Orchid Woodlands Healthcare Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Risks to people were not always assessed and mitigated, including those related to the environment. Medication was not always managed safely.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We didn't receive any feedback from people living at the home, or relatives about this area.

Staff said they were able to raise any concerns affecting their work with the management team.

The provider used a system for documenting accidents and incidents. However, although actions taken were recorded, we found little evidence analysis of what had occurred had been completed and lessons learned considered. This process is helpful in identifying patterns and trends and in preventing similar incidents from occurring in the future. When asked about accident and incident monitoring and looking for patterns & trends, the manager told us, “I’ve only just found the incident trends option on the system, so have not done this yet.” The provider’s complaints process was not robust or being used consistently. During the second day of the assessment, we asked the deputy manager for the complaints file. They told us they were unsure where this was and would speak with the manager. After doing so, the deputy told us there was currently not a complaints log or file, but the manager would create one for when we returned to complete the assessment. The manager provided a copy of the new complaints log via email. This was a spreadsheet dated 2024, which contained sections for recording who had complained, the nature of the complaint, actions taken and outcome. One complaint, submitted by a relative in June 2024, had been recorded. Although actions taken to address the concerns raised had been documented, there was no further information about whether these had been successful or what had been done to prevent the same issues from occurring again. The provider had a Duty of Candour policy in place, which explained the process which would be followed when an incident or accident had occurred, to ensure the provider was being open and honest with people involved and their next of kin. However, we saw no examples of the process being followed. We had sight of an email from November 2023, which the previous manager had sent to the provider.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the home. Comments included, “Everything is okay here. The staff are nice and I feel supported by them” and “I am safe here.”

Although records showed not all staff had completed or were up to date with safeguarding training, staff we spoke with, knew how to identify and report any concerns. Staff told us they would report any issues or suspected abuse to the senior on shift or management.

We observed staff treating people well throughout the inspection.

Abuse or allegations of abuse had been reported in line with local authority reporting procedures. As with accidents and incidents, whilst documentation explained what had happened and actions taken, reporting of outcomes and lessons learned was limited. A file was used to store information and applications relating to Deprivation of Liberty Safeguards (DoLS). The file contained a matrix which listed each person’s name, date DoLS application had been submitted, date it had been approved, when it expired and any conditions the local authority had attached to the DoLS. At the time of the assessment, 35 applications had been submitted. Of these 35, 13 assessments had been completed and DoLS granted, the rest were still awaiting an assessment by the local authority. We checked a random sample of the 13 DoLS which had been granted and noted a number of these had conditions attached, which had not been included on the matrix. We spoke with the deputy manager about this, who told us they had not finished adding all of the conditions onto the matrix. We looked at these people’s care records, and also found no record of the DoLS conditions. As such, we were not assured staff were aware of required conditions, such as ensuring specific risk assessments were completed or record keeping and monitoring was completed consistently.

People told us they felt safe living at the home. Comments included, “Everything is okay here. The staff are nice and I feel supported by them” and “I am safe here.”

Staff understood about people's care needs and any associated risks.

We observed staff treating people well throughout the inspection.

People’s care records contained a range of risk assessments, however, it was not clear whether they or a legally appointed representative had been involved in the risk assessment process. People’s risk assessments explained what the risk was and how this would be managed. Each risk was rated, either low, medium or high. Where people were at risk of falls, their care plan and risk assessment explained how the risk would be reduced and what action to take after a fall had occurred. Within at least 2 people’s records we noted reference to staff only using a hoist to support people up from the floor after a fall, if the ‘3 man lift’ was not successful. We asked the manager about this, who told us they were not sure what this meant, and that staff would only use recognised manual and people handling techniques. During the assessment, the medicines inspector observed staff using an inappropriate method to support a person to stand up. At least 1 of the 2 staff members grabbed a handful of the person’s trousers and used this to help pull them up. This is not a recognised manual and people handling technique, and could place the person at risk of harm. We reported this to the manager, who took prompt action to address this. Where people had experienced a number of falls, care records indicated they had been referred to the local falls team, for advice and guidance. We asked to see evidence of these referrals. For one person, although an initial referral had been made in 2019, a more recent referral had not been made until after we had requested evidence of this. At the time of the assessment, the home was experiencing an enteric outbreak, which was affecting a number of people living at the home and some staff members. The provider had taken appropriate steps to manage the outbreak, including isolating people with symptoms in one area of the home, who were supported by a designated staff team wearing all necessary personal protective equipment.

People living at the home did not make any comments about the home environment.

Staff did not make any comments to us about the home environment.

The manager told us some work had been completed since the last inspection to improve the décor within the home and upgrade fixtures and fittings. This included flooring being replaced in both lounges, lounges being painted and 17 new chairs being purchased.

At the last inspection in January 2023, we found required safety checks had not been completed consistently and there was no contingency plan in place to cover the absence of the maintenance person. We found the same issues at this assessment. We found gaps in safety check records. For example, weekly checks of the fire alarm system had not been documented between 18 January and 26 March 2024. There were also gaps between 3 May and 22 May 2024. We also noted there was no record of any fire drills having been completed. These are important to ensure staff understand their responsibilities in the event of a fire. Limited water safety checks had been completed, such as the cleaning and disinfecting of shower heads and running of infrequently used outlets or taps, with the only records on file being dated 31 January 2024 and 18 April 2024. Water temperature checks had been completed more consistently, and these showed hot and cold water coming out of people’s taps was within the recommended range. However, there were no records to confirm hot water was being stored at the correct temperature, which is important in managing the risk of legionella. None of the planned safety checks which were required, had been completed in February 2024. The current manager was unable to provide a rationale for this, due to only commencing post in April 2024. However, as no checks had been completed, it was apparent there was not a contingency plan in place to ensure contemporaneous monitoring was completed.

Enough staff were deployed to meet people's needs. People, relative and staff feedback supported this. One person told us, “I have a buzzer for if I need the staff and when I press it, they are quite quick to come and help.” A relative stated, “The staffing levels seem okay.”

Staff told us they tended to use same agency staff to help with continuity of care. The provider had improved their induction process for agency staff, with a detailed checklist in place which needed to be completed prior to them commencing shift. This ensured they had the information needed to work safely in the home and meet people’s needs.

We observed staff supporting people appropriately throughout the inspection.

Staff had not received sufficient training and support to ensure they could carry out their roles safely and effectively. The manager acknowledged this telling us, “Staff training is still an issue. There were too many sessions for them to complete on e-learning and completion rates were poor. I have put all staff on the care certificate, which is to be completed by the end of June.” The provider did not have a list of training they considered to be mandatory. We looked at the training matrix and selected sessions linked to the needs and safety of people living at the home. As per the manager’s feedback, completion rates were low. For example, of the 25 staff listed on the matrix only 9 had completed dementia training, 6 fire safety training, 12 manual handling training and 14 safeguarding training. The current manager had recently introduced a supervision schedule and commenced meetings with staff. Prior to this there were no records of staff receiving supervision, nor of having discussed the format and frequency of supervision during their annual appraisal as was stated within the provider’s supervision policy. The provider used a system for determining how many staff they needed to meet people’s needs. We noted staff rotas were completed using this information. The provider was currently reliant on agency staff to supplement staffing numbers. Staff told us the tended to use same agency staff to help with continuity of care. The provider had improved their induction process for agency staff, with a detailed checklist in place which needed to be completed prior to them commencing shift. This ensured they had the information needed to work safely in the home and meet people’s needs.

People living at the home and relatives did not make any comments to us about infection control.

Staff did not make any comments about this to us during the assessment.

The home appeared clean and tidy with cleaners on duty throughout the inspection. Communal bathrooms that we observed were clean and stocked with soap and hand towels. People looked clean and well-presented. Men were shaved and the ladies hair looked washed. People's clothes also appeared to be clean and we observed people were discreetly encouraged to change if there were any spillages.

Appropriate systems were in place regarding infection control and we observed cleaning staff carrying out tasks throughout the assessment.

People who were prescribed medicines at specific times, had their medicines on time. The actual quantities of remaining medicines did not always match the records; therefore we were not assured people had their medicines as prescribed. When people had thickener added to their drinks, to reduce the risk of them choking, it was not always recorded. Therefore, we were not assured people had their drinks thickened, which placed them at risk of choking. When other health professionals were involved with a person's medicines, their medicines administration record and other related documentation did not always contain all of the required information, this placed them at risk of harm.

Staff knew where to find the medicines policy and described the process they would follow if there was a medicines incident. The manager told us a healthcare professional attended the home weekly to review people and their medicines. A recent medicines audit had been completed by a pharmacist, however a number of the issues identified had not been actioned and were found to be an issue on this inspection.

When people had their medicines covertly, hidden in found or drink, the correct processes had not always been followed to ensure this had been done inline with the Mental Capacity Act 2005. Information to support staff to safely administer the medicines was not available to staff at the point of giving the medicines. A number of people were prescribed ‘when required’ medicines, information to support staff to safely administer these medicines was not always available so there was a risk people might not have got their medicines when they needed them. When people were prescribed topical preparations for example creams, they did not always have them applied as prescribed; this meant their skin was not being cared for properly.