About the service: Orchid Care Home provides care to people who may require nursing care and for people living with dementia. Orchid Care Home accommodates up to 83 people in three separate units, each of which has separate purpose-adapted facilities. There were 76 people using the service at the time of the inspection. One of the units specialises in providing care to people living with dementia.

People’s experience of using this service:

People told us they felt safe living at the service. However, we found people were not protected from all risks because assessments regarding the risks of mobility and falls were not always reviewed and updated following an incident. Accidents and incidents were not always analysed for trends and patterns which resulted in some people not being referred to health care professionals. People told us there were not enough staff to keep them safe.

There was no registered manager in post. The management and governance arrangements of the service were not adequate and therefore staff felt unsupported by the management team. Medicine audits were effective, however, care plan audits failed to identify shortfalls revealed during our inspection. We were not always notified about accidents/incidents taking place in the service.

Staff were recruited safely and they knew how to protect people from abuse.

Rating at last inspection: At the last inspection the service was rated requires improvement (published 11 November 2018) and there were multiple breaches of regulation. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider continued to be in breach of the regulations.

Why we inspected: We undertook this focused responsive inspection on 9 May 2019. This inspection was carried out following concerns reported by health professionals about staffing levels not being appropriate to meet people’s needs. At the previous inspection in October 2018 we had rated the service ‘require improvement’ with breaches of regulations in the ‘safe’ and ‘well-led‘ domains. At the latest inspection we looked to see if improvements in these areas had been made since the last inspection.

Enforcement: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 CQC (Registration) Regulations 2009. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

This inspection took place on 9 and 16 October 2018 and was unannounced.

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

Orchid Care Home provides care to people who may require nursing care and for people living with dementia. Orchid Care Home accommodates up to 84 people in three separate units, each of which have separate purpose-adapted facilities. There were 81 people using the service at the time of the inspection. One of the units specialises in providing care to people living with dementia.

At our last inspection on 17 and 18 August 2017 we had rated the service 'Requires Improvement' and identified breaches relating to management of medicines, failure to follow the Mental Capacity Act 2005 (MCA), and records being out-of-date.

Following the last inspection, we asked the provider to complete an action plan. We needed the provider to inform us how they intended to improve.

There was no registered manager in post. 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 application to register the manager with the Care Quality Commission (CQC) was submitted precisely on the first day of the inspection.

Recruitment checks of new staff were not sufficiently robust to ensure candidates were safe to work with people using the service.

Records contained in the emergency folder and the fire risk assessment were out -of -date. We raised these issues with the manager and saw evidence they updated the information on the second day of the inspection.

Where it was questionable whether a person had capacity to make care and support related decisions, the service did not always follow the principles of the Mental Capacity Act 2005. The Act helps to ensure actions are taken in people's best interests.

People gave mixed feedback about the quality of meals served to them.

There were gaps in the care records. Quality assurance systems were in place but not always effective and had failed to identify the issues which we found at the inspection.

Staff told us they were not always supported to obtain nationally recognised qualifications and were not always actively involved in developing the service. They told us they were not able to participate in discussing and considering new ways of enhancing the service, including changes in the management structure, which affected their work.

People told us they felt safe. Systems were in place to ensure people were safeguarded from abuse. Staff knew how to protect people from avoidable harm or abuse and were confident in raising concerns if they needed to.

Staff received support through one-to-one or group supervision, regular meetings and performance appraisals.

Effective general healthcare support was provided and external healthcare practitioners were consulted when required.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

People's privacy and dignity were respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

There was a range of activities available to people both within the home and in the local community that were adjusted to suit people’s preferences.

People had access to a complaints procedure and people knew how to make a complaint if they needed to.

People, their relatives and staff praised the manger. Althou

The inspection took place on 17 and 18 August 2017 and was unannounced on the first day. Orchid Care Home provides care for people who may require nursing care and for people who are living with dementia. Orchid Care provides care and accommodation for up to 83 people. On the day of the inspection 83 people lived in the home. The home is owned by Angel Care (Orchid Care Homes) Ltd. This was the first rated inspection of this service since a change in legal entity.

A registered manager was employed 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.

Medicines were not always managed safely. We inspected medicines at a time when the provider was switching to a new medicine provider. We found some people had not received their medicines as prescribed. We also found some medicine administration sheets were unclear which could lead to error. There were discrepancies in topical medicine administration (skin creams) and a lack of protocols in place to guide staff in administering medicine which people might need occasionally, known as PRN (Medicines that are taken “as needed” are known as “PRN” medicines.)

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Staff were aware of when people who lacked capacity could be supported to make everyday decisions and staff understood how to gain consent to care and treatment. A staff member told us they gave people time and encouraged people to make simple day to day decisions. Where people lacked the capacity to make decisions for themselves, there were some processes in place to ensure that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. However, documentation in people’s care records did not support the Mental Capacity Act Code of Practice being followed. We found people did not have individual capacity assessments in place to guide staff about what decisions people were able to make for themselves when there was concern over their decision making ability. There was little written evidence that any effort had been made to enable people to understand the decisions being asked of them. Advance care plans were in place but undated and signed by people’s relatives who did not have the legal authority to sign these. These had also been written by staff when care records indicated people no longer had capacity. Capacity assessments in place were generic and not decision specific.

People’s care records required improvement. We found there was not enough detail in care plans to guide staff. For example, if people had mental health needs, skin care needs or particular health needs such as diabetes.

People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. People were involved in planning the menus and their feedback on the food was sought. Allergies and preferences were known. We observed people’s meal time experience on one of the units. The way lunch was served was not always tailored to meeting individual preferences and needs. People at risk of poor hydration or nutrition we monitored closely and cared for well. However, people’s care records lacked sufficient detail on how to manage their dietary needs or requirements. These issues were fedback to the registered manager who took prompt action to address concerns.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People were kept safe by suitable staffing lev