Orchard Lodge Care Home

Updated 18 June 2021

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.

Inspection team

The inspection was carried out by one inspector and one inspection manager.

Service and service type

Orchard Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission at the time of inspection. Although the provider had appointed a manager, who had begun the process of registration. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

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 Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with one person who used the service about their experience of the care provided. We also spoke with two care assistants; one cook; one housekeeper; one nurse; the manager and the provider. The provider is responsible for supervising the management of the service.

We asked the manager to send us a range of records so we could review these away from the care home. Records included care plans, risk assessments, medication records and staff training and supervision records. Additionally, we requested some policies, the provider’s statement of purpose and other records relating to the management and oversight of the service.

After the inspection

Following the visit, the inspection continued, and we reviewed the records which were sent to us. We also spoke with one further nurse and had contact with a trainee GP; a pharmacist and a palliative care nurse. We spoke with another person who used the service and four peoples’ relatives. We sought further clarification from the manager and provider so we could confirm the accuracy of the records.

Updated 18 June 2021

About the service

Orchard Lodge Care home is a care home providing accommodation and nursing care to older adults who may be living with dementia or life limiting conditions. The service is a two storey adapted building and can support up to 28 people. At the time of our inspection the first floor of the service was not being used and six people were living on the ground floor.

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

Medicines were not always managed safely. We identified improvements were required for medication recording practices and administration protocols. Whilst we did not find people had come to harm, there was an increased risk. Management oversight in this area should be reviewed.

The provider’s end of life care protocols and procedures required review. We found that guidance was not always available for staff, and further training was required. This had been identified by the provider and manager prior to our review, and specialist training had been sourced. The training took place during our inspection timeframe and we will review its effectiveness at the next inspection.

Relatives told us the manager and provider had offered increased communication updates during the COVID-19 pandemic, however, this had not always been received. Relatives also told us they were left with some uncertainty because the provider had not maintained communication following the service being placed in Special Measures. We have fed this back to both the manager and the provider for their review.

We have made a recommendation for the provider to review their medication and end of life procedures and protocols. Additionally, the provider should consider how best to embed general communication methods with relatives.

People told us they felt safe at Orchard Lodge Care Home. Staff completed safeguarding training and had the skills and knowledge to identify and report any concerns should staff become aware of these.

People’s needs had been assessed, and we found consent to care and best interests had been explored. Referrals took place for specialist health care reviews, and we received positive feedback surrounding this practice.

People’s eating and drinking needs had been assessed and specialist advice and requirements were followed by staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, and in their best interests; the policies and systems in the service supported this practice.

Relatives told us staff updated them should the health needs of their relative change, and health professionals said they felt the service was responsive to people’s needs.

People were treated as individuals and were shown kindness and respect. People and their relatives were involved in decisions, and care was individualised, and person centred.

A new manager had been appointed by the provider and they were undertaking the registration process with the Care Quality Commission (CQC) to become the registered manager.

Staff, relatives and people told us they knew who to talk to if they had any concerns and felt confident these would be acted upon. Health professionals told us the communication and responsiveness of the manager and staff was very good.

The provider had developed oversight of the service and planned to further improve outcomes for people.

People were supported to have choice and control of their lives.

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

Rating at last inspection and update

The last rating for this service was inadequate (inspection undertaken 02 March and 05 March 2020. Inspection report published 03 April 2020). There were multiple breaches of regulation and the service was in Special Measures. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve.

On 14 July 2020 we completed a targeted inspection to ensure that the service had made necessary improvements. We also followed up on concerns raised by the local authority. The targeted inspection looked only at specific areas of concern, and therefore a formal review of breaches did not take place, nor was a new rating generated.

This service has been in Special Measures since December 2018. During this inspection (May 2021) the provider demonstrated improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out a comprehensive inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.