Archived: Orchard Court

At the previous inspection on 23 November 2017, we found breaches of legal requirements and the service was rated inadequate overall and the service was put into special measures. We imposed urgent conditions on the registration which prevented new admissions to the service and required the provider to submit regular reports to prove the safety of people using the service.

After the comprehensive inspection, the provider was asked to provide an action plan to tell us what they would do to meet legal requirements in relation to breaches in person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified.

At this inspection we found the service had made some of the required improvements. However, the rating for the service remains Inadequate and the service remains in special measures. We found three continued breaches and three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Orchard Court is registered to provide residential and personal care for up to 20 people. There are three separate units within the service with six to seven people living on each unit. At the time of this inspection there were 20 people living in the service. There were people using the service who could not always express their needs and wishes because they had a mental health condition or because their ability to communicate was impaired. Many of the people using the service had complex needs which, at times, needed one to one or two to one support from staff who were trained in specific and specialised areas of care delivery. During our inspection it was not evident that support was being provided to the level people needed, to provide both meaningful activities or ensure their safety.

The service had a registered manager. 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 staff team had received training on the safeguarding of adults and were aware of their responsibilities for keeping people safe from avoidable harm. The provider’s safeguarding policy had not always been followed when a safeguarding concern had been identified.

The risks associated with people's care and support had been assessed though not all of the assessments had been personalised to cover the individual needs of the person.

The deployment of staff was ineffective and people were not being provided with the support they needed at a time that suited them. The way in which shifts were organised and the necessity for the staff team to carry out cleaning duties meant the people using the service missed out on participating in activities and interests that were important to them.

Appropriate checks had been carried out on new members of staff to make sure they were safe and suitable to work at the service and an induction had been provided. Whilst the staff team had received a number of training courses since our last inspection, some staff members had yet to receive training on specific health conditions people lived with.

People were not always supported with their medicines as prescribed by their GP. Not all of the staff team were aware of which of the people using the service were receiving their medicines covertly. [Disguised in food].

The premises were not clean or hygienic. The staff team were required to carry out cleaning and laundry duties as well as providing the complex care and support people needed. It was evident that this arrangement was not working. Chairs were stained and dirty and floors and surfaces were sticky to the touch. Not all areas of the service were well maintained. This included people’s bedrooms and the outdoor spaces people had access to.

The registered manager explained that lessons were learned when things went wrong however, records held did not demonstrate this.

The staff team supported people to make decisions about their day to day care and support and were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked the capacity to make their own decisions, documentation to show decisions had been made for them in their best interest was not always completed. Where people required additional support to make decisions, advocacy support was available to them.

The menus seen did not demonstrate that people had been involved in their development or they catered for people’s individual needs or preferences. The provider and taken away the opportunity for people to be involved in the cooking of both the main meal of the day and the evening meal by introducing a cook to prepare these meals and have them served at set times. People’s choice of what and when they wanted to eat was not promoted and the provider was not working to current guidelines in providing people with individualised care.

The service has not been developed and designed in line with the values that underpin Registering the Right Support. This was because the service was created a number of years before Registering the Right Support was published. However, people using the service were not enabled to have choice, are not able to live as independently as they could and do not live as ordinary a life as any other citizen.

People had access to relevant healthcare services and they received on-going healthcare support.

The staff team were kind and caring, though did not always treat people with thought or consideration. People’s preferences, likes and interests had been identified but there was little evidence to demonstrate that these were promoted or encouraged.

People were not able to spend their time engaged in activities they enjoyed and spent long periods of time with little or nothing to do. There was a lack of emphasis on people's goals and aspirations and people were not living fulfilled lives.

People had plans of care that, on the whole, reflected their care and support needs. The staff team knew the needs of the people they were supporting well but were not always able to support people in line with their plan of care because of the deployment of staff. Plans of care had been reviewed, though not with the involvement of the people using the service.

The provider’s complaints process was displayed for people’s information and this was available in picture form.

The staff team had completed training on end of life care and people using the service were supported to help them understand when a person passed away. The registered manager was working to ensure they understood people’s wishes at the end of their life.

Monitoring systems were ineffective and failed to identify the issues and concerns found during our inspection.

The provider had not taken into account the needs of the people using the service and had not worked in line with best practice regarding individualised support for people with a learning disability. The opportunity to provide individual care and support and been taken away from the staff team resulting in people not getting their care or support in an individual way or in a way they preferred.

The staff team did not always feel supported by the management team and continued to lack confidence in the provider and how the service was being run. Regular staff meetings had been held, however concerns and ideas raised had not been taken into consideration.

Whilst surveys had been used to gather relatives thoughts of the service provided they had not been used to gather the views of either the people using the service, the staff team or professionals involved with the service.

The provider had a statement of purpose and the relevant policies and procedures in place however; these were out of date and included incorrect information.

The service remains 'Inadequate' in well led therefore remains in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

For adult social care services the maximum time for being in special measures will usually be no more than12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Further information about our concerns are detailed in the findings below.

At this inspection we found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulations 2009. The breaches we identified posed a significant risk to people who used the service due to the complexity of their care needs. Many of the people using the service were extremely vulnerable, and highly dependent on the care staff supporting them. Our observations of peoples’ needs during our inspection showed that they were not always receiving the necessary support to ensure risks to their health, safety and well-being were effectively managed. There was a lack of care delivered to meet people’s individual needs and to promote and encourage their independence.

Due to the breaches we identified during our inspection and the risk these posed to some people, we made a safeguarding referral to the Local Authority as we were concerned about people's safety and well-being. The overall rating for this is inadequate.

Orchard Court is registered to provide residential and personal care for up to 20 people. There are three separate units within the service with six to seven people living on each unit. At the time of this inspection there were 20 people living in the service. One of these people was in hospital during our inspection. There were people using the service who could not always express their needs and wishes because they had a mental health condition or because their ability to communicate was impaired. Many of the people using the service had complex needs which, at times, needed one to one or two to one support from staff who were trained in specific and specialised areas of care delivery. During our inspection we found that this was not being provided at the service to the level people needed to ensure their safety.

There was a registered manager in post at the time of our inspection. 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.

We found there to be insufficient numbers of staff working at the service to keep people safe. People were not receiving the levels of supervision they needed and staff lacked the specialist knowledge and skills to care for and support people safely. People had experienced and were at risk of experiencing unsafe care and support as a result. Staff training was not adequate and not designed to meet the needs of people who used the service.

People were not safe due to safeguarding incidents not being appropriately acted on or reported and risks to people were not adequately planned for. Care plans and risk assessments did not always reflect people's current needs.

Medicines were being managed safely when we inspected the service, however, there was a lack of information for people with diabetes. We raised this with the provider who took steps to address this during the course of our inspection.

People had a choice of food and drink each day and were given these in sufficient quantities, however, people's nutritional risk was not always safely monitored and addressed.

People were not able to spend their time engaged in activities they may have enjoyed and people were not often given the opportunity to access the community. This was due to staffing levels at the service. People were not living fulfilling lives and there was a lack of emphasis on people's goals and aspirations. People spent long periods of time with little or nothing to do.

We found some staff to be caring and compassionate towards people, however, due to staffing levels at the service they lacked time to be able to spend with people.

Staff training and performance was not being effectively monitored and staff told us they felt unsupported and under-valued at the service. There was an unhealthy culture of mistrust between management and staff and this impacted on the quality of care being delivered.

There was a lack of effective monitoring in place at the service and this had resulted in poor outcomes for people. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection.

The service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.