About the service:

Orchard House Care Centre is a residential care home that provides personal and nursing care to 60 older and younger people. Orchard House Care Centre provides a service for people living with dementia or a physical disability who also require nursing care.

People’s experience of using this service:

¿ People were happy living at Orchard House Care Centre. They told us their needs were met by staff who were competent, kind and caring. People were treated with dignity and respect.

¿ Most individual risks were managed appropriately, however we identified some concerns in how risks to people were being recorded and acted upon by staff.

¿ Medicines were managed safely and people received the personal care they required. They were involved in the development of their personalised care plans that were reviewed regularly. Staff worked with local health and social care professionals to ensure health care needs were known and met.

¿ People's rights and freedoms were upheld. People could make all their own choices and decisions. When people lacked the ability to make their own decisions, systems were in place to ensure these were made legally and in their best interests.

¿ There were sufficient numbers of staff who were well trained and worked well together. The registered manager continually considered ways to improve the service for the benefit people living there. Where we identified areas for improvement, they acted immediately.

The service met the characteristics of Good in most areas and is rated Good overall. More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Good. (Report published 27 March 2017).

Why we inspected: This was a planned inspection based on the rating at the previous inspection.

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

Follow up: We will continue to monitor the service.

The Orchard is a privately run nursing home, part of the Barchester Healthcare Homes Limited group. It is registered to provide accommodation for up to 60 older people, including people living with dementia or other cognitive impairments. At the time of our inspection there were 54 people living in the home.

The inspection was unannounced and was carried on 17 and 23 January 2017.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessment. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring. Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided through ‘resident meetings’ and an annual survey. They were also supported to raise complaints should they wish to.

People’s families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The provider was fully engaged in running the home, through the regional director and provided regular support to the registered manager. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the home. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

During this inspection we looked at how the home managed people’s medicines. This was because we had previously found these were not being managed safely. We spoke with two of the 49 people who were living at the home. We also spoke with three relatives. People told us they were supported to administer their own medicines where appropriate. People also told us they were offered as required pain relief and received their medicines on time.

We spoke with the registered manager, nursing and care staff. We observed part of the lunch time medicines administration and viewed records relating to medicines administration. Staff had received medicines management training and the procedures observed were appropriate. All medicines were secure and full records were maintained. Medicines audits had been undertaken to monitor the way medicines were being managed.

The expert-by-experience spoke with six of the 46 people who were living at the home and one relative. We also spoke with three other people and one relative. All people said they were happy with the way they were cared for. People told us “staff are courteous and friendly". Another said “the carers are excellent and know their jobs well". One relative said “the staff are very approachable and friendly".

Staff were aware of how people should be supported. Staff stated they felt they had sufficient time to meet people’s needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

We also spent time observing care in communal areas. We found people had positive experiences and staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The care we observed corresponded with the care plans and risk assessments we viewed. We found medication was stored appropriately however correct administration and recording procedures were not always followed.

People received a varied diet with a choice provided at each meal. There were sufficient staff available to meet people’s needs. Staff received training, support and supervision. A range of quality monitoring procedures were in place and all necessary records were available and stored securely.

We spoke with six of the 40 people who were living at the home. They said that they were “very happy” with their care and that staff “treated them with respect” and when moving them “were careful and gentle”. One person said they were” looked after very well” and “the call bell is answered quickly”. Another said they had “nothing to complain about” and that the staff were “all happy and cherry”.

We spoke with seven relatives of people living in the home. They said that staff “always told them about the care” their loved on was receiving including information about ‘medication and food intake’. They said staff were “brilliant” and call bells were responded to quickly.

We observed care being provided in a respectful and caring manner with people being asked if they wanted to move to the lounge or wanted a second cup of tea. We observed appropriate use of moving and handling equipment. Staff were aware of the care needs of people. Care plans were relevant to people and the necessary records were maintained. However people were placed at risk due to incorrect use of pressure mattresses and the unnecessary of recording of some blood sugar levels. People received food and fluids although these were not always at regular intervals. Although medication was stored securely we identified concerns with the way medication was managed.

People said that they were very happy with the way their health and care needs were met. People said that they had been involved in planning their care and that their individual wishes were met. People had no concerns about their privacy and dignity.

People were also very happy with the staff who they said worked hard and were aware of how to meet their needs. People said staff were available when they needed them.

We also spoke with visitors who said that they were kept informed. They also said that they were happy with the care their relatives received.

We did not talk to people about their medicines on this occasion. We watched medicines being administered at lunchtime and saw that staff gave medicines with sensitivity and did not interrupt lunch just to administer medication.

We spoke to people who told us that they were able to make day to day decisions about aspects of their care. These included choices and decisions about what time they have care, where they spend their time and what they have to eat.

People also said that their privacy and dignity was respected when they were receiving care. One person stated that they did not like male carers and that they only had female carers. We also spoke with some visitors who said that although their relatives were not themselves able to express choices anymore they, as relatives, were consulted about care choices.

People told us that they were happy with the way care was provided although they were unaware of their care plans. Care plans contained a space for people or relatives to sign to confirm they agreed to the plan of care. This was blank in most care plans viewed.

Visitors also confirmed that they were happy with the care their relatives had received.

People stated that they received care at a time suitable for them. People also confirmed that activities were provided. Some people chose to take part and other people stated that they were not interested.

People said they felt safe and visitors said that they did not worry about their relatives and were confident people were safe.

People and visitors said that if they had any concerns or complaints they would raise these with the manager.

This inspection took place on 10 and 14 December 2015 and was unannounced. The home provides accommodation, nursing and personal care for up to 60 people, including people living with dementia. There were 54 people living at the home when we visited.

After the comprehensive inspection in June 2015, we identified that improvements were required to ensure people received a safe, effective service. We received action plans from the provider stating what they would do to meet the legal requirements in relation to improving their service. At this inspection we found improvements had been made but these need time to become sustained and fully embedded in practise.

The home did not have 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 provider had arranged for an operations support manager to take over running the home until a suitable manager could be appointed. The operations manager had applied to the commission to become the registered manager although their appointment was not intended to be long term. They told us a permanent manager had been appointed who would commence employment in January 2016.

The manager had notified us of medicines errors which they were investigating.

People felt safe and staff knew how to identify, prevent and report abuse. People and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet. A range of daily activities were offered with people able to choose to attend or not.

Legislation designed to protect people’s legal rights was followed. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Where people had been assessed as lacking capacity, best interest decisions about some elements of their care had been made. These included the use of bed rails and covert (hidden in food) medicines. Other aspects of care which the person may have lacked capacity to consent to had not been assessed.

Staff offered people choices and respected their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly.

There were enough staff to meet people’s needs. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received appropriate training and were supported through the use of one to one supervision and appraisals.

People and relatives were able to complain or raise issues on a formal and informal basis with the manager and were confident these would be resolved. There was an open culture within the home. Visitors were welcomed and had been kept fully informed about the previous inspection and the action that was being taken to address the concerns identified. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.