This inspection took place on 30 January and 2 February 2017 and was unannounced. At our last comprehensive inspection in January 2016 we found one breach of regulations in relation to good governance. When we carried out a follow-up inspection in June 2016 we found the provider had made the necessary improvements and the service was meeting legal requirements.Orchard House provides accommodation with nursing and personal care for up to 44 people. This includes palliative and end-of-life care. At the time of our inspection there were 35 people using the service.
The service was required to have a registered manager in post but did not have one at the time we carried out this inspection. However, the home did have a manager who had recently been the registered manager at another service operated by the same provider and was in the process of applying to become the registered manager at Orchard House. 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 this inspection we found three breaches of regulations in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and good governance. Some taps in handwashing sinks produced water that was hotter than the maximum safe temperature. Chemicals were not always stored securely and in appropriately labelled containers. Some risks around people’s use of the garden and the storage of large pieces of equipment in bathrooms were not assessed and managed appropriately. There was not a robust system in place to monitor and check stock levels of some medicines, meaning errors or unauthorised removal of medicines could go unnoticed. Additionally, we found that some people may have been deprived of their liberty without the correct legal safeguards in place because the provider had not always followed legal requirements in relation to this. The provider had quality checks but they were not robust enough because they had not identified these problems.
You can see what action we told the provider to take at the back of the full version of the report.
The provider had systems in place to protect people from the risks of infection and poor hygiene, including food hygiene. People had individual risk assessments and management plans to help protect them from risks specific to them and the care they received. Staff received appropriate training around safeguarding people from abuse and there were procedures in place to enable staff to identify and report possible abuse promptly.
There were enough staff to keep people safe, although some people and staff felt there were not enough to spend meaningful amounts of social time with people. There were systems to review staffing levels and ensure they remained safe. The provider had robust recruitment systems to help protect people from the risk of being cared for by unsuitable staff.
Staff obtained people’s consent before carrying out care tasks. Where people did not have the capacity to consent, the provider confirmed this by carrying out capacity assessments and involved families and other professionals involved in people’s care to help ensure decisions made on their behalf were in their best interests.
The provider gathered information from a variety of sources to help staff keep up to date with current research and best practice. Staff had access to the training, supervision and support they needed to carry out their roles effectively.
People were able to choose from a variety of suitable, nutritious food and drink that met their needs. Staff monitored people’s weight and other health indicators when needed, using the data to inform them when they needed to support people to access health services. People had regular access to healthcare professionals for check-ups and appointments. Staff shared information when needed to help them monitor people’s health and wellbeing.
Staff spoke to people in a kind and respectful way, although sometimes they talked about people’s private matters within earshot of others. People’s personal records were not always stored securely to maintain confidentiality. However, staff knew how to promote people’s privacy, dignity and independence while providing personal care.
Staff used appropriate communication styles, knew people well and had built friendly caring relationships with them. They knew about people’s likes and dislikes and supported people to make choices about their care.
Staff assessed people’s needs and produced personalised care plans that took into account people’s wishes, preferences, religious and cultural needs, healthcare needs, what they could do for themselves and what they needed more support with. The service worked to ensure smooth transitions when people moved between services, particularly with hospital admissions. The service worked well with other providers to ensure people’s needs were met and that staff had access to any expert advice they required to meet people’s needs effectively.
Although activities were provided, some people who remained in their bedrooms during the day did not have access to these and some people did not feel they had a choice of activities corresponding with their interests and needs. We recommend that the provider seek appropriate guidance on providing person-centred activities for the people who use the service.
The service had an accessible complaints policy and there was evidence that managers responded appropriately to people’s concerns. The provider carried out an annual survey to gather people’s feedback and this was used to improve the service. The feedback we received about the manager was positive and the service had an open culture where people, relatives and staff had opportunities to express their opinions about the service.