Archived: Orchard House

Updated 22 June 2023

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 Health and Social Care Act 2008.

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

The inspection was carried out by 2 inspectors.

Service and service type

Orchard House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Orchard House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for five months and was planning on registering to become the registered manager but had not yet submitted their application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection, we spoke with the manager, the operations director, 4 rehabilitation assistants, 1 agency member of staff and a cook. We also spoke with 3 people using the service. We looked at records including 4 care plans, 4 staff files, including information about recruitment. We also looked at a range of records relating to the safety, quality, and management of the service. We sought feedback from 1 relative of those in the service, and healthcare professionals who visit the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection we spoke with the nominated individual, and the managing director. A nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 22 June 2023

About the service

Orchard House is a ‘care home’ registered to provide accommodation and personal care. The service is a neurological rehabilitation centre providing specialist community-based transitional rehabilitation for people with brain and spinal injuries, stroke, minimally conscious states, and a range of progressive neurological conditions. The service could support up to 11 people in one adapted building with communal areas. There were 10 people living at Orchard House at the time of the inspection.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met.

The provider did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. The management of medicines was not always safe. Not all staff were up to date with or had completed mandatory training. Staff did not receive regular supervisions, spot checks and team meetings were infrequent.

Staffing levels did not always support people to stay safe and well. Staff members did not always treat people with warmth, dignity and respect when interacting with people. People were not always supported to express their views using their preferred method of communication.

The service did not ensure that clear and consistent records were kept for people who used the service and the service management did not always inform CQC about notifiable incidents.

People, their families and friends did not feel that they were involved in the planning of their care. Care plans did not always contain information specific to people's needs or contain information on how to support people to manage any conditions they had, and in most cases up to date care plans were not in place. Staff were not provided with detailed guidance to follow when supporting people with complex needs.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Activities were limited and not all people using the service had access to available therapies.

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 outstanding (published 14 March 2019).

Why we inspected

We undertook a focused inspection of the key questions of safe and well-led to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safety of the service. These concerns were around up to date and accurate records and risk assessments not in place. There were also concerns about the effectiveness of the management in relation to governance by ensuring the service was safe and of a high quality. A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with other areas of the service, so we widened the scope of the inspection to become a comprehensive inspection which included all key questions.

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.

The overall rating for the service has changed from outstanding to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to good governance, person centred care, safe care and treatment, staffing, need for consent, safeguarding, duty of candour and fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.