The Orchards Residential Home

The Orchards is a residential care home providing accommodation to up to 44 people. At the time of our inspection there were 39 people living at the service.

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

People living at The Orchards received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs.

Medicines were managed safely, and people received their medicines as prescribed. The provider had made significant changes and ensured there were clear processes and procedures to manage all aspects of medicines safely.

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 COVID-19 and other infection outbreaks effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The home was well-led by a registered manager who was committed to improving people's quality of life. We received positive feedback about the management of the home from people, relatives and staff. The provider and registered manager had made significant changes to the service including the environment. They had effective quality assurance processes which were used to improve people’s care. The service had a clear management and staffing structure in place and staff worked well as a team. Staff worked well with external social and health care professionals.

Rating at last inspection

The last rating for this service was good (published 26 September 2019)

Why we inspected

We received concerns in relation to staffing, recruitment, staff knowledge of people’s needs and management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The orchards Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Orchards Residential Home is a residential care home providing personal and nursing care to 43 people aged 65 and over at the time of the inspection.

The Orchards Residential Home accommodates 44 people in one adapted building. The home supports people with a range of needs and includes people living with dementia.

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

Medicines were not always managed safely. The registered manager took prompt action to address the issues found. Systems and processes were in place to keep people safe and risks associated with people's care needs were assessed and managed. There were sufficient staff to meet people's needs. There were effective recruitment processes in place to ensure staff were suitable to work in the service. The service was clean, and there were procedures in place to minimise the risks associated with cross infection.

The registered manager promoted a positive, caring culture which was evident across the whole staff team. People were positive about the staff and told us everyone was "Like one big family." People and staff felt valued and listened to.

People enjoyed living at The Orchards and benefitted from a wide range of activities which were planned to ensure they met people’s individual needs. Care plans were person-centred and reflected people’s preferences. Care plans related to end of life care were being developed. There were effective systems in place to investigate and respond to complaints.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People enjoyed their meals and received food and drink to meet their needs. Staff had the skills and knowledge to meet peoples’ needs and were well supported. People were supported to access health professionals when necessary.

The registered manager was committed to continuous improvement. There had been significant improvements in the service and feedback showed the improvements had been driven by the management team. There were a range of effective systems in place to monitor and improve the service. People, relatives and staff were involved in the service and felt valued for their contribution.

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 requires improvement (published 13 September 2019).

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.

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

The Orchards Residential Care Home accommodates up to 44 people in a three-storey building. At the time of the inspection there were 29 people using the service.

At the last inspection on 28 February 2018 and 5 March 2018 we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as inadequate and was placed in special measures.

Although the provider was meeting the regulations we have rated the service as Requires Improvement as we need to be sure the service can sustain the improvements.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a 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. At the time of the inspection the registered manager was not available and has since been deregistered with CQC.

There was a relaxed and cheerful atmosphere throughout the inspection. People were well cared for by kind and compassionate staff. The culture had improved and people were at the centre of staff and management actions. People looked well cared for and enjoyed many positive social interactions with staff during our visit. This included enjoyment of a range of activities which took account of people’s personal preferences and interests.

The home was being managed by a support manager who promoted a strong caring approach and had made significant improvements to the quality of the care people received.

People received food and drink to meet their dietary needs. Meals were enjoyed in a calm and sociable environment where people received support in line with their care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Improvements had been made in the systems to monitor the service and keep people safe. Medicines were managed safely. Risks to people were assessed and there were plans in place to manage the risks. There were sufficient staff deployed to ensure people’s needs were met.

Staff felt well supported and were positive about the improvements made. They were committed to the continuous improvement of the service.

There were systems in place to enable people and their relatives to give feedback about the service and people told us they felt listened to.

Improvements had been made to care records. However further improvements were needed to ensure records were accurate and reflected people’s needs.

We undertook this focused inspection to check that they had met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Orchards Residential Home on our website at www.cqc.org.uk

We undertook an unannounced focused inspection of The Orchards Residential Home on 19 June 2018.This inspection was done to check that improvements to meet legal requirements had been made. The team inspected the service against one of the five questions we ask about services: is the service safe?

The ratings from the previous comprehensive inspection for the other four Key Questions were included in calculating the overall rating in this inspection.

The Orchards Residential Home is a care home supporting up to 44 people. At the time of our inspection there were 32 people living in the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports people with a range of conditions which includes people living with dementia.

There was a registered manager in post at the time of the inspection. 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.

We found that improvements had not been made in all areas and the service was rated inadequate in the key question. Is the service safe.

Medicines continued to be managed in a way that put people at risk of not receiving their medicines as prescribed. Medicines were not always stored in line with manufacturers guidance which put people at risk of receiving medicines that were not effective.

Risks to people were not always assessed and there were not always plans in place to manage the risks. Staff were not aware of the actions required to keep people safe and there were not always records to evidence that risks were being managed in line with people's care plans.

Accident and incident records did not include any evidence of accidents and incidents being investigated. Where people had experienced an accident or incident there was no review of their care records to look for ways to minimise the risk of reoccurrence.

Infection control procedures had improved and the home was clean and free from malodours.

We found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection we met with the providers to discuss the concerns found. The provider has submitted an action plan detailing the action they will take to meet the regulations. We will follow up this action plan at the next inspection.

The Orchards Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Orchards Residential Home accommodates 44 people in one adapted building. At the time of our inspection there were 42 people using the service.

There was a 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 service did not promote a person-centred culture that valued people as individuals. People were not always treated with dignity and respect. Some staff were task focused and did not always treat people in a kind and compassionate way.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support best practice.

Systems to monitor and improve the service were not effective and the registered manager did not have a clear overview of the service and the quality of care being provided to people.

Accidents and incidents were poorly managed. There was no record of any action taken as result of accidents and incidents and no evidence of investigations being completed. There was no system in place to monitor accidents and incidents for trends and patterns.

Risks to people were not always identified and where risks were identified there were not always effective plans in place to manage those risks. Medicines were not managed safely to ensure people received their medicines as prescribed.

Systems in place to prevent the risk of infection were not effective. Areas of the home were malodorous. Some equipment was in a poor state of repair and not kept clean.

Staff were not deployed in a way that ensured people’s needs were met in a timely manner. Staff did not always have the skills and knowledge to meet people’s needs.

People did not always receive food and drink to meet their dietary needs and there was no effective system in place to monitor people’s weights, when required. Where people had lost weight action had not been taken to address concern’s relating to their weight loss.

Records were not accurate, up to date or fully completed. There were not always care plans in place and people’s care records did not always reflect their current needs.

Records were not stored securely to ensure people’s confidential information was protected in line with legislation.

People enjoyed a range of activities that were developed to meet their individual needs.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (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.

The overall rating for this service is ‘Inadequate’ and the service is therefore remains 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.

The Orchards Residential Home provides accommodation and personal care to up to 44 people, some of whom have dementia. At the time of our inspection, there were 41 people living at the home.

At our last inspection on 5 and 7 January 2016 we asked the provider to take action to make improvements relating to the management of risks and accidents and incidents.

At this inspection on 18 May 2017 we found the provider had made improvements to address our concerns from the previous inspection. However, we found records in relation to people who used the service were not always complete and accurate. Some information in care plans was out of date. The registered manager was redesigning and reviewing care plans. The manager conducted regular audits to monitor the quality of service. However, audits were not always effective. A recent medicine audit did not identify our concerns relating to medicine records. The registered manager immediately implemented a new audit system to address this concern. Learning from other audits had been used to make improvements.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. These included risks relating to the environment and falls. Staff were aware of people’s needs and followed guidance to keep them safe.

Accidents and incidents were investigated, analysed and action was taken to prevent reoccurrence. Learning from incidents was shared with staff to keep people safe.

People told us they enjoyed activities in the home and a published programme of events was available to people. We were able to observe activities taking place. Staff also interacted with people on a one to one basis.

We were greeted warmly by people and staff at the service. The atmosphere was open and friendly. The home displayed an open and honest culture where management and staff were keen to learn and improve.

People told us they were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff that were extremely knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

People received their medicines as prescribed. However, medicine records were not always accurately maintained. We raised this with the registered manager who took immediate action to address this concern.

There were sufficient staff to meet people’s needs. Staff responded promptly where people required assistance. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The service responded to people’s changing needs. People and their families were involved in their care and how their care progressed and developed.

Staff spoke extremely positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was very approachable and supportive and that there was a very good level of communication and trust within the service.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who clearly understood the dietary needs of the people they were catering for.

People we spoke with who lived in the home were generally positive about the care and support they received. One person we spoke with told us 'Staff are wonderful. Living here is the next best thing to being at home'. We saw evidence that good care and support was being provided.

There was an effective complaints system. Comments and complaints were listened to and acted on. The provider had access to advocacy services to support people who used their service.

There were enough staff to support people's needs. One person living in the home explained that they only had to press their call alarm and staff would come and assist them. Another person told us that if they asked then staff would take them out.

We reviewed the care plans of people living at The Orchards. We found that monitoring charts were now being consistently completed. We found that care plans contained information which was designed to meet their specific needs.

Whilst the provider had a complaints procedure we found that there were inconsistencies with the reporting and logging of complaints. People that we spoke with said that they would feel comfortable raising any concerns and felt confident that they would be listened to and appropriate action would be taken.

We found that people were protected from the risks of inadequate nutrition and dehydration. One relative told us that their family member loved the food. They said 'staff are very flexible here. When I arrived my family member was just having their breakfast as they had not got up till late'. Another person told us 'the chef is really good. If there is something I don't like they will always get me an alternative'.

Staff we spoke with told us that they received planned supervision and felt supported by the management team. They told us that they had access to training opportunities which were relevant to their role.

The provider had effective systems in place to monitor and evaluate the quality of services provided.

We saw that the home was kept clean and hygienic. Staff and people living in the home told us these standards were maintained.

We found that medications were correctly stored and administered.

The home had improved its procedure for staff recruitment and the correct checks and references were in place. People who lived in the home told us they were treated with respect by the staff.

The home had improved the systems in place to monitor and check the quality of care being provided and to manage potential risk.