Orchard Court

We found the following examples of good practice.

People were part of a regular testing programme.

People were supported to have visitors and safe visiting processes were followed in line with national guidance.

Staff were vaccinated and took part in regular testing. They wore personal protective equipment in line with current guidance to minimise risk of infections potentially spreading.

The provider took prompt action to address a number of areas where aspects of infection control practice, and risk management were not being assessed and monitored consistently.

Orchard Court Care Home is a residential care home providing personal care to 25 older people at the time of the inspection. The service can support up to 43 older people, some may be living with a dementia related condition.

The accommodation is spread over two floors and is currently in the process of being refurbished.

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

A new management team had recently been appointed and were making improvements since our last inspection. They had identified where improvements were needed and had plans in place to embed them into the service.

People had access to an outdoor area with seating and various activities based on their interests and hobbies. Staff engaged people in meaningful conversations about their life histories. Some dementia friendly activities were in place which the provider was looking to enhance further.

People were supported to have maximum choice and control of their lives. The application of the Mental Capacity Act (2005) was in place.

Some risk assessments were not reflective of people’s current needs. The provider was in the process of updating these. Staff knew people well and could tell us how they managed risks to keep people safe.

Care plans were in the process of being reviewed and updated to include comprehensive records of people’s current needs. Staff were knowledgeable about the people they cared for and supported them in line with their wishes and preferences.

People and their relatives told us they felt safe and trusted the staff that supported them. Staff knew how to protect people from potential abuse or harm. Safeguarding incidents had been logged and reported to the appropriate agencies.

Medicines management had been improved to include appropriate administration and recording of topical medicines. The provider was in the process of reviewing their practices to address the management and recording of medicines for pain relief and behaviour management. Lessons learnt were shared with staff during team and daily huddle meetings.

Staffing levels were consistently maintained, and contingency plans were in place to manage any shortfalls. New recruitment procedures were being put in place to ensure newly recruited staff were suitable to work in care. Staff told us that communications between management and staff had improved, they felt more involved in decisions about their role and the management of the service.

The provider had scheduled a comprehensive training package to update staff’s skills and knowledge. Supervisions and appraisals had been scheduled for all staff and staff told us they felt supported.

The premises were designed to meet the needs of the people that used the service and further work was included in the refurbishment plans.

People told us staff were caring, kind and knew their needs well. Staff understood their roles and knew what was expected of them. Staff treated people with dignity at respect and supported them to be as independent as they could be.

The registered manager and the provider had plans in place to review all care records to ensure they were reflective of people’s current needs. These reviews included people and their relatives or representatives to ensure their feedback and views were captured.

Staff told us they felt supported and valued by the registered manager and that substantial improvements had been made in a short period of time. People and relatives told us they could speak with the registered manager at any time and felt welcome when visiting the service. Complaints and concerns had been dealt with appropriately and people felt they were able to discuss any concerns they may have.

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 16 October 2018). 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. The service has improved its rating to Good.

Why we inspected

This was a planned inspection based on the previous rating.

Orchard Court 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 home is situated in South Cave, a village in the East Riding of Yorkshire. It is purpose built over two floors, with two lounges, a dining area and other small seating areas. The service has a garden and a car park.

At our last inspection we rated the service good. At this inspection we found that improvements were needed in safe, effective, responsive and well-led and have rated the service as requires improvement.

The service had a registered manager who had been in post since January 2018. 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.

Areas of the environment were not regularly maintained and required attention. Possible risks within the environment were not assessed to ensure the safety of people.

Care plans were inconsistent and lacked detail. Risk assessments did not include guidance to enable staff to support people’s needs in line with their preferences.

Staff had received training in dementia care. However, observations showed a lack of positive interactions between staff and people living at the service. Activities were varied and we saw that staff welcomed visitors to the service. People were supported to practice their religious beliefs if they wished.

Complaints were not dealt with in line with company policies and procedures. Actions identified from complaints were not always completed.

Best interest meetings were not recorded or detailed in peoples care plans.

Quality assurance systems had not been effective in ensuring that standards in relation to record keeping had been consistently maintained. Audits had failed to identify some of the issues raised during this inspection.

Systems were in place to ensure people were safeguarded from abuse. Staff showed understanding of how to protect people from avoidable harm or abuse and were confident in raising concerns if they needed to.

We observed staffing levels were sufficient to meet people’s needs.

People who used the service told us that staff were caring. We observed staff supporting people in a way that promoted their dignity and independence.

Orchard Court is a care home which provides accommodation for up to 43 people. The service supports older people, some of whom may be living with dementia.

The service is located in South Cave, a village in the East Riding of Yorkshire. Accommodation is provided across two floors. The service also has two lounges, a dining room and bathrooms on each floor. There is a safe garden and car parking available for visitors. At the time of our inspection there were 43 people living at Orchard Court.

There was a manager in post who had registered with the Care Quality Commission in April 2017. 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 registered manager will be referred to as 'manager' throughout the report. The manager was on holiday during this inspection. A manager from another of the provider’s services supported us on the first day of this inspection. On the second day we were supported by the deputy manager and a regional manager for the provider.

At the last inspection in November 2016 the provider was rated as required improvement. This was because they were in breach of three Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance. We asked the provider to submit an action plan regarding the breaches identified and during this inspection we saw these actions were met. The service was no longer in breach of these regulations.

Systems and processes were in place that helped keep people safe from harm and abuse. Staff had completed safeguarding training and knew the signs of abuse to look out for and how to raise any concerns.

People told us they felt safe. The provider followed safe recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way. Medicine management practices were managed appropriately to ensure medicines were given safely and as prescribed by people's GPs.

The provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

People and their representatives told us they were involved in their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People's dignity and privacy was protected. Staff understood people's individual needs in relation to their care. Care plans were in the process of being improved and the new plans were centred on the person and reflected individual's preferences.

People who were able told us they were happy with the variety and choice of meals available to them.

People told us they were happy with the activities organised at Orchard Court. Activities were arranged for individuals and for groups.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the manager was approachable.

The provider had implemented a range of audits which were completed regularly to maintain people's safety and welfare.

Orchard Court is a care home registered to provide accommodation and personal care for up to 42 older people, including those living with dementia. It is situated in South Cave, a village in the East Riding of Yorkshire and is purpose built over two floors, with two lounges, a dining area and other small seating areas. The service does not provide nursing care. All bedrooms are single occupancy and fifteen of them have an en-suite toilet, with six of those also having shower facilities. The service has a garden and car parking for eight cars. At the time of our inspection there were 37 people living there permanently and one person staying there on respite.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last two years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered provider had systems in place to identify, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. However, there was a minority of staff whose actions were not always appropriate and which were perceived by people that used the service as 'bullying', which meant not all staff fully understood their responsibilities with regard to their behaviour. Risks were managed and reduced on an individual and group basis so that people avoided injury of harm whenever possible.

There was up-to-date electrical safety certificate and people were at risk of being locked in their bedrooms and unable to exit independently in an emergency. The registered manager arranged for an electrical safety check to be carried out soon after the inspection, but evidence of this was still unavailable three weeks later and was only sent to us when we requested it a second time.

We contacted the registered provider after the inspection, using our formal systems for requesting further information, and on 10 August 2016 we received a copy of an electrical installations inspection that had been carried out on 9 July 2016. We also received information that sneck locks had been removed from all bedroom doors and personal emergency evacuation plans had been produced for those people that required them.

Other utilities and the premises in general were safely maintained and there was evidence of this in the form of maintenance certificates, contracts and records.

Staff understood the principles of the Mental Capacity Act 2005 and the management followed these in relation to making applications for Deprivation of Liberty authorisations. On the day of the site visit we found that people were at risk of having their liberty deprived if their bedroom doors were locked when people were in them; this was rectified following this inspection. People were at risk of financial abuse because of inadequate management of their money held in safe keeping.

We saw that the service was not always well-led. People did not always have the benefit of a positive and empowering culture and although the management style of the service was positive, it was found to be very informal. We had a number of concerns about the culture of the service, which we shared with the local authority safeguarding team and asked the registered provider to investigate. This area of concern will be reported on at a later date when the registered provider and safeguarding team have concluded their findings.

There was a system in place for checking the quality of the service using audits, satisfaction surveys and meetings but these had not been used effectively enough to ensure risks were mitigated, people were properly consulted and the need for improvements were identified and made.

There was insufficient information obtained from people and what information was gathered was not analysed and used effectively to identify concerns that people had but were reluctant to express. All of this and the issues of minor concern identified in earlier sections of the report all added up to general ineffective management of the service. Risk assessment, monitoring and assessing of service provision and improving the quality of life for people through improvements in the service were inadequately addressed.

Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the people that were on duty. However, people expressed concern that their calls for assistance were not always answered quickly enough and they were resigned this would not improve. We made a recommendation about this.

Recruitment policies, procedures and practices were followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was generally safely carried out and so people were not at risk of harm from receiving medicines incorrectly, but receipting new medicines into the service and storing those that were unused and waiting to be disposed of, was not safely managed. We made a recommendation about this.

We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and appraised regarding their personal performance. Communication in general within the service was satisfactory but the management team were not aware of some medication practices or of some money that was missing and so communication was not always adequate.

People that used the service commented upon the approach and attitude of a small minority of the staff and the strength of these comments ranged from a view that some staff were ‘bullying’ to some staff were ‘controlling’ and ‘sharp tongued.’ This did not apply to all staff, however, but those people who raised concerns were clearly unhappy about it.

People’s privacy, dignity and independence were monitored and respected and the majority of staff worked to maintain these wherever possible. There was a minority of staff that did not ensure people’s general wellbeing because people inferred in their comments that staff ‘oppressed’ them into a way of thinking that removed some of their autonomy and resolved them into believing it was not worth challenging. This did not always ensure people felt respected or satisfied and were enabled to take control of their lives.

People were involved in most aspects of their care and were always asked for their consent before staff undertook care and support tasks.

People received adequate nutrition and hydration to maintain their health and wellbeing. The premises were suitable for providing care to older people and to people living with dementia.

People had person-centred care plans in place, which reflected their needs and which were regularly reviewed. Care files were adequate and told staff how best to meet people’s needs. Some minor re-formatting of care plans was taking place. People had the opportunity to engage in some pastimes and activities if they wished to in order to maintain an active mind. People had very good family connections and support networks and accessed the community via their relatives.

Equipment in the service was suitably and safely used and while most people preferred to mingle with each other some enjoyed the isolation of their bedrooms. However, we found that they expressed displeasure at not being visited regularly enough by staff. People were offered choice in most areas of their lives by the staff.

We found that there was a complaint procedure in place and people were able to have complaints investigated. Not everyone we spoke with felt they could complain without reprisals and so there was a dual belief among people that used the service. Therefore complaints to the service were few because people told us they felt it was useless to complain. People that used the service, relatives and their friends were encouraged to maintain healthy relationships together by frequent visits, telephone calls and sharing of one another’s news. We made a recommendation about this.

We found breaches of regulation in relation to good governance, safeguarding people from abuse and safe care and treatment. You can see what action we told the provider to take at the end of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were quite happy at Orchard Court. The said, "I have been here four years now and I find it very satisfactory," "We are well looked after" and "The manager is excellent and the staff are very helpful." We found that people were safely cared for by staff that were competent or appropriately supervised to do so.

People that used the service were protected from the risks of harm and the service was safe because there were systems in place to prevent abuse happening or to report and deal with it if it happened. The senior staff understood their responsibilities.

We found that the management of medicines was safe, because staff handling them had been trained to do so, safe systems were being properly followed and people received the correct medication at the time they needed it.

What we observed during our visit was a staff group that were efficient, kind, caring and considerate towards people that required their support. We found that peoples' needs were being appropriately met by capable and competent staff and therefore the service was safe.

Is the service effective?

People were effectively cared for because staff followed well developed and reviewed care plans which meant people effectively received the support they required.

Is the service caring?

Staff were caring and understanding and treated people respectfully. People said, "The staff are lovely," "We are well looked after" and "We get on well with the staff." We saw that staff were attentive to people at lunch time and helped them with their comfort.

Is the service responsive?

Staff were responsive to peoples' needs, but encouraged people to maintain their independence. Staff supported people when they required it.

Is the service well led?

The manager had begun to develop new ways of working and had produced new care plans for staff to follow. There was still 'some way to go' in respect of achieving high standards within the service but the manager knew what the shortfalls were and what still needed to be achieved. These were being worked towards.

There was a system of quality monitoring and assuring the care and support people required, which included surveys and audits and which had yet to develop to include other areas of the service so that all aspects were assessed.

In response the provider had sent us an improvement plan telling us how they would ensure the above standard was met. We visited Orchard Court and spoke with three staff and people who used the service about the improvements made. We reviewed their improvement plan and inspected the premises to check the improvements had been made. We also checked the overall safety, suitability and maintenance of the building and looked at other relevant documentation.

At this visit we saw the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

Due to having a variety of needs and communication difficulties, some people who used the service were not able to tell us directly about their care and treatment. We used a number of different methods to help us understand the experiences of people who used the service. During the day we sat with the people who used the service and observed their daily activities including the lunchtime meal. We also observed their interactions with staff. We spoke with some people who used the service, members of staff and a visiting health professional.

We saw care needs were discussed with people and/or their relatives and before people received care their consent was asked for. One person said 'We can choose when we get up. The staff know when I like my bath', and another person told us 'They know what I like ' they ask me'.

The visiting health professional told us they thought the cleanliness of the home was fine. There were effective recruitment procedures in place which ensured staff were employed with the appropriate qualifications, skills and experience necessary. The provider had systems in place to assess and monitor the quality of service that people received.

During our visit we noted a number of areas of concern regarding the safety and maintenance of the premises that could have caused harmed to staff and people that lived at the home.