Orford House Residential Care Home

We found the following examples of good practice:

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. The provider kept in touch with family members and people's friends through emails.

The provider had arrangements for visitors to meet with people virtually through video conferencing and physically in visiting pods (designated area for visits) with a transparent screen separating the room and an intercom for people to speak with their family. All visitors were asked to complete a COVID-19 screening form on arrival, and had their temperature checked. Visitors had to show proof of negative lateral flow test taken on the day of the visit; in addition, visiting professionals had to show proof of their COVID-19 vaccination. People were supported to see their family in the garden during summer and the provider also facilitated window visits.

In order to control the spread of infection the provider informed us that they spaced out lunch times for staff. The provider informed us that all service users required personal care and staff used Personal Protective Equipment including gloves, mask and apron when providing personal care and when social distancing was not possible.

All COVID-19 positive service users were isolated according to Public Health England Guidelines.

The provider had an admissions process in place. The provider informed us that as soon as the service users arrive, they perform a lateral flow test in the car park and a PCR test was undertaken on the day of admission into the service. The provider informed us that all new service users were usually isolated for 10 days; however, if the service users had received two doses of the COVID-19 vaccine and received a negative COVID-19 PCR test after admission, they were not required to isolate.

The home had PPE stations for staff to don and doff (put on and take off) Personal Protective Equipment (PPE).

Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider informed us that all staff had received the infection prevention and control and personal protective equipment training.

The provider informed us that all staff undertook daily COVID-19 lateral flow tests and weekly PCR tests. The provider confirmed us that all staff working at the service had received the first two doses of COVID-19 vaccine and some of the staff had received their booster dose. The provider had maintained a vaccination and testing register for staff and service users.

The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing. The provider informed us that they had an open-door policy and have regular meetings with staff; they also had an instant messaging group for staff where they could contact the manager any time through their smartphone. The provider informed us they supported the wellbeing of staff by encouraging them to take regular annual leave, allowing them to attend hospital appointments during work time, providing extra annual leave for staff who may have family issues. The provider also informed us that they gave Christmas presents for staff. The care home manager indicated they had a really good support system in place and were supported by the management; the manager informed us that they attended a six-week learning course where they discussed on how to deal with issues related to COVID-19.

Further information is in the detailed findings below.

At this inspection we found the service had improved in relation to each key question and as a result the service’s overall rating has risen to ‘Good’.

Orford House Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Orford House Residential Home accommodates up to 29 people in one adapted building. The service specialises in supporting older people some of whom maybe living with dementia. At the time of our inspection there were 22 people using the service.

The service did not have 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 manager of the service had submitted an application to register with CQC shortly before our inspection.

People’s safety was enhanced by the preparedness of staff to respond to emergencies. Staff received on-going training to ensure they were clear about their roles and responsibilities in safeguarding people from improper treatment and the provider took prompt and decisive action where safeguarding concerns arose. Risk assessments were in place to reduce people’s risks of experiencing avoidable harm. The provider ensured that staff were safe and suitable to deliver care and support. The environment of the care home was clean.

People’s assessed needs were met by trained, supervised and appraised staff. People’s mental capacity was assessed and supported. People ate well and staff supported them to access healthcare services whenever required. People, their relatives and healthcare professionals were actively involved in successful transitioning into the service.

People and relatives told us the staff were caring and kind. Staff respected people’s privacy and dignity and promoted their independence. People and staff shared positive relationships and visitors were made to feel welcome at the service.

Staff were responsive to people’s changing needs. People’s needs were detailed in their care plans which people participated in developing. People engaged in a range of activities made available at the service. The provider managed complaints appropriately. Staff ensured that people were cared for compassionately at the end of their lives and in line with their preferences.

The service had improved the robustness of its quality assurance processes so that action was taken where shortfalls were identified. Staff felt supported by the manager and encouraged to share their views regarding improvements to the service. The provider sought and responded to feedback from people and relatives and made information available to them. People benefitted from the provider’s partnership working with external organisations.

At our last inspection in August 2015 the service received an overall rating of Good.

Orford House Residential Care Home accommodates up to 29 older people in one adapted building. 24 people were living in the service at the time of our inspection. People had individual bedrooms, three of which had en suite facilities.

The service had 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.

People were not protected by the readiness of staff to respond as planned in the event of an emergency. The service had not complied with its policy to undertake building evacuation drills and staff were not clear what the provider’s evacuation plan was.

There were sufficient numbers of staff available to support people effectively. Robust procedures were in place to ensure that only safe and suitable staff were recruited. However, further routine checks were not systematically carried out once staff were in post.

Staff were not always supported to reflect on their practice or plan their professional development because they did not always receive regular one to one supervision or annual appraisals. The registered manager and the provider carried out detailed audits of the service. However, where shortfalls were identified such as the absence of evacuation drills, DBS updates and staff supervisions action plans were not followed through and the shortfalls persisted.

People were supported with risk assessments and risk management plans to reduce their likelihood of experiencing avoidable harm. Staff were trained to administer people’s medicines and did so safely. The environment of the care home was visually clean and staff followed appropriate infection prevention practices.

People had detailed needs assessments and plans were in place to meet those needs. Staff received on-going training to deliver care and support effectively and appropriately referred people to healthcare services when required. People received the support they required to eat and drink well. The service was approaching the end of extensive refurbishments, redecoration and improvements at the time of the inspection. This had been well received by people, their relatives and staff. People were treated in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Kindness and compassion were in evidence at the service. People and their relatives were pleased with the positive relationships they shared with staff. People’s cultures were recognised and they were supported with cultural expression when they chose. Staff promoted people’s privacy, dignity and independence.

People received care and support that met their needs and preferences. People participated in activities at home and in the community. Staff supported people to continue to follow their interests and hobbies. The registered manager addressed complaints promptly and in line with the provider’s policy. Complaints were reviewed for collective learning and improvement. People were treated with dignity and compassion during their end of life care.

People, relatives and staff spoke favourable about the registered manager. The responsibilities of the registered manager had increased to include the management of another of the provider’s services. This meant they were able to spend less time managing people’s care at Orford House. The service had an open culture and actively gathered the views of people and their relatives which they were responsive to them. The service worked in partnership with other services and agencies to improve the quality of care people received.

At this inspection we identified breaches in relation to good governance and staff support. You can see what action we told the provider to take at the back of the full version of the report.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Care plans detailed that people's needs were identified and met. These plans were regularly reviewed and updated so that they were meeting people's current needs. Any risks were assessed and reviewed regularly to ensure people's safety was promoted whilst ensuring their independence.

People living at the home told us they felt safe, one person commented 'They're so quick at answering the call bell especially at night' and a relative told us 'I've never seen anything untoward'. Staff had all completed training in keeping vulnerable adults safe and this training was refreshed regularly so staff were aware of the types of abuse and what to do should they suspect abuse. The home had all the appropriate policies and procedures in place.

The Care Quality Commission monitors the operation of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We saw staff had received training and that the home knew how to make a referral to the local authority if a DoLS assessment was required. This could help to ensure that people's human rights were properly recognised, respected and promoted.

Is the service caring?

People we spoke with were positive about the care provided at Orford House. Comments included, 'The staff are lovely, they're caring' and another person told us 'I think they're wonderful'. We saw people who used the service were supported by kind, attentive and compassionate staff. Staff treated the people who used the service with respect and dignity.

Is the service responsive?

We found staff continually monitored people's condition and where necessary sought advice and assistance from other community based health and social care professionals. In one example, a referral had been made to a physiotherapist as a person's walking frame was not suitable for them.

The service had a complaints policy and procedure. People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. The home sent out an annual survey for people who used the service and their relatives to comment on the care provided by the home.

There was choice of activities available for people who used the service. These ranged from bingo and quizzes, to aromatherapy and massage, to days out by the seaside.

Is the service effective?

People received effective support from staff that were trained and supported by the manager. Staff told us and we saw evidence that they had received specific training to meet the support needs of people who used the service. There were sufficient numbers of suitably qualified and experienced staff on duty to safeguard the welfare of people who used the service.

People's specific needs were taken into account and there was guidance and instructions for staff on how these should be met. People's care plans were reviewed regularly and any necessary changes made. In this way people were receiving care that was appropriate to their needs.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

Is the service well-led?

The service had a registered manager who knew the service well.

The service had quality assurance systems in place. We saw records that showed us any issues identified were addressed promptly. As a result the quality of the service was continuingly improving. An annual survey was completed by people who used the service or their relatives.

Regular audits of the care plans, medication and infection control were carried out to help ensure that people received good quality care at all times. There were systems in place to make sure staff learnt from incidents and accidents and other untoward events.

We reviewed six people's care files and found that people's needs were assessed. We saw that a variety of activities were available to people who use the service. One person told us, 'I join in the activities as much as I can and when they have a picnic I always go." Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were satisfied with the way their care was delivered. People using the service told us, 'I am very happy here.' 'The staff are lovely.' A relative said of the service, 'Staff are nice but there could be more interaction between the staff and residents.'

We found that people were cared for in a clean and hygienic environment. However, we were concerned that people who use the service, staff and visitors were not protected against the risks of unsafe premises. Asbestos containing material had been discovered in the building in 2012, but the provider had not taken the necessary steps to make the building safe.

There were effective recruitment and selection processes in place and appropriate checks were carried out before staff began to work with people using the service.