Orchid House

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• 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

We reviewed 3 quality statements for this key question. There were systems to keep people safe from abuse and harm. Staff had a good understanding of how to safeguard vulnerable adults and the escalation routes for safeguarding concerns. Staff felt assured that management would deal with safeguarding incidents appropriately. We observed no direct safeguarding concerns however we did observe that some staff interactions were not always respectful. Staff had a good understanding of managing risks for people and showed awareness of positive and managed risk-taking with people who used the service. Risks to people’s safety were assessed and guidance was available for staff. We found one care plan did not reflect restrictions as described by one staff member. The registered manager confirmed the information in the care plan was correct. There were enough staff to meet people’s needs. Staff had applied to the local authority for Deprivation of Liberty Safeguards (DoLS) authorisations.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture 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.

Relatives told us people were safe and would raise concerns if needed.

Staff had a good understanding of how to safeguard vulnerable adults and the escalation routes for safeguarding concerns. Staff felt assured that management would deal with safeguarding incidents appropriately. The registered manager told us they were a member of the organisations West Region Safeguarding Board where they discussed safeguarding cases, failings and lessons learnt. They passed this learning on to their teams. Staff were aware of how to ‘speak up’ within the organisation and who to contact.

We did not observe any direct safeguarding concerns however we observed some staff interactions were not always respectful. This information was provided to the registered manager.

Safeguarding concerns were reported appropriately. There was a safeguarding policy in place with a reporting concern contact sheet. There was an on-call system in place between staff and management to escalate any safeguarding concerns. The anti-harassment, discrimination and bullying at work policies highlighted processes for raising concerns. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider had applied for DoLS authorisations appropriately.

Relatives told us that they were happy with the way risk was managed in the home. They told us they were involved in making decisions on how to manage risk and were kept updated when new risks were identified. Some relatives told us they had been involved in reviewing people's care and support plans in the past, but not recently. Comments included "I have been involved in the past, haven't done one for a few years" and "We haven't heard of anything for quite a while actually, I haven't seen any updates recently." Relatives told us their family members were supported to work towards long term goals, comments included "Yeah I feel since [person] has been there, [person] done so much, [person] out riding bikes which I never thought I'd see, [person] is out with friendship groups, I can't believe the change in [person] so happy." and "They do a lot of life skills with [person] which is what we want, [person] helps with housework and things like that."

Staff had a good knowledge of how to manage risk. One staff member told us “I try to be proactive when it comes to risks. Whether it’s supporting a resident to cross the road or when they are eating and at risk of choking. If there is ever an emergency, then I would know what to do thanks to my training. Depending on the severity I would determine what I would do. Whether I’d need to call emergency services, or if I’d call the doctors regarding a medical emergency or report to management if there was an urgent issue in the home.” The registered manager told us that they liaise with other agencies to manage risks such as “local community disability team, positive behavioural support (PBS) in house teams, neurology and epilepsy team, social workers, and nurses.”

We observed that staff were aware of some individual risks, for example, two people were required to have a staff member sat between them due to a number of previous physical altercations. We saw staff were doing this regularly. A staff member told us that some people had certain restrictions in place that were not always reflected in their care plan. For example, one staff member told us that a persons bedding needed to be removed and placed on the bedroom floor daily because the person would get distressed. The care plan did not reflect that bedding should be removed and placed on the floor. However, due to a medical condition the person should be monitored in their bedroom via a camera.

Care plans and risk assessments were detailed. All staff had completed autism awareness training and emergency first aid at work. Most of the staff have received training in positive behavioural support. There were policies in place that support positive risk taking and the management of aggressive behaviours. Some information in the care plans were not consistent with what some staff told us about risks for people. Daily record sheets show a variety of activities taking place which shows positive risk taking.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt their relatives were safe.

Staff told us they had sufficient training to meet their needs. One staff member told us that they would benefit from autism communication training. Staff told us they get regular supervisions and ongoing informal support through handover meetings. The registered manager told us that there were 5 staff members during the day and 2 at night, the rotas confirmed this information. The registered manager told us they had a high retention rate of staff. The provider prefers not to use agency staff and use other internal staff to cover annual leave and sickness to provide consistency for people.

We observed there was enough staff to meet people’s needs without rushing. One staff member told us “I believe 9 times out of 10, yes, I am able to care for the residents without rushing. Obviously, there are the odd occasions where there are less staff on shift due to someone calling in sick etc where then it is a bit more rushed, especially personal care.”

Staff had mainly been recruited safely. Employment checks had been completed prior to staff commencing work. There were two staff members where a reference was not sought from the previous employer. The recruitment policy stated: the decision on the suitability of an applicant, on the basis of their references, lies with the Home/Service Manager and supporting Assistant Regional Director & Regional Director and should be assessed on case-by-case basis. Correspondence viewed identified that a manager had assessed and decided on the suitability of the applicants. At the time of the assessment compliance for staff training was 90%. The registered manager confirmed that the company compliance for training is 80%. Staffing dependencies showed a good mix of staff working at different times. Staff had been provided with regular supervision and annual reviews. There was a recruitment and supervision and appraisal policy in place.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.