We carried out a review of the data available to us about Orchard House Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Orchard House Care Centre, you can give feedback on this service.
Orchard House Care Centre is a care home providing accommodation and nursing care for up to 60. People are supported across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. There were 58 people living at the home at the time of the inspection.
People’s experience of using this service and what we found
People and relatives told us they felt safe and were happy with their care. They confirmed staff were kind and caring and we observed positive interactions between staff and people.
We received mixed feedback in relation to the staffing levels at the home. The registered manager agreed to review the current staffing levels to ensure sufficient numbers of staff are available to meet people's needs. Safe and effective recruitment practices were in place and followed.
People's care plans and risk assessments contained consistent and detailed information in relation to people’s needs and how these should be managed. People’s health needs and wellbeing was monitored in line with the information highlighted in their care plans and risk assessments.
People received their medicine as prescribed. Medicine administration care plans and ‘as required’ (PRN) plans provided staff with clear and detailed information on how people liked to receive their medicines and when these medicines should be given.
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.
Orchard House Care Centre was clean and well maintained. Environmental risks had been considered and acted on were required. Infection, prevention and control processes and up to date policies were in place. The provider, management and staff adhered to the latest government guidance in relation to infection, prevention and control.
The management team understood their regulatory responsibilities. There were effective governance systems in place to identify concerns in the service and drive improvement.
There was a person-centred culture within the service. People were actively involved in making decisions about their care and were asked for their views about all aspects of the service.
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 good (Report published 10 April 2019).
Why we inspected
This inspection was prompted by a review of the information we held about this service. We, therefore, undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
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.
The overall rating for the service has remained good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard House Care Centre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Orchard House Care Centre is a residential care home that provides personal and nursing care to 60 older and younger people. Orchard House Care Centre provides a service for people living with dementia or a physical disability who also require nursing care.
People’s experience of using this service:
¿ People were happy living at Orchard House Care Centre. They told us their needs were met by staff who were competent, kind and caring. People were treated with dignity and respect.
¿ Most individual risks were managed appropriately, however we identified some concerns in how risks to people were being recorded and acted upon by staff.
¿ Medicines were managed safely and people received the personal care they required. They were involved in the development of their personalised care plans that were reviewed regularly. Staff worked with local health and social care professionals to ensure health care needs were known and met.
¿ People's rights and freedoms were upheld. People could make all their own choices and decisions. When people lacked the ability to make their own decisions, systems were in place to ensure these were made legally and in their best interests.
¿ There were sufficient numbers of staff who were well trained and worked well together. The registered manager continually considered ways to improve the service for the benefit people living there. Where we identified areas for improvement, they acted immediately.
The service met the characteristics of Good in most areas and is rated Good overall. More information is in the full report.
Rating at last inspection: At the last inspection the service was rated Good. (Report published 27 March 2017).
Why we inspected: This was a planned inspection based on the rating at the previous inspection.
For more details of this inspection, please see the full report which is on the CQC website at www.cqc.org.uk
Follow up: We will continue to monitor the service.
The inspection was unannounced and was carried on 17 and 23 January 2017.
There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.
There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessment. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.
Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring. Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.
People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.
Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.
People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.
People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.
There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided through ‘resident meetings’ and an annual survey. They were also supported to raise complaints should they wish to.
People’s families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The provider was fully engaged in running the home, through the regional director and provided regular support to the registered manager. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.
There were systems in place to monitor quality and safety of the home. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.
This inspection took place on 10 and 14 December 2015 and was unannounced. The home provides accommodation, nursing and personal care for up to 60 people, including people living with dementia. There were 54 people living at the home when we visited.
After the comprehensive inspection in June 2015, we identified that improvements were required to ensure people received a safe, effective service. We received action plans from the provider stating what they would do to meet the legal requirements in relation to improving their service. At this inspection we found improvements had been made but these need time to become sustained and fully embedded in practise.
The home did not have a registered manager. 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 provider had arranged for an operations support manager to take over running the home until a suitable manager could be appointed. The operations manager had applied to the commission to become the registered manager although their appointment was not intended to be long term. They told us a permanent manager had been appointed who would commence employment in January 2016.
The manager had notified us of medicines errors which they were investigating.
People felt safe and staff knew how to identify, prevent and report abuse. People and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet. A range of daily activities were offered with people able to choose to attend or not.
Legislation designed to protect people’s legal rights was followed. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Where people had been assessed as lacking capacity, best interest decisions about some elements of their care had been made. These included the use of bed rails and covert (hidden in food) medicines. Other aspects of care which the person may have lacked capacity to consent to had not been assessed.
Staff offered people choices and respected their decisions appropriately.
The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.
Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations.
Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly.
There were enough staff to meet people’s needs. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received appropriate training and were supported through the use of one to one supervision and appraisals.
People and relatives were able to complain or raise issues on a formal and informal basis with the manager and were confident these would be resolved. There was an open culture within the home. Visitors were welcomed and had been kept fully informed about the previous inspection and the action that was being taken to address the concerns identified. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.
This inspection took place on 9 and 12 June 2015 and was unannounced. The service provides accommodation for up to 60 people who have nursing needs and/or are living with dementia. There were 59 people living at the service when we visited.
The service had a registered manager in place. 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.
Most people and relatives praised the staff and care provided. However, they also raised issues about the lack of activities, lack of attention to individual needs and staff being rushed and very busy.
The provider’s quality monitoring systems failed to ensure people received a safe, effective, caring and responsive service. Consequently, people were at risk of not having their health and other needs met, not being protected from abuse and having their rights compromised.
Staff were not following the provider’s procedures for recording and reporting incidents, which meant senior staff were unaware incidents had occurred. Therefore incidents were not properly investigated and actions were not taken to reduce the risks to people, visitors and staff. This included a number of significant safeguarding concerns. The concerns we found in relation to the safety, effectiveness, caring and responsiveness of the service had not been identified by the provider’s quality assurance systems. The provider had failed to ensure we were kept informed about all incidents which it is required by law to notify us about.
People did not always receive the health care they required. National Institute for Clinical Excellence (NICE) guidance for monitoring people who had suffered head injuries was not followed. Wounds were not always managed appropriately. Care plans contained some individual information but did not have all necessary information or had conflicting information.
Pain assessments were not in use. ‘As and when necessary’ (prn) care plans did not contain sufficient detail for people who were unable to state they were in pain. This failed to ensure they received consistent pain relief when they required it. Not all medicines were given safely as per manufactures guidance. Prescribed topical creams were not applied by care staff on a regular basis.
Staff did not always follow legislation designed to protect people’s rights. Care records demonstrated that staff did not understand how to legally make decisions on behalf of people who lacked capacity. Mental capacity legislation designed to protect people’s rights was not followed.
People were encouraged to eat well and most were positive about the meals provided, although some had to wait up to forty minutes before receiving their meals. People were cared for with kindness and compassion. People’s individual preferences were not always met. Some activities were provided but people told us they were inadequate and they were bored.
There was not enough staff to meet people’s needs safely at all times. Staff received appropriate training but not all received regular supervision and appraisals. The recruitment process was safe and ensured staff were suitable for their role.
There were no formal opportunities for people and relatives to express their views about the service. Information about the complaints procedure was available and people and visitors were able to make a complaint. However, these were not always recorded or investigated in a timely way. When people had raised issues they were not always aware of the outcome.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The overall rating for this provider is ‘inadequate’. This means that it is in ‘Special measures’. Special measures in Adult Social Care provides a framework within which CQC can use our enforcement powers in response to inadequate care and can work with, or signpost to, other organisations in the system to help ensure improvements are made.
Services in special measures are kept under review and, if we have not taken immediate action to cancel registration, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
You can see what action we have taken at the back of the full version of the report.
We spoke with the registered manager, nursing and care staff. We observed part of the lunch time medicines administration and viewed records relating to medicines administration. Staff had received medicines management training and the procedures observed were appropriate. All medicines were secure and full records were maintained. Medicines audits had been undertaken to monitor the way medicines were being managed.
Staff were aware of how people should be supported. Staff stated they felt they had sufficient time to meet people’s needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.
We also spent time observing care in communal areas. We found people had positive experiences and staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The care we observed corresponded with the care plans and risk assessments we viewed. We found medication was stored appropriately however correct administration and recording procedures were not always followed.
People received a varied diet with a choice provided at each meal. There were sufficient staff available to meet people’s needs. Staff received training, support and supervision. A range of quality monitoring procedures were in place and all necessary records were available and stored securely.
We spoke with seven relatives of people living in the home. They said that staff 'always told them about the care' their loved on was receiving including information about 'medication and food intake'. They said staff were 'brilliant' and call bells were responded to quickly.
We observed care being provided in a respectful and caring manner with people being asked if they wanted to move to the lounge or wanted a second cup of tea. We observed appropriate use of moving and handling equipment. Staff were aware of the care needs of people. Care plans were relevant to people and the necessary records were maintained. However people were placed at risk due to incorrect use of pressure mattresses and the unnecessary of recording of some blood sugar levels. People received food and fluids although these were not always at regular intervals. Although medication was stored securely we identified concerns with the way medication was managed.
People were also very happy with the staff who they said worked hard and were aware of how to meet their needs. People said staff were available when they needed them.
We also spoke with visitors who said that they were kept informed. They also said that they were happy with the care their relatives received.
We did not talk to people about their medicines on this occasion. We watched medicines being administered at lunchtime and saw that staff gave medicines with sensitivity and did not interrupt lunch just to administer medication.
People also said that their privacy and dignity was respected when they were receiving care. One person stated that they did not like male carers and that they only had female carers. We also spoke with some visitors who said that although their relatives were not themselves able to express choices anymore they, as relatives, were consulted about care choices.
People told us that they were happy with the way care was provided although they were unaware of their care plans. Care plans contained a space for people or relatives to sign to confirm they agreed to the plan of care. This was blank in most care plans viewed.
Visitors also confirmed that they were happy with the care their relatives had received.
People stated that they received care at a time suitable for them. People also confirmed that activities were provided. Some people chose to take part and other people stated that they were not interested.
People said they felt safe and visitors said that they did not worry about their relatives and were confident people were safe.
People and visitors said that if they had any concerns or complaints they would raise these with the manager.
People said that staff were pleasant and friendly and knew how to look after them. Visitors said that staff were helpful and dealt with issues they raised.
People said that staff were generally available when they need them. However some people said that call bells can sometimes take a longer time to be answered.
Many people were not able to express an opinion. We saw that they looked comfortable and as if they had had their care needs met.
We spoke with some health care professionals who visit the home. They stated that the home contacts them appropriately and puts their advice and guidance into action.