Orchardown Rest Home

We carried out an inspection at Orchardown Rest Home in May 2016 where we found the provider had not met Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured that people’s safety and welfare had been assessed and reviewed. Accurate, contemporaneous records had not been maintained in relation to peoples care and welfare. An action plan was submitted by the provider that detailed how they would meet the legal requirements. At this inspection we found improvements had been made and the provider was now meeting the regulations. We have made a recommendation about improving communication between the home and relatives.

Orchardown Rest Home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home, supported by a deputy manager and registered provider. People were aware who the manager was and felt able to talk to them or raise any concerns with them. People felt that they would speak to any of the staff if they were concerned about anything and this would be responded to. There was a complaints procedure displayed in the main entrance area. There were no on-going complaints at the time of the inspection.

A new care plan format had been introduced. Care records and documentation was more person centred and included information regarding peoples specific health needs. Care plans had associated risk assessments in place to ensure staff had a good understanding of the risks associated with the people they looked after. Medicines processes had been improved and people received their medicines safely. People enjoyed the meals provided and information was in place to ensure people’s nutritional needs were met. Referrals had taken place when issues had been identified for example nutritional or falls. Information received from other health professionals had been included in care documentation to inform staff.

There were systems in place to assess and monitor the quality of service provided. A new auditing system had been introduced with further audits and quality assurance planned. Audits were being used to identify actions needed and these were being reviewed and responded to ensure improvements were maintained. There was on-going maintenance and servicing to all systems and equipment within the home. Accidents, incidents and falls were recorded and reviewed. The registered manager was aware of how to report safeguarding concerns. Staff had safeguarding training and understood their responsibilities to ensure peoples safety was assured at all times.

Staff were working with the registered manager to continually improve systems and processes to ensure people received the best care possible.

Staff and people living at the home felt that staffing levels were appropriate. Staff responded to people’s needs promptly and call bells were answered in a timely manner. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home. Staff received the training and support they needed to enable them to meet people’s needs. WE saw documentation which showed that further training was being planned to ensure staff had knowledge and understanding of specific health related needs. Staff responded to people with patience in a kind and caring manner and had a good understanding of providing person-centred care as they knew people well.

The daily activity schedule included one planned activity each day. This included quizzes, games, music and exercise. People were encouraged and supported to go out, and staff accompanied people on walks or to the shops. Some weeks a visiting entertainer came to Orchardown Rest Home to provide music and singing. People were seen to spend their time reading, watching television or spending time in the garden or communal areas. For people who preferred to stay in their rooms staff spent time each day ensuring they did not become socially isolated.

The registered manager understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People felt involved in choices and decisions about how they received care. Staff respected people's dignity and right to privacy, they always knocked before entering people’s rooms and ensured they supported people to dress the way they wished. Peoples care records and daily documentation was stored in a staff only area to ensure confidentiality.

The home is two houses which have been converted into one building with central communal rooms. The home has a passenger lift and staircases with handrails to assist people to access all areas of the building.

Orchardown Rest Home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home, supported by the registered provider. People and staff spoke highly of the registered manager and told us that they felt supported by them and knew that there was always someone available to support them when needed. Staff told us that the registered manager spent a lot of time at the home and knew everyone well.

The provider did not have an effective system in place to continually assess and monitor the quality of service provided. People’s safety had not been maintained as specific health concerns had not been identified and risk assessments had not been completed. Fire risk assessments and personal emergency evacuation plans (PEEPS) did not take into account people’s mobility or that only one member of staff worked at night. Auditing of accidents, incidents and falls had not taken place consistently to ensure any trends or themes had been identified.

Care plans did not contain relevant information to inform staff how to provide care for people. Care plans had not been implemented for specific health related needs, including diabetes, behaviours that may challenge and catheter care. This meant that staff were not supported by accurate up to date information to follow to ensure people’s needs were met safely and effectively.

Medicine procedures had not followed best practice guidelines and people may not have received their medicine in a safe and consistent manner.

Staff needed to ensure they followed infection control guidance when entering the kitchen area.

Staff demonstrated a good understanding around safeguarding and protecting people from the risk of abuse. Training was in place, however we found some areas of care needed to be supported by training or guidance, for example diabetes and catheter care.

Maintenance checks had been done, this included health and safety checks, water and legionella and PAT testing for electrical equipment.

Recruitment systems were in place. New staff had a period of induction and competency checks took place before people worked unsupervised. Supervision and appraisals took place and staff felt their views and feedback was listened and responded to.

A complaints procedure had been implemented since the last inspection. People felt able to talk to staff and told us they would speak to any of the staff if they had any concerns.

People were encouraged to spend their time how they chose. An activity programme was available for people and we saw people walking around the service, accessing communal areas or sitting in their room as they chose.

Meals were well presented and people told us that meals provided were of a good standard, with alternatives available if they did not like what was on the menu that day. People’s weights were regularly monitored and any changes reported to their GP.

Notifications had been sent when required to CQC or other organisations.

We found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Below is a summary of what we found.

The summary describes what people using the service, visitors and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, and well maintained. Equipment at the home had been serviced regularly and environmental risk assessments completed as appropriate.

People were looked after by staff who knew their needs and individual likes, dislikes and preferences. Staff spoken with demonstrated an understanding around safeguarding and how to recognise and report abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Training had been provided in relation to The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. People felt that they were involved in decisions about their care.

We saw from training records that staff had received appropriate training to meet the needs of the people living at the home. Staff we spoke with told us they felt supported by the manager, provider and the care team.

We saw evidence that the home worked closely with other professionals involved in people's care. Including community and district nursing teams, speech and language therapy, podiatry services and GPs.

Is the service caring?

We observed positive interaction between staff and people living in the home. We observed staff chatting with people throughout the day, and saw they were polite and courteous at all times. People were encouraged to make decisions about how they spent their time. We were told 'They help you when you need it, and take good care of you.'

Is the service responsive?

Care documentation provided staff with information about people's needs. We saw that the service worked collaboratively with other outside professionals. With referrals made when required. Feedback had been gained from people and their relatives, any feedback received had been taken forward and actioned if appropriate.

People had access to activities and told us they enjoyed the activities provided.

Is the service well-led?

The home had a newly registered manager who had been working at the home since February 2014.

People were asked for their feedback on the service they received. We saw that satisfaction surveys had been sent out to people living in the home and their relatives. No complaints had been received by the home since the last inspection.

Staff were clear about their roles and responsibilities, and were able to tell us who they were keyworker for, and what this entailed

Staff we spoke with told us they felt supported by the manager, provider and the care team. One told us 'Things are so much better here, the atmosphere is different and the new manager has made some positive changes, we are a happy bunch." Staff told us that they received regular supervision and that the manager had an 'open door' policy and they would be able to raise any issues or concerns at any time if they arose.

We found that people who use the service were involved in decisions about the care and treatment they receive. Care plans focused on promoting people's independence. People were protected from the risks of poor nutrition. We examined the systems in place for the safe management of medicines and found these to be effective. We found that the service did not have effective systems in place to gather information about the safety and quality of service.