Comprehensive inspection of 31 July 2014
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This inspection was unannounced.
The Orchards provides personal and nursing care for up to 72 people. People living in the home may be older or younger people with physical disabilities, dementia or have health conditions that require nursing. Bedrooms are provided over two floors and each bedroom has en suite facilities. There are communal areas consisting of lounges, dining rooms, activity room and courtyard garden for people to use. There are adaptations and equipment available so that the needs of people with reduced mobility can be supported and access all areas of the home.
At our previous routine inspection of 15 and16 October 2013 we found that there had been breaches of legal requirements in respect of managing people’s dignity, nutrition and records management. At our responsive inspection of February 2014 we found that people’s dignity was being maintained however there were other breaches of legal requirements. These were in respect of meeting people’s needs, management of medicines, quality monitoring of the service and records management. At this inspection we saw that some improvements had been made but further improvements were needed. Following our inspection we held a meeting on13 August 2014 to discuss our findings and decide on the actions we were going to take. You can see what actions we have told the provider to take at the back of the full version of the report.
There was no registered manager in post at the time of this inspection however the provider had appointed an acting manager. This meant that actions had been taken to someone who would be responsible for the day to day management of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
There had been a lack of consistent management in the home since October 2011 and this meant that people had not always received good quality care and staff were not always provided with support and leadership. There were some audits that monitored the service provided but there was not always adequate analysis and action planning to address identified issues. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
At the time of our inspection there were 48 people living in the home. We saw that people were not always safe and protected from harm because the service continued to be in breach of Regulation13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the shortfalls in the safe administration of medicines. Our checks on the amounts of medicines in the home showed that some people had either been given more or less than the prescribed levels of medicines. This meant that their medical conditions were not always treated appropriately and according to the prescriber’s instructions. The necessary information to ensure that medicines given disguised in food or drink, on a when required basis and when people were responsible for their own medicines was not in place. As a result of these breaches we have decided to take enforcement action to ensure the future safe administration of medicines.
The provider had taken steps to protect people from abuse and although most people told us they felt safe in the home two people told us they were shouted at by staff. They were unable to give us specific details about this so we brought it to the provider’s attention to monitor. Recruitment procedures ensured that checks were undertaken to ensure that staff were suitable to work with vulnerable adults. Staff received training and care records contained the information staff needed to support people safely.
People’s rights were not always protected because meetings had not been held to determine that the actions taken were in people’s best interests when they were not able to make decisions for themselves. No Deprivation of Liberty Safeguards (DoLS) applications had been made although bed rails were in use and they could restrict people’s liberty.
We saw that staff were able to meet people’s basic needs but at times staff were not available to support people and there had been a high dependency on agency staff so that people did not always know the staff supporting them. Staff recruitment was underway to address these issues.
People’s nutritional and hydration needs were planned for and advice obtained when people were at risk of poor nutrition. People had a diet that was varied, nutritional and presented mashed or pureed where needed so that people were protected from the risks of choking. Improvements could be made to the management of mealtimes.
People’s health care needs were met by referral to the appropriate healthcare professionals including doctors, nurses, dieticians and chiropodists
People with capacity were able to choose whether they took part in activities but some people without capacity received inconsistent access to activities.
Focused inspection of 8 October 2014
We found that the service had improved greatly since the last inspection in the way they managed medicines. We found that medicines were now being managed safely and people were receiving their medicines as prescribed.