The Orangery

Updated 17 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection took place over two days. On day one, an inspector and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

Although both the Orangery and Marlborough House were part of the inspection, we only visited the Orangery. We spoke to people and their relatives from Marlborough house over the telephone.

We spoke with nine people who lived at the Orangery and three relatives about their experience of the care provided. We spoke with nine members of staff including the registered manager, care manager, two senior care workers and five care staff.

We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We spoke with two people that lived at Marlborough house and two relatives of other people that lived there. We were not able to gather any feedback from health and social care professionals.

Updated 17 April 2020

About the service

The Orangery provides extra care housing, which is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. The provider had two buildings in this scheme, the Orangery in Bexhill and Marlborough house in St Leonards. As part of the inspection, we visited the Orangery and contacted people and their relatives at Marlborough house by telephone.

People had their own large flats, with kitchen, lounge, bedroom and bathroom. At the Orangery, flats were situated over four floors, with larger penthouse flats on the top floor. There were several large communal areas and a dining room that people socialised in daily. There were also communal bathrooms with specialised mobility equipment and a hairdressing salon.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

There were 40 flats at Marlborough house and 58 flats at the Orangery. Across both buildings, 66 people were being supported with personal care.

People’s experience of using this service and what we found

We found improvements were needed to people’s care documentation to ensure their current support needs were reflected accurately. However, staff knew people well and so we felt this had minimal impact on people. Although we found improvements were needed to records, people, their relatives and staff were positive about the registered manager and felt the service was well led. One person said, “We are fortunate, the care manager is very good.” Another said, “The registered manager is great, they’re very on the ball.”

The registered manager was passionate about working with others to improve the experiences of people. They were involved in various pilots and projects to improve people’s health and social wellbeing. Staff told us they felt valued by the registered manager and provider. Everyone we spoke to felt the care, housing and catering providers worked well as a team to benefit people.

People and their relatives told us that people were kept safe by supportive staff who understood risks to their wellbeing. Staff had a good understanding of keeping people safe and recognised signs that they could be at risk of abuse. People told us there were always enough staff to keep them safe and to meet their needs. Staff were rarely late to care calls and people knew in advance which staff would be supporting them. Medicines were given safely by trained and competent staff. The registered manager and care manager had good oversight of accidents or incidents and acted to prevent incidents reoccurring.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People told us they were given choices on a daily basis regarding their care needs.

Staff told us their training gave them the skills and confidence they needed to work effectively with people. One staff member said, “They give us the training we need to be able to do our jobs and then we review it regularly, so we stay up to date.” People were supported by a variety of health and social care professionals to promote their wellbeing, and staff ensured people’s nutrition and hydration needs were also met. People’s needs were assessed and regularly reviewed to ensure they were always receiving the right care and support.

People and their relatives were consistent in their view of staff and told us they were supported in a kind, caring and attentive way. One person said, “Every single carer always asks if there's anything else they can do. They don’t just do what task they’re assigned, they will do extra if I ask.” Another said, “They are very nice, and they are very caring.” People’s views and decisions about their care, were listened to and respected. People told us their privacy, dignity and independence were continuously respected and promoted. One person said, “They respect my dignity. I'm forever telling my family how wonderful they are.”

People told us that staff understood their support needs, preferences and wishes well. This included how they preferred to communicate, and staff used a variety of tools to support with this. People and their relatives knew how to raise concerns and told us when they had, they had been dealt with professionally and within appropriate timescales. People received caring and dignified support at the end of their lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The service registered with the Care Quality Commission in April 2019 and this was their first inspection.

Why we inspected

This was a planned comprehensive inspection, following the registration of the location.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.