address this.

We spoke with the relatives of the people who used the service. They told us they were 'happy with the care' and that this service was the 'best one our (relative) has lived in.'