We undertook a focused inspection on 28 May, 03 and 04 June 2015 to assess whether the provider had made improvements to meet requirements of the regulations. The provider had sent the Care Quality Commission an action plan to say what they would do in order to meet the regulations the home was in breach of. We wanted to check if the provider had followed their plan and to confirm that they now met legal requirements.
We carried out an unannounced comprehensive inspection of this service on 27 November 2014. During this inspection, we found multiple breaches of legal requirements. As part of our findings we issued seven warning notices in relation to people’s consent to care and treatment; their care and welfare; the assessment and monitoring of the quality of service provision; cleanliness and infection control; management of medicines; maintenance of safe and suitable premises; and the staffing levels the provider had in place. We additionally found concerns with how the provider safeguarded service users from abuse; met their nutritional needs; respected and involved service users; managed complaints; and supported staff.
This report only covers our findings in relation to the latest inspection. You can read the report from our last inspection in November 2014, by selecting the 'all reports' link for Orchard Lodge Care Home on our website at: www.cqc.org.uk.
Orchard Lodge provides care and support for a maximum of 44 older people, some of whom may have physical disabilities or sensory impairment. At the time of our inspection in May and June 2015, there were 24 people who lived at the home. Orchard Lodge is situated in a residential area of Blackpool. It offers single and shared accommodation over two floors. Garden areas to the front and rear are accessible for wheelchair users via a ramp. Communal space is accommodated in three lounges and a dining room.
There was a registered manager in place. 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.
During this inspection in May and June 2015, we found that the provider had failed to meet the requirements of the warning notices. Additionally, the provider had not undertaken all of the actions on their plan, which they had told us would be completed by the 30 April 2015.
We observed poor practices in relation to the maintenance of people’s safety when being supported. Individuals were not consistently given clear explanation of support that was provided and were supported by staff who were not always trained to do so.
We have made a recommendation about policies and procedures in relation to safeguarding people against abuse and whistleblowing.
We found multiple breaches of people’s environmental safety. There was no indication as to how the provider had managed people’s safety when accessing the main staircase. The provider had removed the stair gate without putting in place any protective alternative for people’s safety. Not all window restrictors or door closures were present and they did not consistently offer ample protection for people’s safety. The provider had continued to fail to ensure accidents and incidents were properly managed, analysed and monitored to ensure the risk of their reoccurrence was minimised.
Fire, kitchen and equipment safety was poorly maintained. For example, boiling pans in the kitchen were not being continuously monitored even though people who lived at the home entered this area. Health and safety risk assessments were poor and did not always protect individuals who lived at the home. The provider had failed to ensure risk assessments were in people’s care records to manage the risk to them of receiving unsafe care.
We found multiple concerns with the maintenance of infection control and cleanliness at orchard Lodge. Staff had no awareness of the Code of practice in relation to Healthcare Associated Infection and the new infection control audit had not picked up concerns we found. Additionally, the medication audit had not been carried out monthly as indicated on records held by the home. Although we observed medication was administered safely there were periods during the week when there were no staff on duty who were appropriately trained in medicines. This meant the provider had continued to fail to ensure people who received medicines were continuously monitored or had support should they need it.
We noted there continued to be periods during the week when there were inadequate numbers and skill mixes of staff on duty to provide care. Comments received, our observations and checks of records confirmed staffing levels were not sufficient to meet people’s needs in a timely manner.
We have made a recommendation about the provider seeking evidence-based, best practice guidance related to the assessment of staffing levels.
We noted staff did not promote lunchtime as a social occasion. We observed poor practices in relation to staff assistance to help people to eat their meal. For example, staff did not always engage with people, explain what they were doing or seek consent to carry out support. One staff member who provided support did not have training to do so. Associated care records were poor and had missing information. For example, there were no nutritional risk assessments. People who had lost weight were not always monitored or managed effectively to prevent the risks of malnutrition.
The provider had implemented a range of staff training and guidance since our last inspection in November 2014. However, we found domestic staff, who undertook care duties, had limited training and two other staff provided care without any training at all.
The provider continued to fail to work within the Mental Capacity Act. We observed incidences where people were deprived of their liberty without authorisation. There was no documentation that best interests, consent, risk assessment and mental capacity assessments had been undertaken in relation to deprivation of liberty or the continued use of bedrails. Recorded consent to care was not always evident.
We have made a recommendation about the effective provision of a dementia-friendly environment.
Throughout our observations, we observed poor practices from staff when they supported people. We noted staff interactions were poor and they did not demonstrate a caring attitude. Staff failed to promote people’s dignity or show respect to individuals. People’s recorded preferences were not always updated or were missing from care files. Care records did not always evidence that individuals or their representatives had been involved in their care planning and assessment.
The provider had ensured people’s confidential information was stored securely following our last inspection in November 2014. However, we found people’s privacy and their dignity was not always maintained. For example, the provider had failed to ensure a lock was in place on the first floor shower that was in use.
People were not protected against inappropriate care because the management team had failed to maintain up-to-date, suitable records that met people’s planned needs. For example, care files were not always regularly reviewed, signed and dated by staff. Not all care plans were in-depth to ensure staff were given guidance that enabled them to respond to people’s requirements.
The registered manager had continued to fail to provide up-to-date information to assist people to make a complaint if they chose to. Details on display for individuals who lived at the home and their representatives had not been changed following concerns we identified at our comprehensive inspection. There were three policies in place that were conflicting and did not adequately guide people and staff about the relevant procedures.
New policies had been introduced that followed national guidance and legislation. However, not all procedures were in-depth and there were two sets of policies in place. This meant the provider had not adequately and clearly guided staff in their roles and responsibilities.
Staff told us they felt management support had improved in the last two weeks since the introduction of a new management team. Quality audits had been introduced since our last inspection in November 2014. However, these did not pick up issues we identified with infection control, medication, environmental safety, nutrition, kitchen safety and care records.
Staff, visitors, people and their representatives had limited opportunity to feedback about the quality of the service. This included the opportunity to reflect upon improvements and the provider’s action plan since our last inspection in November 2014.
We found a number of 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 this report.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
- Ensure that providers found to be providing inadequate care significantly improve.
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.