Orchid Care Home

Orchid Care Home provides care to people who may require nursing care and for people living with dementia. Orchid Care Home accommodates up to 84 people in three separate units, each of which comprises separate purpose-adapted facilities. There were 51 people using the service at the time of the inspection.

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

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. Risks to people were well managed. Individual risks had been considered and incorporated into care plans.

The home was clean and odour free. People were protected from the spread of infection. Staff had access to PPE and had received training in how and when to use it effectively. We observed staff used PPE appropriately.

There were sufficient staff with the correct skill mix on duty to support people with their required needs and keep them safe. Medicines were managed safely.

People and staff felt supported by the manager. The provider had effective systems and processes in place to ensure the quality and safety of the service. Staff were proud of the service and felt well supported by the manager and the provider.

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 good (27 November 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the management of medicines and concerns about staffing levels. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

Orchid Care Home provides care to people who may require nursing care and for people living with dementia. Orchid Care Home accommodates up to 84 people in three separate units, each of which comprises separate purpose-adapted facilities. There were 76 people using the service at the time of the inspection. One of the units specialises in providing care to people living with dementia.

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

Risks associated with people's individual care needs, the premises and the equipment in use were assessed and managed. The provider employed enough staff to safely meet people's care needs. Systems and procedures were in place to ensure people received their medicines safely and as prescribed.

People's individual care needs were assessed before they moved into the home. Staff received induction followed by ongoing training and management support to enable them to work safely and effectively. External professionals were involved in providing care to individuals when necessary. Staff encouraged people who were under-weight to eat fortified foods. A range of menu choices was available.

People were supported to have maximum choice and control of their lives. Staff provided them with care and assistance in the least restrictive way possible and acted in their best interests. The policies and systems in the service supported this practice.

Staff treated people with dignity and respect and maintained their privacy. They were kind and caring and knew people well.

People's care plans were tailored to people's individual needs and promoted a person-centred approach. There was a complaints process in place which was managed effectively. The provider had procedures in place to identify and address people's wishes and choices regarding end-of-life care.

At this inspection we rated the service as requires improvement in the well led domain. This is because we need to ensure that the improvements made are well embedded into the service and that they are sustainable. People and their relatives spoke positively about the overall management of the service. Staff felt valued and supported by the management team. The management team understood their responsibility to inform people and relevant others if something went wrong with the care provided. They took steps to keep themselves up to date with current legislation and best practice guidelines, and sought to engage with people, their relatives and staff. The provider had quality assurance systems and processes in place to monitor and improve the quality of people's care.

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 requires improvement (published 4 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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’s experience of using this service:

People told us they felt safe living at the service. However, we found people were not protected from all risks because assessments regarding the risks of mobility and falls were not always reviewed and updated following an incident. Accidents and incidents were not always analysed for trends and patterns which resulted in some people not being referred to health care professionals. People told us there were not enough staff to keep them safe.

There was no registered manager in post. The management and governance arrangements of the service were not adequate and therefore staff felt unsupported by the management team. Medicine audits were effective, however, care plan audits failed to identify shortfalls revealed during our inspection. We were not always notified about accidents/incidents taking place in the service.

Staff were recruited safely and they knew how to protect people from abuse.

Rating at last inspection: At the last inspection the service was rated requires improvement (published 11 November 2018) and there were multiple breaches of regulation. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider continued to be in breach of the regulations.

Why we inspected: We undertook this focused responsive inspection on 9 May 2019. This inspection was carried out following concerns reported by health professionals about staffing levels not being appropriate to meet people’s needs. At the previous inspection in October 2018 we had rated the service ‘require improvement’ with breaches of regulations in the ‘safe’ and ‘well-led‘ domains. At the latest inspection we looked to see if improvements in these areas had been made since the last inspection.

Enforcement: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 CQC (Registration) Regulations 2009. 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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Orchid Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Orchid Care Home provides care to people who may require nursing care and for people living with dementia. Orchid Care Home accommodates up to 84 people in three separate units, each of which have separate purpose-adapted facilities. There were 81 people using the service at the time of the inspection. One of the units specialises in providing care to people living with dementia.

At our last inspection on 17 and 18 August 2017 we had rated the service 'Requires Improvement' and identified breaches relating to management of medicines, failure to follow the Mental Capacity Act 2005 (MCA), and records being out-of-date.

Following the last inspection, we asked the provider to complete an action plan. We needed the provider to inform us how they intended to improve.

There was no registered manager in post. 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. The application to register the manager with the Care Quality Commission (CQC) was submitted precisely on the first day of the inspection.

Recruitment checks of new staff were not sufficiently robust to ensure candidates were safe to work with people using the service.

Records contained in the emergency folder and the fire risk assessment were out -of -date. We raised these issues with the manager and saw evidence they updated the information on the second day of the inspection.

Where it was questionable whether a person had capacity to make care and support related decisions, the service did not always follow the principles of the Mental Capacity Act 2005. The Act helps to ensure actions are taken in people's best interests.

People gave mixed feedback about the quality of meals served to them.

There were gaps in the care records. Quality assurance systems were in place but not always effective and had failed to identify the issues which we found at the inspection.

Staff told us they were not always supported to obtain nationally recognised qualifications and were not always actively involved in developing the service. They told us they were not able to participate in discussing and considering new ways of enhancing the service, including changes in the management structure, which affected their work.

People told us they felt safe. Systems were in place to ensure people were safeguarded from abuse. Staff knew how to protect people from avoidable harm or abuse and were confident in raising concerns if they needed to.

Staff received support through one-to-one or group supervision, regular meetings and performance appraisals.

Effective general healthcare support was provided and external healthcare practitioners were consulted when required.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

People's privacy and dignity were respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

There was a range of activities available to people both within the home and in the local community that were adjusted to suit people’s preferences.

People had access to a complaints procedure and people knew how to make a complaint if they needed to.

People, their relatives and staff praised the manger. Although the manager had been newly appointed and it was too early to see significant improvements, the manager was perceived as very accessible and listened to the views of others and acted on them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we advised the provider to take at the back of the full version of this report.

A registered manager was employed 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.

Medicines were not always managed safely. We inspected medicines at a time when the provider was switching to a new medicine provider. We found some people had not received their medicines as prescribed. We also found some medicine administration sheets were unclear which could lead to error. There were discrepancies in topical medicine administration (skin creams) and a lack of protocols in place to guide staff in administering medicine which people might need occasionally, known as PRN (Medicines that are taken “as needed” are known as “PRN” medicines.)

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Staff were aware of when people who lacked capacity could be supported to make everyday decisions and staff understood how to gain consent to care and treatment. A staff member told us they gave people time and encouraged people to make simple day to day decisions. Where people lacked the capacity to make decisions for themselves, there were some processes in place to ensure that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. However, documentation in people’s care records did not support the Mental Capacity Act Code of Practice being followed. We found people did not have individual capacity assessments in place to guide staff about what decisions people were able to make for themselves when there was concern over their decision making ability. There was little written evidence that any effort had been made to enable people to understand the decisions being asked of them. Advance care plans were in place but undated and signed by people’s relatives who did not have the legal authority to sign these. These had also been written by staff when care records indicated people no longer had capacity. Capacity assessments in place were generic and not decision specific.

People’s care records required improvement. We found there was not enough detail in care plans to guide staff. For example, if people had mental health needs, skin care needs or particular health needs such as diabetes.

People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. People were involved in planning the menus and their feedback on the food was sought. Allergies and preferences were known. We observed people’s meal time experience on one of the units. The way lunch was served was not always tailored to meeting individual preferences and needs. People at risk of poor hydration or nutrition we monitored closely and cared for well. However, people’s care records lacked sufficient detail on how to manage their dietary needs or requirements. These issues were fedback to the registered manager who took prompt action to address concerns.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant that people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff received a thorough induction and essential training to ensure they were skilled in their roles. Competency was monitored and staff were supported through a regular system if informal and formal supervision. Additionally health and social care qualifications and enhanced clinical skills training was offered to staff to meet people’s needs.

People had their healthcare needs met. Robust handover processes ensured important information was shared quickly with staff. Prompt referrals were made to external professionals when required. People were supported to see a range of health and social care professionals including social workers, chiropodists, physiotherapists and doctors.

Staff were thoughtful and kind. Their care and love for people at Orchid Care made people feel they mattered. Staff and relatives gave many examples of staff making people someone feel special. Feedback we received about staff was good.

End of life care was good. People’s last days were dignified; pain free and relatives were fully involved and supported at all stages. However, end of life care plans were minimal.

There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about ‘personalised care’ and ‘respecting people’s choices’ and had a clear aim about improving people’s lives and enabling opportunities where possible.

There was a management structure in the service which provided clear lines of responsibility and accountability. A registered manager was valued and well respected. They were supported by a caring team of nurses and support staff who had designated management responsibilities. People told us they knew who to speak to in the office and any changes or concerns were dealt with swiftly and efficiently.

Feedback received by people, relatives and professionals about the service and staff was positive. The registered manager and staff monitored the quality of the service by regularly speaking with people to ensure they were happy with the service they received. People, relatives and professionals told us the management team were excellent, visible and included them in discussions about their care and the running of the service. However, systems and processes required improvement to ensure audits were identifying potential problems within the service related to mental capacity, medicine management, care planning and records keeping.

We found three breaches of regulations, namely Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have advised the provider to take at the end of this report.