This inspection was carried out on 16 August 2018 and was unannounced.

The Orchards Residential Home is a ‘care home’. 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.

The Orchards Residential Care Home accommodates up to 44 people in a three-storey building. At the time of the inspection there were 29 people using the service.

At the last inspection on 28 February 2018 and 5 March 2018 we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as inadequate and was placed in special measures.

Although the provider was meeting the regulations we have rated the service as Requires Improvement as we need to be sure the service can sustain the improvements.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a 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. At the time of the inspection the registered manager was not available and has since been deregistered with CQC.

There was a relaxed and cheerful atmosphere throughout the inspection. People were well cared for by kind and compassionate staff. The culture had improved and people were at the centre of staff and management actions. People looked well cared for and enjoyed many positive social interactions with staff during our visit. This included enjoyment of a range of activities which took account of people’s personal preferences and interests.

The home was being managed by a support manager who promoted a strong caring approach and had made significant improvements to the quality of the care people received.

People received food and drink to meet their dietary needs. Meals were enjoyed in a calm and sociable environment where people received support in line with their care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Improvements had been made in the systems to monitor the service and keep people safe. Medicines were managed safely. Risks to people were assessed and there were plans in place to manage the risks. There were sufficient staff deployed to ensure people’s needs were met.

Staff felt well supported and were positive about the improvements made. They were committed to the continuous improvement of the service.

There were systems in place to enable people and their relatives to give feedback about the service and people told us they felt listened to.

Improvements had been made to care records. However further improvements were needed to ensure records were accurate and reflected people’s needs.

We carried out an unannounced comprehensive inspection of this service on 27 February 2018 and 5 March 2018. Breaches of legal requirements were found which included a breach of Regulation 12 relating to the safe care and treatment of people. After the comprehensive inspection, we took enforcement action telling the provider they must meet the legal requirements of Regulation 12 by 31 May 2018.

We undertook this focused inspection to check that they had met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Orchards Residential Home on our website at www.cqc.org.uk

We undertook an unannounced focused inspection of The Orchards Residential Home on 19 June 2018.This inspection was done to check that improvements to meet legal requirements had been made. The team inspected the service against one of the five questions we ask about services: is the service safe?

The ratings from the previous comprehensive inspection for the other four Key Questions were included in calculating the overall rating in this inspection.

The Orchards Residential Home is a care home supporting up to 44 people. At the time of our inspection there were 32 people living in the service. 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. The service supports people with a range of conditions which includes people living with dementia.

There was a registered manager in post at the time of the 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 that improvements had not been made in all areas and the service was rated inadequate in the key question. Is the service safe.

Medicines continued to be managed in a way that put people at risk of not receiving their medicines as prescribed. Medicines were not always stored in line with manufacturers guidance which put people at risk of receiving medicines that were not effective.

Risks to people were not always assessed and there were not always plans in place to manage the risks. Staff were not aware of the actions required to keep people safe and there were not always records to evidence that risks were being managed in line with people's care plans.

Accident and incident records did not include any evidence of accidents and incidents being investigated. Where people had experienced an accident or incident there was no review of their care records to look for ways to minimise the risk of reoccurrence.

Infection control procedures had improved and the home was clean and free from malodours.

We found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection we met with the providers to discuss the concerns found. The provider has submitted an action plan detailing the action they will take to meet the regulations. We will follow up this action plan at the next inspection.

The inspection took place on 27 February 2018 and 5 March 2018 and was unannounced. We carried out this inspection following concerns relating to incidents resulting in injuries to people.

The Orchards Residential Home is a 'care home'. 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. The Orchards Residential Home accommodates 44 people in one adapted building. At the time of our inspection there were 42 people using the service.

There was a 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 service did not promote a person-centred culture that valued people as individuals. People were not always treated with dignity and respect. Some staff were task focused and did not always treat people in a kind and compassionate way.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support best practice.

Systems to monitor and improve the service were not effective and the registered manager did not have a clear overview of the service and the quality of care being provided to people.

Accidents and incidents were poorly managed. There was no record of any action taken as result of accidents and incidents and no evidence of investigations being completed. There was no system in place to monitor accidents and incidents for trends and patterns.

Risks to people were not always identified and where risks were identified there were not always effective plans in place to manage those risks. Medicines were not managed safely to ensure people received their medicines as prescribed.

Systems in place to prevent the risk of infection were not effective. Areas of the home were malodorous. Some equipment was in a poor state of repair and not kept clean.

Staff were not deployed in a way that ensured people’s needs were met in a timely manner. Staff did not always have the skills and knowledge to meet people’s needs.

People did not always receive food and drink to meet their dietary needs and there was no effective system in place to monitor people’s weights, when required. Where people had lost weight action had not been taken to address concern’s relating to their weight loss.

Records were not accurate, up to date or fully completed. There were not always care plans in place and people’s care records did not always reflect their current needs.

Records were not stored securely to ensure people’s confidential information was protected in line with legislation.

People enjoyed a range of activities that were developed to meet their individual needs.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (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.

The overall rating for this service is ‘Inadequate’ and the service is 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.

If not enough improvement is made withi

We undertook an unannounced inspection of The Orchards on 18 May 2017.

The Orchards Residential Home provides accommodation and personal care to up to 44 people, some of whom have dementia. At the time of our inspection, there were 41 people living at the home.

At our last inspection on 5 and 7 January 2016 we asked the provider to take action to make improvements relating to the management of risks and accidents and incidents.

At this inspection on 18 May 2017 we found the provider had made improvements to address our concerns from the previous inspection. However, we found records in relation to people who used the service were not always complete and accurate. Some information in care plans was out of date. The registered manager was redesigning and reviewing care plans. The manager conducted regular audits to monitor the quality of service. However, audits were not always effective. A recent medicine audit did not identify our concerns relating to medicine records. The registered manager immediately implemented a new audit system to address this concern. Learning from other audits had been used to make improvements.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. These included risks relating to the environment and falls. Staff were aware of people’s needs and followed guidance to keep them safe.

Accidents and incidents were investigated, analysed and action was taken to prevent reoccurrence. Learning from incidents was shared with staff to keep people safe.

People told us they enjoyed activities in the home and a published programme of events was available to people. We were able to observe activities taking place. Staff also interacted with people on a one to one basis.

We were greeted warmly by people and staff at the service. The atmosphere was open and friendly. The home displayed an open and honest culture where management and staff were keen to learn and improve.

People told us they were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff that were extremely knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

People received their medicines as prescribed. However, medicine records were not always accurately maintained. We raised this with the registered manager who took immediate action to address this concern.

There were sufficient staff to meet people’s needs. Staff responded promptly where people required assistance. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The service responded to people’s changing needs. People and their families were involved in their care and how their care progressed and developed.

Staff spoke extremely positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was very approachable and supportive and that there was a very good level of communication and trust within the service.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who clearly understood the dietary needs of the people they were catering for.

We last inspected The Orchards in June 2013. We found the provider was not meeting two of the essential standards of quality and safety. On the 30 December 2013 we undertook a follow up inspection of The Orchards. We observed care, reviewed eight care plans and spoke with six people who used the service.

People we spoke with who lived in the home were generally positive about the care and support they received. One person we spoke with told us “Staff are wonderful. Living here is the next best thing to being at home”. We saw evidence that good care and support was being provided.

There was an effective complaints system. Comments and complaints were listened to and acted on. The provider had access to advocacy services to support people who used their service.

There were enough staff to support people’s needs. One person living in the home explained that they only had to press their call alarm and staff would come and assist them. Another person told us that if they asked then staff would take them out.

We reviewed the care plans of people living at The Orchards. We found that monitoring charts were now being consistently completed. We found that care plans contained information which was designed to meet their specific needs.

We spoke with people who used the service, visiting relatives and friends and two health care professionals. One person we spoke with told us “I am very happy living here, the staff are always nice and so helpful”. Another person said “my room is very nice and I can have my own things in there”.

Whilst the provider had a complaints procedure we found that there were inconsistencies with the reporting and logging of complaints. People that we spoke with said that they would feel comfortable raising any concerns and felt confident that they would be listened to and appropriate action would be taken.

We found that people were protected from the risks of inadequate nutrition and dehydration. One relative told us that their family member loved the food. They said “staff are very flexible here. When I arrived my family member was just having their breakfast as they had not got up till late”. Another person told us “the chef is really good. If there is something I don’t like they will always get me an alternative”.

Staff we spoke with told us that they received planned supervision and felt supported by the management team. They told us that they had access to training opportunities which were relevant to their role.

The provider had effective systems in place to monitor and evaluate the quality of services provided.

People who lived in the home told us they were treated well by the staff and were happy with the quality of care and support that was provided.

We saw that the home was kept clean and hygienic. Staff and people living in the home told us these standards were maintained.

We found that medications were correctly stored and administered.

The home had improved its procedure for staff recruitment and the correct checks and references were in place. People who lived in the home told us they were treated with respect by the staff.

The home had improved the systems in place to monitor and check the quality of care being provided and to manage potential risk.

People who lived in the home told us they were treated with respect by the staff and had their needs attended to. Privacy was respected and staff were friendly and caring.

People enjoyed the activities that were organised and were happy with the variety that was provided. People enjoyed the food and told us that sufficient choice was provided.

The home was kept clean and well maintained and people enjoyed their accommodation.

The manager told us they were improving the care planning system and moving to a different format for recording the care plans. Improvements were being made to the staffing supervision arrangements.

We carried out this inspection over two days on the 5 and 7 January 2015. The first day of the inspection was unannounced. Our last inspection to the service was on 30 December 2013. This was to check the provider had made improvements, which had been identified during a previous inspection in June 2013. The shortfalls were related to people’s care, staffing and the management of complaints. In December 2013, improvements had been made and the provider satisfied the legal requirements in these areas.

The Orchards Residential Home provides accommodation and personal care to up to 44 people, some of whom have dementia. At the time of our inspection, there were 42 people living at the home.

There was a 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 registered manager was available throughout our inspection.

Not all risks to people’s safety were identified and appropriately addressed. Water from a hand wash basin was hot to touch and a window on the first floor, presented a risk of a person falling from a height. One person at high risk of falling was not supported effectively when mobilising. They were told to sit down rather than find out what the person wanted. There had been a consistent number of falls each month and whilst possible trends had been identified, measures to minimise further occurrences were not effective.

Staff were not always responsive to people’s needs. This included one person becoming highly anxious and distressed about being in the home. Another person became louder when vocalising and then became upset. They had soiled their clothing but staff had not identified the signs the person had portrayed. Another person had similarly required assistance to change their clothing.

Not all people received interaction and stimulation from staff. Some staff spoke to each other rather than to people who used the service. A relaxing environment was not consistently maintained. The television was on in the lounge and music was playing in the adjoining conservatory. Both were very loud.

People’s care plans were up to date and regularly reviewed although the information was not person centred. The plans did not clearly inform staff of the support the person required or their personal preferences. Some information was conflicting which increased the risk of inappropriate care. Not all staff were consistently documenting people’s food and fluid intake if they were at risk of malnutrition or dehydration. This did not enable effective monitoring.

There were some interactions, which were much more positive. This included a member of staff assisting a person to drink. They were attentive and focused on the person. Other staff were friendly and reassuring when supporting people with their anxiety. Staff were aware of promoting people’s privacy and consistently knocked on doors before entering.

There were sufficient staff available to meet people’s needs. There was a stable team who regularly undertook additional shifts at times of staff sickness. Staff were well supported in their role and received a range of training to enhance their knowledge and skills. An effective recruitment procedure was followed to ensure all staff were suitable for their role.

People were supported to access healthcare services to maintain and support good health. People’s medicines were safely managed and administered in a person centred way. There were a range of audits to assess and monitor the quality of the service. People and their relatives were encouraged to give their views and knew how to make a complaint. They felt listened to and were confident any issues would be satisfactorily addressed.

People were complimentary about the meals and had enough to eat and drink. People were offered a variety of foods and could always have something else if they did not like what was on the menu. People’s risk of malnutrition was assessed and their weight was monitored. Any concerns were reported to the GP and a referral to the dietician would be made, as required.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.