Archived: The Orangery

Updated 25 November 2017

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.

This is the first inspection since the service was registered with the CQC. The CQC was advised of an incident involving a person using the service. This incident is subject to an investigation and as a result this inspection was not used to examine the circumstances of the incident. However, the information shared with CQC was used to inform the inspection and ensure systems were in place so people remained safe.

This inspection took place on 30 August 2017 and was announced. We told the manager 48 hours before our inspection that we would be coming. This was because we wanted to make sure that the manager and other appropriate staff were available to speak with us on the day of our inspection. Two inspectors undertook the inspection, with an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience helped us with the telephone calls to get feedback from people being supported. One Inspector carried out telephone calls to care staff.

Before the inspection, we reviewed information we held about the service. This included previous inspection reports, complaints and any notifications. A notification is information about important events which the service is required to send us by law. We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We contacted the local authority commissioning team to ask them about their experiences of the service provided. We spoke 12 people with using the service and five care staff.

During the inspection we went to the service’s office and spoke with the manager, the regional manager, and two care staff. We spoke with one person using the service and their relative. We also visited the satellite office at Marlborough House and spoke with a visiting officer. We spent time reviewing the records of the service, including policies and procedures, seven people’s care and support plans, the recruitment and training records for six new care staff, complaints recording, accident/incident and safeguarding recording, and staff rotas. We also looked at the provider’s quality assurance audits and service development plans.

Updated 25 November 2017

This inspection took place on 30 August 2017 and was announced.

The Orangery Extra Care Scheme is a domiciliary care service and is registered to provide personal care. Care is provided to people living in their own home in The Orangery and Marlborough House, two Extra Care Schemes each managed by a housing association. Both provide accommodation for people over 60 years of age and care and support can be provided to people with a physical disability or learning disability, people with a sensory loss, for example hearing or sight loss and people with mental health problems or living with dementia. Twenty four hour care, seven days a week is provided with on-site care staff and with an emergency call facility. Additional services provided include organised social activities, a café, and a hairdressing salon. At The Orangery there is also a restaurant (for main meals). Around 90 people across both sites were receiving a service, of those 56 received support with the regulated activity of personal care.

This is the first inspection since the service was registered with the Care Quality Commission (CQC). On the day of our inspection, there was not a registered manager in post. 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. The registered manager had left and there had been a period of interim management arrangements. A new manager had just been recruited. The CQC had not received an application for the new manager to register for the service.

People and staff told us it had been a difficult period with a number of staff changes including senior staff and difficulties in recruiting care staff. One person told us, “There’s quite a turnover of girls I’m afraid.” Another person told us, “It is a very tight ship; they are always short of carers.” There were vacancies of care staff and in the senior management team, which we were told were being recruited to. People were cared for by staff who had not always been recruited through a safe recruitment procedure. We found regular auditing by senior staff in the service to ensure the quality of the service had not been completed or regularly maintained and embedded in the running of the service. People had been able to feedback on the care and support they had received. However, it was not evident how this had been used to inform and improve the service provided. Where the provider and local authority had audited the service, action plans to address the issues had not been drawn up, and it was not clear any actions which had not been taken or planned to address issues highlighted through the audits to be addressed. There was no evidence of how the provider monitored or analysed the information received to look for any emerging trends or make improvements to the service provided. These are areas in need of improvement.

Care staff received a five day induction and essential training to ensure they have the knowledge and skills to meet people’s care needs. Care staff told us they felt well supported. However, care staff had not always received regular supervision and appraisal in one to one meetings in order for them to discuss their role, training needs and share any information or concerns. One member of staff told us, “I haven’t had supervision since I started, or an appraisal.” Spot checks, which included arriving at times when the senior staff were there to observe the standard of care and to obtain feedback from the person using the service, had not always been completed. Staff meetings had not been maintained. These are areas in need of improvement.

Consent was sought from people with regard to the care that was delivered. All staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. Staff told us they always asked for people’s consent before they provided any care and support. However, supporting documentation was not always in place. This is an area in need of improvement.

The needs and choices of people had been clearly documented in their care and support plans. People told us that they felt safe with the staff that supported them. Risk assessments were in place to ensure people were safe within their own home and when they received care and support. Where people’s needs changed, their care and support plans had been reviewed to ensure the person received the care and treatment they required. Care staff told us they were kept up-to-date with people’s care needs through reading the care plans and daily handovers between staff shifts. However, a system to ensure a regular review of people’s care needs had not been fully maintained. This had not ensured all people’s current care needs had been identified and the required paperwork had been fully completed and was up-to-date. This is an area in need of improvement.

Procedures were in place to ensure the safe administration of medicines. However, records of when medicines had been administered had not always been completed as needed.

People told us they felt safe with the care provided. One person told us, “I was in a home for three years, right now it is a dream and I sit there at night, I know I’m safe straight away and that gives me comfort.” Another person told us, “Yes, I use a wheelchair and have to use two lifts when I want to go out but they help me to get down safely and I never have a problem.” People told us they were supported by kind and caring staff. One person told us, “The carers are like friends.” Another person told us, “I’m fine and happy here, it works, all nice and friendly.” A third person said, “They’re always respectful.” A further person said, “The standard of care is down to the girls they are dedicated as well and go beyond the call of duty.”

Where required, care staff supported people to eat and drink and maintain a healthy diet. People were supported with their healthcare needs.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.