HF Trust - Orchard View

HF Trust - Orchard View is a residential care home providing accommodation for persons who require personal care and have a diagnosis of a learning disability and/or autism. The home can accommodate 6 people and at the time of the inspection, 6 people were receiving support.

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.

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

People did not always receive person centred care in line with Right, Care, Right Support, Right Culture.

Right Support: People had limited opportunities to leave the service and pursue social interests within their local community. Where people had been allocated one to one staff support to complete meaningful activities, people had not always received this support. There was limited guidance to inform staff how to enrich people's lives through positive engagement and meaningful activities. People's goals and aspirations were not always identified with people or those involved in their care. Risks associated with people’s health and wellbeing were not always managed safely. Where risks had been identified, some records contained conflicting information about how staff should manage these risks.

People were not always supported to have maximum choice and control of their lives, but staff supported them in the least restrictive way possible and in their best interests; the providers policies and systems supported best practice, but these were not always followed by staff.

Right Care: People were not always involved in making decisions about their care. There was limited consideration given to the varying ways people could be empowered to make everyday choices using different communication methods.

Right Culture: The service did not always have a person-centred culture which empowered people to achieve their goals and aspirations. Systems were not operated effectively to identify if people were receiving person centred care in line with Right Care, Right Support, Right Culture. There was insufficient recording and reviewing of behaviours where a person had experienced distress.

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 (published 3 October 2019).

Why we inspected

We received concerns in relation to safe staffing numbers and governances. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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 changed from good to requires improvement based on the findings of this inspection. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HF Trust – Orchard View on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person centred care and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

HF Trust Orchard View is a residential care home providing accommodation for persons who require personal care and have a diagnosis of a learning disability. The home can accommodate six people and at the time of the inspection, six people were receiving support.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support and focused on them having as many opportunities as possible for them to gain new skills and become more independent.

As part of the thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

There had been continuous improvement at the service since the last inspection, most particularly in the recruitment of more permanent staff. However, a very new staff team meant the improvements needed to become embedded in the culture of the home.

Staff were confident in their capability to identify and report any safeguarding issues and had a good understanding of the risks associated with people's care. 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.

Positive working relationships with other healthcare professionals gave staff access to best practice guidance to ensure people received effective care. People received their medicines as prescribed.

Staff demonstrated a person-centred approach for the people they supported and understood how each person required support to express their care needs. Staff were caring in their approach and more opportunities to go into the local community had improved people's wellbeing. People's privacy and dignity was maintained and staff promoted independence.

The registered manager was committed to building on improvements made within the last 12 months to ensure the continued development 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 3 November 2018)

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.

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

Orchard View accommodates up to six people with learning disabilities in one purpose built building. There were six people living at the service at the time of our inspection visit. The home is in a rural area and all the accommodation is on one floor.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post at the service. 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 in March 2016 the service was rated as Good. At this inspection we found people continued to receive a service that was caring and effective. However, we found a lack of permanent staff and people's differing needs meant staff could not always be responsive to the needs of those people who benefitted from more involvement and engagement in the local community. It also meant some health and safety checks had not been carried out in accordance with the provider’s policies. We identified one breach of the regulations. The service is now rated 'Requires Improvement'.

There were enough staff to keep people safe, but the provider was reliant on agency staff to maintain safe staffing levels. The provider was actively recruiting new staff, but a lack of permanent staff had impacted on the ability of staff to respond to people’s emotional and social needs.

There was a procedure for staff to follow to identify and manage risks associated with people’s care. Staff had a good understanding of how to safeguard people from harm and report any concerns to the registered manager.

People were supported to access health services when needed and staff regularly worked in conjunction with other health and social care professionals to ensure people received effective care. People received their medicines as prescribed and their nutritional and hydration needs were met.

Staff worked within the principles of the Mental Capacity Act 2005. People were supported to have choice and their decisions and choices were respected. The registered manager understood their responsibilities under the Act. They had applied to the supervisory authority for the right to deprive people of their liberty when their care and support included restrictions in the person's best interests.

Staff received training to ensure they had the skills to meet people’s needs. Some refresher training was overdue, but the provider had plans in place to deliver the required training to the whole staff team.

People continued to receive care that was kind and staff members treated them with dignity and respect. Staff ensured people’s voices were heard and any concerns were addressed.

The service had recently been through a challenging and unsettling period. As a result, changes had been made to the registered manager’s responsibilities within the provider group and they now only had managerial responsibility for Orchard View. Relatives had confidence in the registered manager and provider and said improvements had already been made within the home. The registered manager completed regular audits and had an improvement plan which they assured us would improve the safety and responsiveness of the service.

The provider had failed to notify us of some important events that had occurred in the home in accordance with their regulatory responsibilities.

You can see what action we have asked the provider to take at the end of our report.

The service provides accommodation and personal care for up to six people with learning disabilities or autistic spectrum disorder. There were six ladies living there at the time of our visit.

A requirement of the service’s registration is that they 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection.

There was a homely, friendly and open culture within the home and people and staff appeared to be happy. Interactions between staff and the people who lived there were warm and friendly. Staff demonstrated a good understanding of the importance of supporting people as individuals, protecting their dignity and spending time with them. People were supported to maintain relationships with those who were important to them.

There were enough staff to provide the support and stimulation people required to promote their wellbeing and to keep them safe. Risk management plans ensured people were safe both in the home and when in the community. Staff had a good understanding of their responsibilities in relation to safeguarding in order to protect people from the risk of abuse. The provider checked that staff were suitable to support people before they began working in the service.

Staff received training and support so they could carry out their roles effectively and safely. Staff had an understanding of the Mental Capacity Act 2005 and were watchful of people’s body language, gestures and facial expressions to ensure they were respecting their choices. The registered manager had considered where people’s liberty may need to be restricted to keep them safe and made appropriate applications to the authorising body.

Care plans gave staff information about people so they could ensure they were at the centre of the care and support they received. People had regular access to health care appointments and were referred to health professionals when sudden or unexpected changes in their health occurred. People were supported with their nutritional needs and staff were aware of any risks to people when eating or drinking. People received their medicines as prescribed.

The registered manager was aware of their responsibilities as a registered manager and was aware of the achievements and the challenges which faced the service. Staff found the registered manager approachable and receptive to new ideas. Regular checks were carried out by the registered manager to monitor the quality and safety of the service.