We carried out a review of the data available to us about Orchard Lodge Care Home 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 Lodge Care Home, you can give feedback on this service.
We found the following examples of good practice.
A safe visiting procedure was in place. People's relatives were tested for COVID-19 with lateral flow tests prior to visits taking place. Lateral flow testing is a fast track test which allows the home to receive a COVID-19 test result within 15 to 30 minutes. People's relatives were supported to wear PPE, use a hand sanitiser and maintain social distance in a dedicated conservatory with access via the garden.
The home had a good supply of PPE. Staff had received training on how safely use and dispose of PPE.
The home ensured people and staff were tested regularly for COVID-19. The frequency of testing was in line with current guidance.
All people living at the home had COVID-19 care plans. Risk assessments specific to people's needs were also in place to help reduce the risk of infection.
The home was clean and hygienic throughout. The registered manager told us they had implemented stricter cleaning protocols such as enhanced cleaning of frequently touched areas to minimise the risk of spreading infection.
People were admitted to the service safely. People were tested for COVID-19 prior to their arrival and were cared for in their own room for an initial period of 14 days. Staff monitored people for COVID-19 symptoms and checked their temperature twice a day.
Orchard Lodge is a private residential care home providing personal care for up to 26 people aged 65 and over. At the time of the inspection there were 23 people living at the home.
People’s experience of using this service:
The registered manager was described as supportive and approachable. They demonstrated a good understanding of their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.
The home was clean and the environment was well maintained. During the inspection we identified an action the home had highlighted in a recent health and safety audit requiring replacement radiator covers. We asked the manager to send us evidence that these have been ordered which was sent to us the following day.
People had access to appropriate equipment where needed. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received their prescribed medicines at the right time. This was an improvement since our last inspection. Where issues were identified during this inspection, these were immediately addressed by the registered manager.
There were sufficient numbers safely recruited and suitably qualified and skilled staff in place to meet people's individual needs. The manager was proactive in adjusting staffing levels based on the needs of the people living in the home. Staff received a range training and support appropriate to their role and people's needs.
Staff knew the needs and preferences of people living in the home well. People were treated with kindness, compassion and respect. Staff had developed positive relationships with people and were seen to display kind and compassionate support to people. People's needs had been assessed and their health needs were understood and met.
People’s privacy and dignity was respected and independence promoted. People had access to a selection of activities.
The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. Staff understood and respected people’s right to make their own decisions where possible, and encouraged people to make decisions about the care they received. Consent had been sought before any care had been delivered in line with legal requirements.
People received personalised care and support which was in line with their care plan.
People knew how to make a complaint and they were confident about complaining should they need to.
Rating at last inspection:
At the last inspection, the home was rated “requires improvement” (17 April 2018).
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
We will continue to monitor intelligence we receive about the home until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Orchard Lodge 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. Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility. The home can accommodate up to 26 people. At the time of our inspection, there were 24 people living at the home.
There was a registered manager in post at the time of our inspection. 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.
We carried out an unannounced comprehensive inspection of this service on 29 August 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 11 and Regulation 17.
We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. The team inspected the service against three of the five questions we ask about services: is the service safe, is the service effective and is the service well-led. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Orchard Lodge Care Home on our website at www.cqc.org.uk.
At the last inspection on 29 August 2017, we found that the provider was in breach of Regulation because the principles of the Mental Capacity Act 2005 were not always followed when assessing people’s capacity and arrangements for monitoring standards at the service were not robust.
On this inspection, we found that improvements had been made in relation to the Mental Capacity assessment process and the registered manager had attended training in respect of Deprivation of Liberty Safeguards since our last inspection. The registered manager recognised when someone was potentially being deprived of their liberty and made the necessary DoLS applications to the local supervisory body.
The recording relating to medicine administration was not always accurate. We checked a sample of medications and found that the stock balances did not always correspond to the Medication Administration Record (MAR). We saw that medication audits were not fully effective because they did not cover stock checks of medication. We have made a recommendation regarding this.
Whilst we found that some improvements had been made to how the service was led, we have not revised the rating for this domain. This is because the audit systems required further development to ensure the safety of medicines. In addition, to improve the rating from 'requires improvement' requires a longer term track record of consistent good practice and sustainability of governance. We will check this during our next planned comprehensive inspection.
Our observations and discussions with people confirmed that the staffing levels were sufficient for the support which needed to be provided. Staffing had increased by one staff member for a proportion of the day since our last inspection. Recruitment was safely and effectively managed and the relevant pre-employment checks were completed before staff were appointed.
People told us they felt safe living at the home. Systems were in place to help ensure that people were safeguarded from harm. This included policies and procedures for staff to follow. Staff had undertaken training in safeguarding and knew how to report any concerns.
Risks to people’s health and safety were assessed and preventative action was taken to mitigate risks. The registered manager maintained a log of accidents and incidents which occurred at the service and analysed these to minimise the chance of future occurrence.
People were supported to live in a safe environment that was free from hazards. Regular health and safety checks were completed and the equipment was well maintained. Emergency procedures were in place in the event of fire and regular mock evacuation drills were carried out.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff sought consent before providing care and support and involved people in day-to-day decision making.
People told us the staff were competent in their role. Staff were assisted to be effective through regular training, supervision and an annual appraisal.
The majority of people were satisfied with the food served at the home. We sampled the lunchtime meal and found it to be of good quality.
Health care was accessible for people and appointments were made for regular check-ups as needed. We spoke to one visiting health professional during our inspection who spoke positively about the home and staff who worked within it. They told us staff were responsive and followed health advice given.
The registered manager maintained oversight of the quality of the care being delivered and completed checks on areas such as health and safety, mealtime interactions, cleanliness and care plans. Action plans were developed following health and safety audits and these were signed off once completed.
All of the staff we spoke with liked working in the home, had been in post a long time and had noticed improvement since our last inspection. Staff described the registered manager as ‘approachable’ and felt well supported within their roles.
Opportunities were provided for people and their relatives to comment on their experiences and the quality of service provided through quality assurance surveys and resident meetings.
The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements.
The ratings awarded at the last inspection were displayed in the communal area of the home.
Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The house can accommodate 26 people. At the time of the inspection, there were 23 people living at Orchard lodge. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool.
At the last inspection in February 2017, the service was rated ‘requires improvement’ and breaches were identified in relation to Regulation 12 and Regulation 17.
We saw that improvements had been made to the quality assurance processes in place at Orchard Lodge since our last inspection. The registered manager had put in place a series of audits (checks) to monitor aspects of the service and these were completely regularly. This included audits of the premises, medication, daily records and care plans. However, we found that these audits were not robust as they had failed to address some of the concerns identified during this inspection such as the service’s compliance with the Mental Capacity Act. Additionally, there was no evidence of action taken in response to a recently completed consultancy audit which identified that staffing levels at Orchard Lodge were insufficient. This meant that processes in place to monitor the quality and safety of the service were not always effective. The provider remains in breach of this regulation.
The service did not always operate within the principles of the Mental Capacity Act 2005. Consent was not always sought appropriately and capacity assessments were not decision specific. We found there was a lack of knowledge around the Deprivation of Liberty Safeguards as the registered manager was not fully aware of the principals to determine whether someone was being deprived of their liberty. This is a breach of Regulation 11 (Need for Consent).
During our inspection, we observed that there were sufficient numbers of staff to meet people’s needs in a timely manner, however, people told us that staffing levels were inconsistent. We looked at staff rotas and saw that staffing levels fluctuated, particularly at weekends and throughout the summer months. The staffing levels did not meet the provider’s own required levels in accordance with their dependency assessment. We have made a recommendation regarding this.
We saw that medicines were given to people on time by staff that had been appropriately trained and were told that people were happy with their medicine management. We identified some issues regarding storage of medication and the recording of PRN medication. We have made a recommendation regarding this.
At the last focused inspection in February 2017, we found that the provider was in breach of Regulation 12 (Safe Care and Treatment). This breach related to concerns regarding the management of infection control and the laundry provision. On this inspection, we found that improvements had been made in relation to infection control processes and the provider was no longer in breach of Regulation 12.
We found that staff assessed risk to people and information was updated regularly. Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures.
The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Staff were assisted in their role through induction and supervisions and staff told us they felt well supported through the homes training programme.
People told us they were given choice regarding meals. Staff knew, and catered to, people’s individual dietary needs and preferences.
People we spoke with were complimentary about the staff, the registered manager and the service in general. People told us they liked the staff who supported them. We observed interactions between staff and people living in the home to be familiar and caring.
Through discussions with staff, we found that they knew people they were caring for well, including their needs and preferences. Care plans contained good information regarding people's preferences, likes and dislikes. We noted that personal preferences and recording in care plans had improved from our last inspection. We found that staff worked with the aim of improving or maintaining people's independence, for example, some people managed their own medication.
People were supported to raise complaints or concerns about the service through the use of a suggestion box. People had access to a complaints procedure which provided relevant contact details should people wish to make a complaint.
There were activities available to people living at Orchard Lodge however some people commented there were not enough trips or days out in the local community.
We looked at processes in place to gather feedback from people and listen to their views. Quality assurance surveys were issued to people living in the home and their relatives. People we spoke with told us they were able to provide feedback regarding the service and one person told us about resident meetings that were held. We saw minutes of these meetings and that action had been taken in response to people’s requests. However, it was not clear that these were regularly analysed and circulated to people living at Orchard Lodge.
The home had a registered manager in post. We asked people their views of how the home was managed and feedback was positive. Staff described the registered manager as, "Organised." Staff told us they were encouraged to share their views regarding the service. We saw records of regular staff meetings were to ensure views were gathered from staff which promoted an open and positive culture in the home.
The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred within the home in accordance with our statutory requirements. This meant that CQC were able to monitor risks and information regarding Orchard Lodge.
You can see what action we told the provider to take at the back of the full version of the report.
The breaches of regulations concerned; safe care and treatment, because infection control was not being effectively monitored; receiving and acting on complaints; staff training and support; and the overall governance of the home.
We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us the action they would take to meet legal requirements in relation to the breaches.
We undertook a focused inspection on 2 February 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific areas / breach of regulations. This report therefore covers four of the five questions we normally asked of services; ‘Is the service safe, effective, responsive and well led?’ the other question; whether the service is ‘caring’, was not looked at on this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Orchard Lodge Care Home’ on our website at www.cqc.org.uk.
Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The home can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool.
A new manager had started in post in October 2016 and had applied to the Commission for registration. 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.
At the last inspection we identified a concern relating to the management of infection control and environmental hazards. During this inspection we saw that some specific improvements had been made but we saw other environmental hazards that had not been effectively identified and monitored; these related to the management of the laundry and the overall lack of health and safety audit / checks being carried out. The provider was still in breach of this regulation.
During the previous inspection we identified a breach of regulation in relation to the overall governance of the home; there was a lack of guidance for staff through established policies and procedures. On this inspection the new manager had made improvements in many areas of the running of the home; however, we found there was a lack of established and routine audit which meant some areas of the running of the home were not being effectively monitored. The provider was still in breach of this regulation.
At the last inspection we found that the provider was in breach of regulations relating to the receiving and acting on complaints. On this inspection we saw a complaints procedure in place. This breach had been met.
At the last inspection we found that the provider was in breach of regulations relating to the training and support for staff. On this inspection we saw progress had been made by the new manager. Staff were in receipt of planned training and felt supported by the new manager and a regular programme of supervision. This breach had been met.
You can see what action we told the provider to take at the back of the full version of this report.
Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The home can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. At the time of the inspection 21 people were living at the home.
A registered manager was in post. However, the registered manager was not available on the day of the inspection. 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.
At a previous inspection we identified a concern relating to cleanliness, infection control and environmental hazards. During this inspection we saw that improvements had been made. However, we saw that some improvements to the environment had not been completed. For example, the scheduled refurbishment of the kitchen had not been undertaken. We also saw that previously unidentified risks were present in the home.
During the previous inspection we identified a breach of regulation in relation to the safety of the laundry. We looked at the work that had been undertaken following the previous inspection and found that sufficient improvements had been made with regard to the safety of the physical environment and the risk of infection. This breach had been met.
During the previous inspection we identified a breach of regulation in relation to the assessment and management of risk. This breach had been met.
At the last inspection we found that the provider was in breach of regulations relating to good governance. During this inspection we looked at records of provider visits and saw that they had been completed regularly. We were provided with a schedule of improvements for the home which provided basic information and timescales for completion. However, some important improvements had not been completed. For example, according to information provided a planned refurbishment of the kitchen to reduce the risk of infection had not been completed. Additionally, the Merseyside Fire and Rescue Service made a recommendation to replace the fire alarm system in 2015. The provider had included this as part of the schedule of improvements, but had not completed the work.
Fire safety equipment was tested by external contractors annually and by the home on a regular basis. However, the home had not fully implemented recommendations made by the fire service in November 2015. In particular, the home’s alarm system had not been upgraded as recommended.
Staff were recruited following a robust procedure and deployed in sufficient numbers to safely meet the needs of people living at the home. The provider based staffing allocation on the completion of a dependency tool.
People’s medication was stored and administered in accordance with good practice. A full audit of medicines and records was completed monthly.
Staff were trained in a range of subjects which were relevant to the needs of people living at the home including; infection control, administration of medicines and safeguarding adults. However, not all staff had not been trained in the principles of the Mental Capacity Act 2005 as previously recommended.
The records that we saw demonstrated that the home was operating in accordance with the principles of the MCA. We were told that none of the people currently living at the home had been assessed as lacking capacity. The records that we saw indicated that people’s capacity had been assessed as part of the care-planning process. Some people had indicated their consent to care by signing care plans.
Meals were served in a well presented dining room. The food was well presented and nutritionally balanced. People’s preferences, allergies and health needs were recorded and used in the preparation of meals, snacks and drinks.
The people that we spoke with had a good understanding of their healthcare needs and were able to contribute to care planning in this area. Each person said that they regularly saw healthcare professionals and attended appointments with the support of relatives and staff.
Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used positive, encouraging language. Staff took time to listen to people and responded to comments and requests.
We spoke with visitors and relatives at various points throughout the inspection. They told us that they were free to visit at any time. People living at the home confirmed that this was the case.
Information regarding compliments and complaints was not clearly displayed. Not all of the people that we spoke with said that they knew what to do if they wanted to make a complaint or what response they could expect.
We asked people and their relatives if they had been involved in their care planning and reviewing care needs. Some people explained how they had been involved and what changes had been made as a result. We saw that some people had signed documents indicating their involvement in the production of care plans.
We saw a schedule of activities for each week which included; skittles, exercise sessions, music, films and quizzes. The home also hired a singer to perform on a regular basis.
A registered manager was in post. However, the registered manager was not available on the day of the inspection. An acting manager was in place. We spoke extensively with the acting manager throughout the inspection.
The home had an extensive set of policies and procedures which, with the exception of the medicines’ policy, had not been recently reviewed.
Staff understood what was expected of them, enjoyed their jobs and were motivated to provide good quality care. We saw that staff were relaxed, positive and encouraging in their approach to people throughout the inspection.
You can see what action we told the provider to take at the back of the full version of this report.
We carried out an unannounced comprehensive inspection of this service on 22 April 2015 when six breaches of legal requirements were found. The breaches of regulations were because we had some concerns about the effective recruitment of staff; the need to gain consent to care and treatment; the lack of action regarding the assessing and preventing the risks to people’s health and safety especially the spread of infection in the home, and the overall effectiveness of management systems to regularly assess and monitor the quality and safety of service that people received.
We asked the provider to take action to address these concerns.
We also found that the provider [owner] had not sent us notifications telling us about incidents at the home. These are required by law. We had not been informed about deaths at the home or other incidents such as serious injuries. We served the provider with enforcement notices for these breaches of regulations.
After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 3&4 December 2015 to check that they had they now met legal requirements. This was an unannounced inspection.
This report only covers our findings in relation to these specific areas / breaches of regulations. They cover three of the ‘domains’ we normally inspect; 'Safe', ‘Effective’, and ' Well led'. The domains ‘caring’ and ‘responsive’ were not assessed at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Orchard Lodge Care Home' on our website at www.cqc.org.uk.
Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The home can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. There were 20 people living in the home at the time of the inspection.
The service had a registered manager in post. 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.
We found that improvements had been made in the areas we had concerns about and two of the the previous breaches had been met; these were the effective recruitment of staff and the need to gain consent to care and treatment.
We also found that the provider had been submitting regulatory notifications to us (the Care Quality Commission) so the enforcement notices we issued were also met.
Although there were improvements we still found concerns regarding assessing and preventing the risk of spread of infection in the home. We also found continued failings in the effectiveness of management systems to regularly assess and monitor the quality and safety of service that people received.
The manager showed us the arrangements in place for checking the environment to ensure it was safe. There were auditing and checking systems now in place and the remedial issues identified on the previous inspection, regarding infection control, had been addressed. However, we found further concerns regarding infection control and identified further environmental hazards that had not been acted on.
You can see what action we told the provider to take at the back of the full version of this report.
At the last inspection we found there was a lack of formal process such as effective audits and systems to ensure the quality and safety of the home was monitored. This included a lack of regular input and support from the registered provider. On this inspection we found improvements had been made. There were improved management audits in place to both monitor and improve the service ongoing.
We were able to improve the judgment rating for the ‘Well led’ domain from ‘inadequate’ to ‘requires improvement’.
We were still concerned however that there were gaps remaining in the current management systems so that some remaining shortfalls in the safe running of the home had not been effectivity identified.
You can see what action we told the provider to take at the back of the full version of this report.
We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found that necessary checks had been made to ensure staff were suitable.
We reviewed staffing with the registered manager as we had had a concern raised prior to our inspection. The registered manager responded positively to ensure there were enough staff on duty at all times to maintain safe care.
There were improvements to the way the service complied with the Mental Capacity Act 2005. Staff sought the consent of people before providing care and support. When we looked at people’s care files we saw that people had been asked for their consent at various stages of care and that the care plans were signed by people where possible. We saw that the manager and staff were following the principals in the way important information was recorded.
There was a lack of knowledge with some aspects of the MCA and staff had not undergone training in this area.
We made a recommendation regarding this.
Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The house can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. There were 20 people living in the home at the time of the inspection.
This was an unannounced inspection which took place over two days on 22 and 23 April 2015.
The service did not have a registered manager in post. 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 manager told us they intended to ensure an application for registration was submitted to CQC.
We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found that necessary checks had not always been made to ensure staff were suitable. You can see what action we told the provider to take at the end of this report.
People reported that they felt safe and protected at the home. They said, “I feel safe here; they look out for you and make sure you are alright.’’ When we reviewed the care of some of the people living at the home we found that risks to people’s health such as, monitoring of falls and risk of pressure sores were assessed and monitored.
The staff we spoke with clearly described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report through any concerns they had.
We asked about staffing at the home. People reported they thought there was sufficient staff to meet their needs. We were told, “There is always someone about if you need them.’’
The manager showed us the arrangements in place for checking the environment to ensure it was safe. For example, a health and safety ‘walk about’ was completed by the manager on a regular basis where hazards could be identified. This had not identified health and safety hazards and risks we saw on the inspection.
You can see what action we told the provider to take at the back of the full version of this report.
We looked to see if the service was working within the legal framework of the Mental Capacity Act (2005) [MCA]. We found the manager understood the general principals of the Act but there were some key decisions regarding people’s health and wellbeing that had not been effectively recorded and updated to demonstrate that people’s consent had been attained.
You can see what action we told the provider to take at the back of the full version of this report.
We were told, at the time of our inspection, the home did not support anybody who was on a deprivation of liberty authorisation [DoLS]. We found the manager was aware of the process involved if a referral was needed.
People reported that they had access to medical and healthcare support when they needed it. People told us the home provided good support and staff were very caring.
We looked at the training and support in place for staff. Staff we spoke with confirmed they had up to date and on-going training; they felt the support they got with training was good.
People reported that they liked the food in the home and there was a choice of different food at each meal. One person said, ‘’The food here is excellent, I have no complaints whatsoever.’’
People were treated with dignity, respect, kindness and compassion. Relatives commented on the qualities of the staff, one relative said, “The staff are very respectful and caring, they knock before they come in and they respect [persons] privacy.” We saw staff taking time to interact and involve people throughout the day. The interactive skills displayed by the staff were positive and people’s sense of wellbeing was very evident.
People living at the home and their relatives told us they felt involved with their care. When we looked at people’s care files we saw that people had been asked for their consent at various stages of care and that the care plans were signed by people where possible.
We found care plans listed and covered people’s care needs but they were brief and lacking the detail to make plans personalised for the person concerned. Also some important details regarding care needed to be updated on care plans. We fed this back to the manager who said they would act on this.
We saw some good examples of people experiencing active daily living pastimes. This was not wholly reflected in the general culture of the home however.
There was a complaints procedure in the home which was displayed. None of the people we spoke with had any complaints about the home.
From the interviews and feedback we received, the manager was seen as open and receptive. The manager was seen as supportive and caring.
We found there was a lack of formal process such as effective audits and systems to ensure the quality and safety of the home was monitored. This included a lack of regular input and support from the registered provider.
On this inspection we found there were breaches of regulations covering staff recruitment, infection control, health and safety monitoring and monitoring of how the home operates aspects of the Mental Capacity Act 2005. We were concerned that the home’s current auditing and monitoring processes had not effectively identified any shortfalls or improvements needed.
You can see what action we told the provider to take at the back of the full version of this report.
We found on inspection that issues requiring the service to notify the Care Quality Commission had not been made. The manager said they would notify us retrospectively and would seek to review the regulations and guidance available regarding notifications.
This is being followed up and we will report on any action when it is complete.
People said they got their medication on time and had access to health and medical support when they need it. Medicine administration records [MARs] we saw were completed to show that people had received their medication as prescribed. Care records we saw confirmed that some people had been reviewed recently by a visiting GP.
We checked the medicines records and stocks of fifteen people who used the service. No-one we spoke with expressed any concerns about how their medicines were handled.
We found care records to be well ordered and up to date, with evidence of recent review. We saw people had access to dentists, doctors, chiropodists and opticians. All people we spoke with told us they liked living at the home and felt the care given met their needs whilst respecting their dignity and independence.
When we checked on the standard of meals offered and people's access to fluids throughout the day, we found their dietary needs were met. Meals offered were predominantly home cooked from fresh ingredients but some meals were made up of convenience foods. Drinks were offered throughout the day.
We found the home had a complaints policy that was effective although people we spoke with said they were happy to raise concerns with staff directly. Throughout our inspection, we found staff were responsive to people's needs and displayed a friendly, respectful manner to the people in their care.
People told us the staff were kind and helpful and were able to provide a good level of care and support. The people we spoke to told us that their needs were being met by the staff members and that they did not have any concerns. Relatives of people living in the home said staff were very supportive and helped people to get the most out of life. One person said that since their relative had moved into the home they had seen very positive changes in their attitude and general wellbeing.
Those people spoken with said that staff supported them with their personal care and hygiene.
People were relaxed and talked freely. One person told us they were not well but said the manager had called the doctor and he was due to attend. We spoke with one person who said, 'The staff look after me very well.' Another person said, 'The staff are very kind and do not rush. They are friendly and the care is good.'
Another person said they had had an infection not long ago and the doctor had been called but this was after a delay. They said they were 'fine now.'
We spoke with some visitors to the home [relatives] who told us that they had no concerns about care at Orchard Lodge; 'My relative is well care for. The staff are very good at keeping us informed if there is any change and they will always get the doctor out if needed.'
We spoke with a visiting health care professional. They said that the home generally liaised well. The manager and staff sought advice about peoples health care when needed and were proactive in many instances. They felt the 'family atmosphere' of the home helped ensure a good quality of life for people.
None of the people we spoke with had any issues with the way medication was managed. Two of the people spoke about how staff were always on time with medications and any changes were communicated and agreed.