Archived: OSJCT Orchard House

Updated 3 January 2019

The Inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection team:

One inspector and an Expert by Experience completed the inspection on 31 October and 1 November 2018. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019. Intelligence gathered from this service, with regard to this review, has not been included in this report.

Service and service type:

OSJCT Orchard House is a nursing home. It provides care and treatment to predominantly older people who live with physical needs and who required nursing care. Some people also live with dementia.

The service had not had a registered manager for three months. 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 new manager had been recruited. They had been in post for one month and intended to apply to CQC to be the registered manager.

Notice of inspection:

This inspection was unannounced.

What we did:

Prior to the inspection we reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about by law. A Provider Information Return (PIR) was not requested by us as part of the planning for this inspection. We took this into consideration during the inspection and discussed with managers, the improvements which had taken place and those planned for. A PIR is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from health care professionals who had visited the home, on behalf of the local authority, to review some people’s care. We used all this information to plan our inspection.

During the inspection, we spoke with fourteen people who used the service and four relatives to ask about their experience of the care provided. We made observations of the support people received. We reviewed eleven people’s care records which included, risk assessments, care plans and records relating to the Mental Capacity Act 2005. We reviewed records pertaining to people’s social activities and meaningful interactions. We reviewed a selection of medicine administration records and other records relating to the management of medicines. We reviewed three staff recruitment files.

We spoke with the new manager and a new operations manager. We also spoke with a manager who had provided interim support to the home and to two other managers who had been allocated by the provider, to support the new manager. We spoke with three nurses, two members of care staff, the activities co-ordinator who was also the home’s dementia lead, a cook and one of the housekeepers.

We reviewed a selection of audits and the home’s service improvement plan. We attended one staff handover meeting, a daily head of departments meeting and a meeting between managers

Updated 3 January 2019

At the last inspection in December 2017 we found people’s care was not always planned and delivered in a personalised way to meet their needs. This was a breach of regulation 9 under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the provider to complete an action plan, which we received, to show us what they would do and by when, to improve the overall rating of the service.

During this inspection, 31 October and 1 November 2018, we found improvements had been made to how people received their care and how people’s care had been planned. The breach of regulation had been met. The rating for the key question ‘Is the service Responsive?’ has been changed to ‘Good’.

The previous registered manager had left the service in August 2018 and up until a month before this inspection, there had been interim management arrangements in place. A new manager had been in post for a month prior to this inspection. They planned to become the new registered manager of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Orchard House is required to have a registered manager. 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 the provider had continued to quality monitor the service and actions had been taken following the completion of audits by interim managers. We again rated the key question ‘Is the service well-led?’ Requires Improvement as a period of time was needed for the newly appointed manager to be registered with the CQC and to get to know the needs of the service. Some improvement was needed, to ensure the new communication systems were in place to ensure people’s skin management plans would always be followed, and that shortfalls in staff response times to people’s call bells improved so these would answered promptly. The new manager planned to complete a reassessment of the services quality performance, using the provider’s existing quality review tool. They then planned to amend the existing service improvement plan to bring it in line with the findings of their quality assessment.

Although the overall rating for the service has improved from ‘Requires Improvement’ to ‘Good’ the CQC will continue to monitor the service to ensure improvements are sustained. Following this inspection we will be asking the provider to complete an action plan to show what they would do and by when to improve the key question ‘Is the service Well-led?’ to at least ‘Good’.

What is life like using this service:

People’s needs were assessed and their care planned to ensure they received the right type of support. Care plans and risk assessments were reviewed regularly and staff had access to up to date information about people’s care requirements. Information about people’s care and treatment was kept secure and confidential.

People told us they felt safe. Staffing had been increased following the inspection and provider’s review of the home’s dependency levels. This would ensure staff were better able to meet people’s physical and emotional needs.

Risks to people had been identified and action taken to reduce these, or remove them altogether. Staff had been trained to recognise potential abuse or discrimination and they knew how to manage and report such concerns. The home was kept clean, well maintained and measures were in place to reduce the risk of infection. Medicines were managed safely and people given the support they needed to take their medicines.

Improved working relationships with external professionals and agencies helped to support people’s needs and wellbeing. People had access to health and social care professionals as needed. All staff, received training and support to maintain and improve their knowledge and skills. Nurses received support to maintain their registration with their professional regulator. Staff had been safely recruited. People received help to maintain their nutritional wellbeing and had a choice in what they ate and drank.

The principles of the Mental Capacity Act 2005 were followed. People were supported to make independent decisions and their care was delivered in the least restrictive way possible. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. Any decisions made on behalf of people had been made in their best interests.

Staff were caring and kind towards people. Staff communicated well with people and we observed laughter and banter, as well as compassion and reassurance being afforded to people. Visitors were made welcome and people’s representatives were kept informed of changes to people’s health. People were treated equally and their diversity understood and supported. People were shown respect and their privacy and dignity upheld.

People had opportunities to take part in social activities and their more personal and meaningful interests were also supported. Plans were in place to improve the activity provision in the home by recruiting more activity staff. The new manager planned to explore more community based social opportunities for people. There were links with local church groups so people’s different faiths could be supported.

Complaints were responded to and managed effectively. People’s end of life wishes were met and they were supported to have a comfortable and dignified end of life.

People were benefiting from the home having a new and experienced manager in place. The new manager had already started to interview and recruit additional staff to ensure they had enough staff with the right skills and experience.

The new manager was aware of their responsibilities in relation to the homes registration with the CQC and in relation to other relevant areas of legislation. This included making sure the CQC were notified of all appropriate events and ensuring the last rating awarded to the home was displayed.

Rating at last inspection:

The overall rating for the home, at the last inspection in December 2017, was ‘Requires Improvement’ and it was the second time in succession, the home had been rated this.

Why we inspected:

The inspection of the 31 October and 1 November 2018 was a planned comprehensive inspection based on the rating at the last inspection.

About the service:

Orchard House is a care home which also provides nursing care. It provides care and treatment to people with complex physical needs; also, to people who live with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide care to 50 people; during the inspection 44 people were receiving this.

Further information is in the detailed findings below.