Archived: Orchard Lodge

Updated 27 November 2021

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

This inspection took place between 14 and 24 September 2020. The inspection team consisted of three adult social care (ASC) inspectors, and a medicines inspector.

On 18 September two ASC inspectors carried out an inspection visit to the service. Between 14 and 24 September all four members of the inspection team reviewed care and medicine records and spoke with staff remotely.

Service and service type

Orchard Lodge 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.

The service did not have a manager registered with the Care Quality Commission. This means the provider held sole legal responsibility for how the service is run and for the quality and safety of the care provided.

The service had a manager who had been in post since February 2020 and was in the process of registering with the CQC.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to work with the provider to agree the safest way to inspect during the Covid-19 pandemic to minimise the risks to people who live at the service, staff and our inspection team.

What we did before the inspection

Before the inspection, we reviewed information we held about the service. We considered the information which had been shared with us since the last inspection by the provider as well as the local authority, other agencies and health and social care professionals. We requested medicine and care records, incident reports, rotas and quality assurance records. We worked with the provider to plan the safest way to inspect the service during our site visit.

During the inspection

We spoke with the service manager, the clinical lead, a registered nurse (RGN) and various support staff. We reviewed people’s care and medicine records. We spent time talking to and observing people being supported, including during lunch. We visited some people’s bedrooms.

After the inspection

We continued our review of people’s care and medicine records, training records, rotas, incident reports and quality assurance records. We spoke with the manager, an RGN, three healthcare assistants, a registered nurse and two relatives of people using the service via telephone.

Updated 27 November 2021

About the service

Orchard Lodge is a residential care service that is registered to provide accommodation, nursing and personal care for people with learning disabilities or autistic spectrum disorder, physical disabilities, and younger adults.

The service was registered for the support of up to 33 people. At the time of the inspection 13 people were using the service. The service consisted of two separate bungalows, Orchard and Bouldings Lodge, and was in private grounds in the countryside near a large town.

Orchard Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

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

There was unsafe assessment, monitoring and management of risk for people with support needs regarding behaviours that may challenge, sexuality, constipation, aspiration, respiration, skin integrity, mobility and posture. Staff did not always have the required competencies or knowledge to meet people’s individual needs safely. This had meant people had been exposed to risk of harm and had been harmed.

Staff practice, and reporting systems to safeguard people from abuse, were not always effective to ensure people were safe from harm. Lessons were not always learnt, and actions not taken to investigate safety incidents and prevent them re-occurring. This had exposed people to actual and high risk of harm over prolonged periods.

People’s care records were not always up to date or accurate. Service management and the provider’s wider quality assurance and governance systems had not always ensured actions were taken to address any issues and risks in a timely manner. The provider had failed to act upon known areas of concern, non-compliance and risk to improve the quality of care for people at Orchard Lodge. This had exposed people to on-going poor care and risk of avoidable harm.

Medicines were not always managed safely. People had not always received their medicines as intended when required. PRN protocols were not always accurate according to what was prescribed or gave clear instructions for staff to manage people’s medicines. This increased the risk people’s medicines may not be given safely or effectively.

Feedback from partnership agencies indicated staff were taking steps to improve their engagement and initiative to refer people for outside help, although work was required to make sure all recommendations were then acted on. We found examples where ineffective partnership working had impacted on people's safety.

Staff practice regarding risks associated with service users deteriorating health and hydration had improved since the previous inspection, although more work was needed to make sure staff practice was consistent in these areas.

Arrangements to make sure the premises were kept clean and hygienic on a day to day basis were not always effective. There were offensive odours caused by urine in one person’s room and significant unidentified staining on walls in other people’s bedrooms. This increased the risk of infection.

The provider had taken action to manage infections during the Covid-19 pandemic. Additional infection prevention and control measures in line with Department of Health and Social care guidelines had been put in place to ensure people’s safety.

Staff always wore personal preventative equipment (PPE) when supporting people. The provider had ensured there were adequate stocks and supplies of PPE available. Staff had alerted appropriate external agencies in when they had displayed signs and symptoms of Covid-19. This had helped prevent infection and maintain people’s health and well-being

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting did not maximise people’s choice, control and

independence.

The model of care delivery at the service focused on people’s medical, rather than their social support needs.

The location of the service was geographically isolated, and people relied exclusively on staff to be able to leave. Opportunities for people to access the local community were limited.

Staff wore uniforms and name badges to say they were care staff when supporting people inside and outside the service.

The size of the service was larger than current best practice guidance. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of each bungalow to indicate it was a care home.

Right care:

Care was not always person-centred or promoted people’s dignity, privacy and human

Rights.

People’s privacy and dignity had not always been considered, respected or understood by staff.

Staff did not always respond in a timely or compassionate or appropriate way when people experienced pain or distress.

Right culture:

The provider told us they planned to make changes to ensure they could provide compassionate and inclusive support that promoted people’s choice and independence.

However, significant work was still needed to change the existing culture, ethos, attitude and practice of staff at Orchard Lodge in order to achieve this vision.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 21 February 2020). The service remains rated inadequate. The service has been rated inadequate for the last four consecutive inspections.

At the last inspection we found multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 20 and 21 November 2019. Breaches of legal requirements were found. We undertook this focused inspection to confirm the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard Lodge 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 four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations 12, 13, 17, 18 in relation to: safe care and treatment, safeguarding people from abuse, good governance and staffing.

We have also identified a breach of Care Quality Commission (Registration) Regulations 2009 in relation to failing to notify CQC of incidents regarding abuse or allegations of abuse in relation to service users.

We took enforcement action to issue a Notice of Decision to vary a condition of the provider's registration and remove this location. Orchard Lodge is now de-registered and the provider is no longer able to provide regulated activities at or from this location.