About the service:

Orchard Lodge provides nursing care and accommodation for older people many of whom are living with life limiting conditions and some who are living with various forms of dementia. The premises is an older style, purpose built building with two floors. The service is registered to provide care for up to 28 adults. At the time of the inspection 19 people were living there.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rating at last inspection:

At our last inspection on 17 and 19 December 2018 the service was rated Inadequate and placed 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. 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.

Why we inspected:

We carried out this focussed inspection in response to information of concern we received about the service following our inspection in December 2018. At the time of this inspection we were aware of incidents being investigated by the local authority safeguarding team. As a result, we carried out this focused inspection to look at those concerns and this report only covers our findings in relation to those. This inspection did not assess performance against all five key areas and focussed only on the areas ‘Safe’ and ‘Well Led’. The ratings from the previous comprehensive inspection for the other three key questions were included in calculating the overall rating in this inspection. We will be returning to the service to provide a comprehensive overview of each key question.

People’s experience of using this service:

People were not protected from the risk of harm because risk assessments, care plans and monitoring processes were not detailed enough to support staff to provide safe care.

People were at risk of dehydration because the provider had not kept accurate records . Staff were unaware of the need for target amounts of fluid each person should receive to prevent dehydration.

People were not protected from experiencing unacceptable levels of pain. This was because the service did not have adequate assessment tools in place to monitor pain when people were unable to tell staff verbally.

People were not protected from the risk of neglect. This was because the manager did not always identify, take action to address or report this, particularly when this risk was as a result of the person refusing care.

Care records did not contain i

Orchard Lodge provides nursing care and accommodation for older people many of whom are living with life limiting conditions and some who are living with various forms of dementia. The premises is an older style, purpose built building with two floors. The service is registered to provide care for up to 28 adults. At the time of the inspection 23 people were living there.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We carried out this unannounced comprehensive inspection of Orchard Lodge Care Home on 17 and 19 December 2018. During our last comprehensive inspection in June 2016 we rated the service as ‘Good’ with a rating of requires improvement in responsive. This was because care plans were not kept up to date and showed little evidence of people or their families being involved in the process. During this inspection the rating changed to ‘Inadequate’. This is because we identified that previous concerns had not been adequately addressed and we found additional serious concerns about some aspects of the service. This was in relation to how the service kept people safe, considered their social needs and how the service was led.

We found the provider was in multiple breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in place who was also a registered nurse. 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.

Care records, including preadmission assessments, care plans and risk assessments were insufficiently detailed to ensure people received safe, person centred care that met their individual needs.

Some people did not have a fully functioning supply of heating and hot water in their bedrooms. This was a long - term issue and, although the provider had made attempts to address it, an effective solution had not been carried out. Poor maintenance of the premises placed people at risks of harm, by infection, inhalation of mould spores from damp, and exposure to cold or wet weather.

Staff were not deployed effectively to support people safely and people were left at risk of falling.

Although staff were kind when they spoke with people, interaction was very limited and many people were at risk of social isolation and lack of stimulation. An activities coordinator was in post and had good ideas of how to improve engagement with people. However, these ideas were not acted on when the activities coordinator was not working.

Staff did not always promote people’s dignity and respect. and inappropriate language was sometimes used to describe people. Confidential information was not always stored securely.

People’s social needs were not being meaningfully explored with them. Lifelong interests were not being promoted by the service. Staff were not chatting and engaging with people.

Quality monitoring checks by the provider had not identified many of these issues and therefore action was not taken to address them. Where action was taken it had not been fully effective and people were left in unsafe conditions until the Commission took action to address the issues with the provider.

The culture of the service was task based, and the registered manager did not have a strong understanding of how to promote person centred care.

Although the registered manager responded to relative’s complaints, the way in which this was done was dismis

This inspection took place on 16 and 21 June 2016 and was unannounced. We last inspected this home in September 2014 and found that the provider was meeting the legal requirements in the areas we looked at.

Orchard Lodge is a nursing care home in Leighton Buzzard, providing accommodation for people who require nursing or personal care, diagnostic and screening, and the treatment of disease, disorder or injury. The home had capacity to house up to twenty-eight people but there were twenty-five people living there at the time of our inspection.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service was not always responsive to the changing needs of the people who lived at the home because people were not always involved in the assessment and planning of their care. People’s care records were also not always updated to reflect their changing needs. However, people were encouraged and supported by the staff team to follow their hobbies and interests, and there was an effective system in place for handling complaints.

People who lived at the home were safe because the provider had systems in place to safeguard them from avoidable harm. These systems included the safe recruitment and training of staff who supported people and carrying out risk assessments of the home environment. Personalised risk assessments were carried out to minimise avoidable risk of harm. The effective and safe administration and management of people’s medicines also formed part of the system the provider had in place to ensure people’s safety.

People’s care and support was effective because the staff employed to the service were trained, skilled and understood their role. They supported and encouraged people to eat a healthy and balanced diet and to have access to other health and care services when necessary. They sought people’s consent before they provided any care or support and were compliant with the requirements of the Mental Capacity Act 2005.

People were cared for by staff who were kind, caring and empowering. They supported people in ways that promoted their privacy, dignity and respected their views. They provided support that was personalised to people.

The management team ensured the service ran appropriately providing visible leadership and oversight at all levels. This ensured the provision of a good level of care and support to the people who lived at the home.

An inspector from the Care Quality Commission visited the home and spoke with people who used the service, staff, family members and also a visiting doctor (GP).

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People had up to date risk assessments in place which were reviewed regularly by the provider. The provider carried out regular fire safety checks to ensure that people were safe from the risk of fire in the home and that staff were aware of what actions to take in the event of an emergency. We did however note that the home did not have enough storage available which meant that visitors and staff were not always safe from possible trip hazards in the home.

Is the service effective?

People’s care needs were assessed before they entered the care home and were reviewed after admission to ensure that care plans were developed to reflect people’s individual needs. We observed that people had their personal care needs met. People told us that the staff were 'approachable' and ‘kind’.

Is the service caring?

We observed that staff were responsive to people’s needs, and treated them with respect and dignity. People we spoke with told us that the, “staff are good” and when they rang for assistance the staff would respond quickly. One family member we spoke with told us, ”If anyone needed a home to go to, I would tell them to come to Orchard Lodge” and a visiting professional also stated, “this is the best home in Leighton Buzzard.”

Is the service responsive?

We saw that care plans were reviewed and updated on a regular basis to reflect the changing needs of people. People told us that if they wanted a change to their care the staff would respect their wishes. We saw that food was prepared on site and people told us that their preferences were noted. We also saw that the kitchen staff recorded the food requirements for people with special diets to ensure that they were receiving appropriate nutrition. We were told by a visiting professional that the home “is always calm and under control. Staff are always aware of what is happening in the home.”

Is the service well led?

The service had a registered manager in place, to oversee the day to day management of the home.

The manager of the home was aware of all aspects of the home. Staff told us that the manager was, ”…like a sister… and a pleasure to work with.” They told us that the manager was always approachable and was fully informed about the people who used the service and their needs. Quality assurance systems were in place together with regular audits to ensure that the home was meeting the standards required.

People who used the service and staff were asked for their opinions and feedback was acted on.

We looked at the care records for six of the 28 people who used the service which showed that people had given consent for their care and treatment and were able to access health care from other professionals. People we spoke with told us that staff always gained consent before providing them with support.

We observed a friendly and homely environment, with positive interactions between staff and people. People looked relaxed and well cared for, and we saw that staff took time to talk with people. One person’s relative said they were generally happy with the care provided and that the environment was nice. People who spoke with us told us they felt cared for and well supported by staff. Two people said the care was "wonderful", and one person said, “It's lovely here, staff are nice."

Clear processes were in place to ensure that the home was clean and tidy. We spoke with six members of staff, who told us that there was always enough supplies of protective equipment to enable them to carry out their job safely. They also said that they felt very well supported by the management and that the manager had an "open door" policy which enabled them to seek guidance when required.

The provider had effective processes in place to ensure that people were supported to raise concerns. We saw evidence that confirmed complaints were responded to in a timely manner.

We spoke with five people using the service.

People told us they were happy living at the home and that staff provided care for them as required.

One person said they often had to wait for staff to hep with personal hygiene.

Three people told us they “did not feel staff were over stretched”, and that “staff always attended to them quickly but were often busy.”

People told us the care at Orchard Lodge was good and met their needs. One person told us “The nursing care is wonderful.”

Two relatives told us the care was good and the staff always maintained good communications with them.

Three people who used the service said they enjoyed the food and it was good old fashioned cooking.

People told us they were happy with their rooms and were able to bring in their personal belongings to make their room feel more like home.

Three people said that the staff were always very busy. One visiting relative told us “The staff are usually rushed off their feet and don’t have much time to sit and chat with the residents.”

A second relative told us that staff can take a long time to respond to their relative.

During our visit on 06 February 2012 people told us that staff treated them with respect and encouraged them to make choices about their day to day life. People told us, and we heard, staff speak with them in a kind and respectful manner.

The people we spoke with were all happy with the care provided at Orchard Lodge, and said the staff knew how to support them and understood their needs. They said that call bells were generally answered within a reasonable timeframe.

We were told there was always a choice of menu, that the food was of good quality and was hot when served.

People who use the service made positive comments about the staff that care for them at Orchard Lodge. People told us they felt that any concerns they raised with the manager or deputy would be addressed, that staff listened to them and that they trusted the staff who work at the home.