Orchard Mews

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.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support:

People were supported by staff who understood their care and support needs. Risks in relation to people's care and support were assessed. However, we found these difficult to understand. Assessments contained relevant information but were in a piecemeal order which led to a disjointed approach to determine people’s needs. Despite this staff knew people very well, including new starters.

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. However, we noted staff needed further training around applying MCA (Mental capacity act) due to limited knowledge when considering mental disorders.

There were enough staff to support people as the service had recently undertaken a recruitment drive. Agency staff and internal bank staff had supported the service with any shortfall previous to this. The same agency workers were used to allow continuity of care.

Right Care:

People received kind and compassionate care from staff who knew them well. Staff protected and respected people's privacy and dignity. They understood and responded to people's individual needs. People were safe and staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People’s family members spoke positively about the care planning process. One person's relative told us, "We are very much involved in [person] care, they are always asking us what we think and want.”

Right Culture:

There was a positive culture at the service, that promoted good outcomes for people. Staff were inclusive and natural. Everyday interactions with people that were kind, enabling and very respectful. Systems and processes were in place to monitor the quality of the service and drive improvements. The service was currently undergoing a refurbishment.

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

Rating at last inspection and update

The last rating for this service was good (published August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about medicines and staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service is good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard Mews 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 Mews is a residential care home providing personal and nursing care to 26 people at the time of inspection, some of whom were living with a dementia. The service can support up to 38 people in one large adapted building.

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

Medicines were managed safely at the service. People were involved in planning their care with regards to medicines. Choices were provided to people around how they took their medicines and people had their capacity assessed as part of this. Care plans were personalised and reflected each individual’s personal needs and choices.

Staff received training and had their competency to administer medicines checked prior to providing support to people with their medicines. Checks were in place to monitor the safety of medicine administration. The registered manager had oversight of all aspects of medicines and carried out regular audits and checks.

There was an effective infection prevention and control policy in place and staff followed this to keep people safe. This had been reviewed and updated to reflect the current pandemic relating to COVID-19 and extra steps were in place to minimise the risk to people living at the home.

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 22 August 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about medicines management and due to an outbreak of COVID-19 at the service. The overall rating for the service has not changed following this targeted inspection and remains good.

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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Mews is a care home providing personal and nursing care to 36 people aged 65 and over, some of whom were living with dementia. The service can support up to 36 people.

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

People said they received good care from kind and caring staff. Warm and positive relationships had developed between people and staff.

People, relatives and staff told us the home was safe. Staff were aware of the safeguarding and whistle blowing procedures. They knew how to raise concerns and felt confident to do so if required. Safeguarding concerns were investigated thoroughly. There were enough staff to meet people’s needs quickly. New staff were recruited safely. People received their medicines when they were due. Incidents and accidents were investigated and monitored to check appropriate action had been taken. Checks and risk assessments were completed to help ensure a safe environment.

Staff received good support and accessed the training they needed. 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. People and relatives were happy with the meals provided.

People's needs had been fully assessed; the information gathered was used to develop care plans. The provider was working to improve the quality if people's care plans. People were supported to participate in activities they chose.

People, relatives and staff told us the home was well managed; they said the registered manager was approachable and supportive. The provider had an effective quality assurance system which was used to identify areas for improvement. There were regular opportunities for people, relatives and staff to provide feedback about the home; they confirmed their views were welcomed and listened to.

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 30 December 2016).

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.

We last inspected Orchard Mews in August 2015. At that inspection we found the service was in breach of its legal requirements.

Orchard Mews is a purpose built care home that provides personal and nursing care to a maximum of 36 older people, including people who live with dementia.

A registered manager was 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.

We found improvements had been made to ensure the safe care and treatment of people. People told us they felt safe and there were enough staff on duty. Staff had more time to interact and spend time with people and not just when they carried out tasks. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Regular checks took place to ensure the building was safe and well-maintained. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Most records were in place that reflected the care that staff provided. We have made a recommendation about care plans.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

Staff and people who used the service said the registered manager was supportive and approachable. People told us they felt confident to speak to staff about any concerns if they needed to. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The environment was being refurbished and it was bright and promoted the orientation and independence of people who lived with dementia. The provider undertook a range of audits to check on the quality of care provided.

We considered our inspection findings to answer questions we always ask:

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to meet the person's support requirements.

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

We saw there were enough staff on duty at the time of inspection and we were told staffing was kept under review as people's needs changed.

Is the service effective?

People we spoke with were positive about the service provided. People commented how helpful and friendly the workers were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One person we spoke with commented how pleased they were with the care provided by staff at the home.

Staff we spoke with were knowledgeable about people's care needs. They had received training to help them understand the different care and support needs of people they worked with.

Staff were observed to be patient and supportive as they worked with people.

Is the service caring?

People and relatives spoken with talked well of the level of care provided by staff. We found people were encouraged to be involved in daily decision making. Staff were helpful and offered people information and support about their care. We saw there was good interaction between staff and people who used the service. We observed the interaction and noted the kind and caring way staff supported people, especially people with dementia. Staff allowed sufficient time for people to respond. It was evident that staff had developed a good understanding of people's communication needs and how best to communicate with them.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in all decision making with regard to their care. They were kept informed and given information to help them understand the care and choices available to them.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. It helped with the provision of social activities people may wish to be involved with.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

There was a focus from management on the provision of individual care and support to people who use the service. Staff were knowledgeable about the support needs of people.

Staff received regular supervision and commented they felt supported by the manager and advice and support was available from the management team.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues.

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found staffing levels had increased which ensured there were enough qualified, skilled and experienced staff to meet people's needs.

The premises were better maintained so people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time

We used a number of different methods which included observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

We saw records to show and observed before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We observed staff were very busy as they provided care and support to people who used the service. We spoke to four people who lived at the home who told us staff were kind and helpful.

Due to the low staff numbers on duty at times and the high dependency of some people care and support was not provided in a timely way as people had to wait for staff support. At times they were at risk due to inadequate observation.

We saw the provider had some systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.

Staff were observed to be polite and respectful to people they worked with and there was a good rapport between them.

We saw the provider had taken action since the last inspection to increase staffing levels. This meant there were sufficient staff to provide care to people living in the home.