The Orchards Residential Care Home

The Orchards residential home provides accommodation and personal care to 13 people, some of whom may be living with dementia. At the time of the inspection, 13 people were living in the service.

The Orchards accommodates 13 people in one adapted building. There are two communal lounges, a dining area, and a garden people can access.

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

Risks had been assessed and those identified were safely managed; some improvements were however needed to ensure accurate guidance was in place for staff delivering care. The provider had recruitment checks in place to ensure staff were suitable to work in the service. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm. Medicines were managed safely.

Staffing levels required review to ensure they were meeting the changing needs of people using the service. Following the inspection, the registered manager confirmed they would increase staffing across the day.

People were supported by staff who had completed training to give them the skills and knowledge they needed to meet their needs. People were supported to have sufficient amounts to eat and drink and were protected against the risk of poor nutrition. However, improvement was required in how staff documented people’s dietary intake, particularly where people needed to gain weight.

Staff supported people to maintain their health and well-being. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, some care records did not contain a mental capacity assessment and best interests decision where applications to deprive people of their liberty had been made.

Staff treated people in a kind and caring way. People and relatives valued the service and the support the staff provided. Staff treated people with respect and helped them to maintain their independence and dignity.

Care records contained some inaccurate or contradictory information, but these were being reviewed promptly by the registered manager. People and relatives were confident to raise concerns and complaints, and these were listened to. Activity provision was provided by care staff, and people living in the service were satisfied with this.

There were governance systems in place which included quality audits, however, some had not identified the issues we found. More regular monitoring and auditing of people's care records was required by the registered manager, so they can assure themselves that people's needs are being met. People, relatives and staff were given the opportunity to feedback on their experience 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 Requires Improvement (published 30 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

• People we spoke with told us they felt safe and were well cared for. Staff were observed to be kind and caring in their interactions with people, and this was evident throughout the day. Staff and the registered manager spent time talking with people and knew them well.

• The quality of the service had improved since our last inspection, and additional audits relating to falls had been implemented by the registered manager.

• Further improvements were needed to ensure care plans and risk assessments were accurate and sufficiently detailed. End of life care plans required more information to ensure these were person centred.

• Individual risks to people were managed and mitigated but some information was not accurate.

• Checks to ensure the environment was safe and clean had been completed. However, some environmental risks had not been identified via auditing processes.

• There were sufficient staff to meet people's needs and keep them safe. Recruitment procedures were in place to ensure staff were suitable for their roles.

• The principles of the Mental Capacity Act (2005) were adhered to.

• People were supported to eat and drink enough to maintain a balanced diet.

• People had access to healthcare professionals when required, and staff followed recommendations when needed.

• Staff knew how to care for people and received training in their roles, and support from the registered manager.

• The staff worked well as a team and communicated well.

• Medicines were managed safely, and people received their medicines as prescribed.

• We found the service continued to meet the characteristics of a “Requires Improvement’ rating in safe and well-led This meant the overall rating was “Requires Improvement.”

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published December 2017).

Why we inspected: We inspected this service in line with our inspection schedule for services currently rated Requires Improvement. Following the last inspection the provider sent us an action plan saying how they intended to make improvements in the service.

Follow up: We will continue to monitor this service according to our inspection schedule.

At our last inspection in July 2016, we found a breach of Regulation 17 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. This was because robust systems were not in place to identify risks to the service and individuals. At this inspection carried out on 10 October 2017, we found that the service had implemented an environmental audit to monitor risks that may occur in the building, but that this had not been wholly effective. Other quality audits had also failed to identify the areas we found as requiring improvement. This means the provider remains in breach of Regulation 17. You can see what action we took at the back of the full version of the report.

The Orchards Residential Care Home is registered to provide accommodation and personal care for up to 13 older people, some of whom may be living with dementia. At the time of our inspection there were 12 people using the service.

There was 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.

A provider audit had been implemented to take account of environmental risks, but had not identified all risks. There was now a legionella risk assessment in place and control measures to monitor the water system. Other quality audits the service was carrying out had failed to identify areas which we found as requiring improvement. The service was not analysing falls data in detail as a method of identifying any trends.

The provider had not considered how to maximise the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

Staffing levels were meeting people’s physical needs; however, we have requested that the current arrangements are reviewed to ensure that staffing levels cover both the routine and emergency work of the service.

The registered manager had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. However, Best Interests processes were not fully understood, and we found documentation was not completed correctly.

Systems were in place for managing medicines and people received their medicines in a timely manner. However, where people were having medicines as required, or at a variable dose, improvement was required to ensure it was clear what had been administered and why.

Risks were identified, assessed and managed. However, we found that the level of information documented in certain areas needed to be more detailed to ensure that staff had up-to date and clear guidance to help them support people safely.

Activity provision was provided by care staff. Feedback from some people and their relatives indicated that the current provision of activity was not always meeting individual or specialist needs.

Staff respected people's privacy and dignity and interacted with people in a caring, respectful and professional manner. Systems were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

People and relatives said if they needed to make a complaint they would know how to. There was a complaints procedure in place for people to access if they needed to. The views of people, relatives, professionals and staff were sought via an annual survey.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

The culture in the service was welcoming, friendly, and person-centred. The management team presented as open and transparent throughout the inspection, seeking feedback to improve the care provision.

The Orchards Residential Care Home provides accommodation and care for up to 13 older people, some of whom may be living with dementia. At the time of this inspection there were 11 people living in the home.

A registered manager was in post. They were also one of the two partners in the business. 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 other partner in the business, who was also present during our visit, is referred to as the provider throughout this report.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Whilst risks specific to individuals were well managed we found that some environmental aspects of the home required attention. Some windows lacked window restrictors and the water system needed appropriate inspecting and maintenance. Improvements were required to ensure that some practices in the home did not pose a risk of cross contamination. The provider’s monitoring systems had not identified these concerns.

Staff ensured people’s consent was obtained for day to day matters. A closed circuit television camera was in place in the lounge. However, there were no records to indicate that people living in the home and others had consented to this and privacy issues had not been considered. We have made a recommendation that the provider seeks guidance in relation the use of the camera.

There were enough staff available to ensure that people’s needs were met in a timely and personalised manner. People were cared for by staff who treated them with kindness and respect. Medicines were managed and administered to people in a safe way.

People, and where necessary, those acting on their behalf were involved in making decisions about care and support arrangements.

People were offered choices about what to eat and drink and specific dietary needs were catered for. People were caringly and respectfully encouraged to eat their meals. Staff were well trained and supported to undertake their roles effectively.

The home was well organised and there were systems in place to obtain the views of people and their relatives.

During our inspection we saw that the provider had implemented a new computerised system for care planning which included assessment of risks with action plans where a risk had been identified. We looked at the records of two people who used the service. We saw up to date records for people who required 24 hour bed care, the recording of their food and fluid intake and pressure ulcer prevention. This showed us that staff had been provided with robust guidance to meet the needs of people who used the service.

We spoke with four people who used the service. They told us that they were satisfied with the food provided. One person told us, 'You cannot fault the food here. Nice and homely cooking. Just what I like.' Another told us, 'I have no complaints. I don't go hungry.'

We saw that the provider had recently implemented records to provide evidence of monthly management audits which recorded cleaning and infection control checks. This meant that the provider had taken steps to provide records to evidence their monitoring of the health, safety and wellbeing of people who used the service.

We also spoke with three relatives of people who lived in the service, they told us they were in the main happy with the care provided to their relative. One person told us, 'I am confident in the management. They always inform us of any changes with X's health. If I had one criticism it would be that they could improve by doing the place up a bit, it's looking tired and they could provide more things for people to do.'

We looked at care records and case tracked two people who used the service. We found that people's records such as care plans and risk assessments were not accurate and fit for purpose. Care plans had not been updated to reflect people's current health and personal care needs. Risk assessments in relation to protecting people at risk of malnutrition had not been updated and appropriate specialist support had not been sought. This meant that staff did not always have the up to date guidance they needed to ensure that care was planned and delivered to ensure the health, welfare and safety of people who used the service.

We observed staff were genuinely caring and demonstrated genuine affection for the people they were supporting.

During our inspection we observed that the staff were attentive to people's needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We saw that people were protected from harm by the way staff were recruited and that safeguarding checks were carried out on prospective staff before they started work at the service.

The people living in the service that we spoke with told us that they had not needed to make a complaint. One person said that, 'I don't worry; I have nothing to worry about.'

The building was comfortable, clean and well maintained. We saw that health and safety checks were carried out and that equipment was kept well maintained.

People were encouraged and supported to make complaints. The manager told us that they tried to ensure that complaints were dealt with informally and that they had had very few formal complaints in recent years.