Little Orchard

Updated 25 May 2022

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 Care Act 2014.

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

Two Inspectors, a member of the CQC medicines team and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Little Orchard 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. Little Orchard is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about Little Orchard since their last inspection including notifications of significant events in 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. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service about their experience of the care provided. People who used the service used different ways of communicating including body language and gestures and equipment. People using the service lacked capacity to provide us with feedback, so we contacted relatives on their behalf. We spoke with five members of staff including support workers, the maintenance person, the registered manager and an area director.

We spent time observing people and staff to understand how they interacted and provided support.

We reviewed a range of records. This included two people’s care records and four medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with five relatives by telephone to seek feedback on the service.

Updated 25 May 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Little Orchard is a residential care home providing accommodation and personal care to up to six people. The service provides support to younger people who have learning and / or physical disabilities or autism. At the time of our inspection there were four people using the service. Little Orchard accommodates four people on the ground floor of the premises and there are two vacant rooms on the first floor. The premises are in a converted house in a village location and has a large garden and ample communal areas where people could gather should they want to. Plans are in place to refurbish areas of the service that need updating.

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

People were not consistently protected from risks of harm due to care plans not always being followed, care records not being reviewed or audited and equipment settings not being checked for accuracy.

People were supported by staff trained in safeguarding who would report concerns should they have any. Risks were assessed, and actions taken to minimise residual risks of harm. The management of medicines was mostly effective however we have made a recommendation to improve safety.

We had a concern about use of personal protective equipment that was addressed immediately by the registered manager. We have also made a recommendation about infection prevention and control. The premises were clean, and the provider was following current guidance on visiting care homes.

We were concerned at some staff members communication skills as they were not fluent in English which was the main language of people using the service. We have made a recommendation about this.

Staff were safely recruited and completed an induction before commencing in post.

People’s needs were assessed and developed into clear and informative care plans covering all aspects of peoples care and well-being. Staff participated in regular supervision one-to one meetings and staff meetings. There was a wide range of training some face to face and some online.

People were supported to eat and drink meals prepared according to their taste and needs. Appropriate referrals to SaLTs and the dietician were made and concerns about people’s weight and appetite raised with the GP.

The premises were accessible and met people’s needs however there were refurbishments planned to enhance peoples experience of living there.

The registered manager had an understanding of the MCA and ensured decisions were made in line with this. Staff also understood people’s communication well and could interpret body language and gestures.

People were at ease with staff and staff were clearly fond of people using the service. There were mostly kind and caring interactions throughout the inspection. Staff respected people’s privacy.

People had communication plans in place and details of these were included in their hospital passports. A recent development was an individual newsletter mainly featuring photos of people being produced for people to share with friends and relatives.

There were some activities taking place and people had activities planners. These were not clear and needed additional details to inform peoples and staff what would be happening.

The registered manager had worked hard to improve relationships with relatives. There had been no recent complaints raised.

There were some end of life care plans in place which were detailed and person centred considering not just the person but their relatives as well.

The registered manager had been in post for around eight months and had made significant improvements to aspects of the service. There were some concerns about the oversight of records, and audits were not always effective.

The service demonstrated how it was meeting the principles of Right support, right care, right culture.

Right Support

When possible, people were supported to make choices in their daily lives and to participate in activities that were fulfilling. People had personalised rooms and the provider was working to incorporate more sensory aspects into the service. People accessed the community taking local walks, using the local pool for swimming, and accessing a local day service provider. People were referred to appropriate health and social care professionals to enhance their well-being.

Right Care

We saw kind interactions between staff and people, and staff were familiar with people’s communication needs. People’s wishes were considered as well as needs, and sessions such as swimming and bowling arranged so people could join in their chosen activities.

Right culture

Relatives were involved in developing peoples care plans and advise was also sought from health and social care professionals to inform planning. There were long service staff working at Little Orchard who knew people well and who provided consistent care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

We carried out this scheduled, unannounced inspection as the service had been newly registered under a different provider and to assess that the service was applying the principles of Right support right care right culture. 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.

Enforcement

We have identified a breach in relation to how the provider set up and maintained equipment, and a lack of oversight of records at Little Orchard. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.