Archived: Orchid House

Orchid House is a residential care home that was providing personal care and support for six adults with learning disabilities and autism at the time of the inspection. The service is registered to support up to six people and accommodates five people in one building and one person in a self-contained annexe attached to the building.

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. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. However, we found the provider was not following these best practice guidelines in line with Registering the Right Support (RRS) to achieve effective outcomes.

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

People's relatives told us that they felt their family members were no longer receiving the consistent care they had prior to Choice Care Group (the ‘provider’) taking over the service in May 2019. This was, in part, due to the turnover of care staff, resulting in new members of staff who did not always have the experience to work with people’s complex needs. In addition, agency staff were being used to supplement the permanent staff.

The provider had not ensured that all staff had received the relevant learning and time to support people effectively and safely. The safe management of medicines was not always assured or delivered in line with the provider’s policy and procedures.

Improvements were needed to improve staff training in areas such as safeguarding, infection control, food safety and fire awareness. Not all staff felt they were receiving enough support from managers to ensure their roles and responsibilities were safely delivered. This was because there had been limited opportunities for one to one support meetings to discuss support they needed, in order for them to develop and improve.

People’s needs had not been regularly reviewed to ensure best practice guidance was used to achieve effective outcomes. Staff did not have the support in place to ensure they felt confident to deliver care to people with complex needs. People’s health need requirements, such as specialist health appointments, were not always known. This meant that the provider and registered manager did not have a good overview to manage people’s health conditions. People’s nutritional needs were not always being met to ensure their diet was healthy and adequate to maintain good health.

People were supported by staff that cared for them. However, the provider had not ensured that people were supported with consistent staffing in relation to their autism and other complex care needs. This meant that people were not always supported by staff that had the time to get to know them well and understand their care and support needs, wishes, choices and any associated risks.

People did not always have opportunities to pursue their interests and hobbies. People’s care needs had been recently reviewed and new care plans had been drawn up and were with families to review and comment where necessary.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. This was because people using the service did not receive consistent, planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The provider's quality assurance systems had not always effectively identified shortfalls in the quality of care when they acquired the service. Following a compliance visit, the local authority had identified a number of concerns. We noted some initial improvements to the quality and safety of the service were being actioned. These improvements at the service were not embedded at the time of this inspection.

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.

Relatives told us that improvements had been recently been made. This followed a number of reviews and meetings where they could discuss their concerns on areas discussed in this inspection report.

The provider was actively addressing the issues that had been raised during the inspection and demonstrated a willingness to work transparently and openly with all relevant external stakeholders and agencies.

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 Outstanding (published 15 December 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was brought forward because of concerns raised with the Care Quality Commission about the experience and training of staff. There was also concern about management of medicines. Concerns were also raised about leadership and quality monitoring at the service. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements.

We have identified four breaches in relation to person centred care, safe care and treatment, staffing and good governance at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchid House on our website at www.cqc.org.uk.

Follow up

Full information about CQC’s regulatory response to this inspection is added to the report after any representations and appeals have been concluded. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 25 October 2017 and was announced. 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.

Because of people’s complex needs they were unable to tell us verbally about their experiences of living at Orchid House. We therefore contacted relatives who were keen to be involved in the inspection to tell us how wonderful the service was at providing support to their family members. They were fully confident that their family members were safe, well cared for and treated extremely well by the staff team. We heard from a healthcare professional that they felt the service was ‘one of the best’ and offered ‘outstanding care’.

The registered manager (who is also the provider) provided strong leadership and led by example leading to an outstandingly caring and responsive service for people. Relatives spoke in highly positive terms about the way the service was managed and how this had ensured that their family members received high quality care. The registered manager and staff spoke with passion and a real drive to constantly improve the quality of the service in order to meet people’s needs. This was reflected in the staff team who felt inspired by the manager to constantly achieve the best outcome for the people in the service.

When staff assessed people to see if the service could meet their needs, an in-depth and thorough transition process took place to ensure that as much information as possible was captured to enable the person to be supported with individual and personalised care. We received feedback that this process had been highly effective and had resulted in people receiving high quality and person-centred care.

We observed that the young people were extremely well supported on the day of the inspection. We also had feedback from family members and a professional about how people were supporting by staff that knew them very well. The atmosphere in the service was calm and relaxed and staff clearly understood the needs of the individuals they were supporting. We saw choices were offered and that communication was calm and respectful. Relatives spoke of how caring the staff were and staff felt they were given the time and support to offer people care and kindness on a daily basis. Relatives consistently told us staff treated their family members with respect and supported them in a way that completely preserved their privacy and dignity.

Relatives had confidence in the ability of staff to keep people safe. Staff had received training on safeguarding adults and understood their responsibilities. Risks had been appropriately assessed and control measures in place to minimise the risks. People received their medicines as prescribed. Staff had training and were checked to ensure they continued to be competent when administering medicines.

An effective system was in place to monitor and audit the quality of the service being provided. We saw that records were analysed in detail in order to identify any changes needed for a person’s support. Accidents and incidents were investigated thoroughly and 'lessons learnt' were shared with the staff to promote improvement.

Recruitment processes were designed to ensure only suitable staff were selected to work with people. There were sufficient numbers of staff to meet people’s needs. New staff were supported with an induction when they commenced work in the service, including shadowing opportunities. Relevant training had been received such as managing medicines, food hygiene, health and safety and first aid.

Staff were supported through formal meetings with their managers but also supported on a day to day basis. An annual appraisal took place yearly. Staff told us that they felt very supported by the manager and that communication was effective.

Staff were aware of their duties under the Mental Capacity Act 2005. They obtained people's consent before carrying out care tasks and followed legal requirements where people did not have the capacity to consent.

Relatives know how to make a complaint if needed but none we spoke with had needed to raise any concerns.

We saw that people were supported to undertake a range of activities in the community and had varied and individual routines.

The home had an appropriate and safe system in place for the recruitment of staff. All staff were receiving training and supervision. Staff were completing training on safeguarding and information about how to report concerns was displayed in the home.

The provider had systems and checks in place to audit and monitor the quality of care and support that was provided.