Orchid Lawns

Orchid Lawns is a residential care home service with nursing, providing accommodation for older people, who may be living with dementia and/or who require nursing or personal care. At the time of our inspection, Orchid Lawns was supporting 11 people, many with complex needs and advanced dementia. The service is registered to support up to 24 people.

People’s experience of using this service and what we found

Safeguarding incidents were not always acted upon, nor always reported to the Care Quality Commission or the local authority safeguarding team without delay. This meant people were at risk of not receiving all external support to ensure they were safe.

The registered manager had introduced new ways of working and systems that improved the quality of care. Some of these were still being fully implemented but meant people’s experiences of the care had improved..

People were being supported by a staff team who understood their needs and preferences and treated them with kindness and patience.

Staff received training to ensure they had the right knowledge and skills to safely support people and know the right processes to follow in emergencies. However, this was not followed through in practice in all cases.

Staff ensured people had access to all health professionals when required. Follow up actions were not always recorded but were now being monitored.

People were being kept safe from the risks of COVID-19 as staff were following all current government guidance for infection prevention and control. Visitors were supported to follow the correct processes.

There were sufficient staffing levels to meet people’s needs and manage risks which meant people did not have to wait for support.

People were supported to eat and drink and had a choice of food and drink options. People who required additional support to eat and drink or who had specialist diets were given the support they needed, and all guidance was being followed correctly.

People were given choices of how they wished to spend their time on an individual basis although group activities were also an option.

People were supported to maintain relationship with their relatives and friends. Staff supported communication between them.

People were administered their medicines safely.

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

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

Rating at last inspection and update:

The last rating for this service was inadequate (published 11 January 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider were now only in breach of one regulation, no longer in breach of all regulations except one.

Not enough improvement had been made in regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 and the provider was still in breach of this regulation.

This service has been in Special Measures since 11 January 2021. During this inspection the provider demonstrated that enough improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and in part due to concerns received about a failure to report allegations of abuse. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvement, but people were not at risk of harm from this concern.

The provider had reflected on lessons learnt in relation to allegations or poor care and failure to report. They had implemented new systems and staff practices to ensure all concerns could be identified early and acted on.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to failing to report incidents without delay. Please see the action we have told the provider to take at the end of this report.

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.

Orchid Lawns is a residential care home providing accommodation for older people, who may be living with dementia, a physical disability or mental health needs, who require nursing or personal care. At the time of our inspection, Orchid Lawns was supporting 16 people, many with complex needs and advanced dementia.

People’s experience of using this service and what we found

Effective arrangements were not in place to manage and reduce risks for people using the service and lessons were not always learned when things went wrong. Staff were not effectively deployed to ensure people’s needs were met and did not put their safeguarding knowledge into practice to protect people. Improvements were being made in the management of medicines. Infection control processes were in place.

Staff were not provided with the training, skills and information they needed to care for people effectively. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. People received food to meet their individual dietary needs, however the mealtime experience was not relaxed. Referrals were made for additional support to other professionals when needed.

People were not always engaged in meaningful activities to ensure their wellbeing. Although care plans were in place, they did not always contain information to guide staff and staff did not have time to read them.

Management, leadership and governance arrangements did not provide assurance the service was well led, that people were safe or their specific and complex needs were being met. There had been an increase in safeguarding concerns over the last six months. We were not assured the provider’s plan for improvement focused on the right areas to ensure a positive impact for people.

We received positive feedback from relatives that staff were kind and caring, however the care was not always attentive, and staff did not have time to spend with people.

We raised a safeguarding referral with the local authority regarding some of our concerns after the inspection.

Rating at last inspection

The last rating for this service was Good (29 May 2019)

Why we inspected

The inspection was prompted in part by notification of a specific incident following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The inspection was also prompted due to concerns about people receiving poor care and support, ineffective safeguarding processes and concerns related to a lack of managerial oversight and leadership. A decision was made for us to inspect and examine those risks. We inspected and found further concerns which impacted on other areas of the quality and safety of care. We widened the scope of the inspection into a comprehensive inspection which included all the key questions.

We have found evidence the provider needs to make improvements. Please see the safe, effective, responsive, caring and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchid Lawns on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, staffing, governance, leadership and oversight and statutory notifications.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

People’s experience of using this service: People and their relatives were positive about the care that they received. One relative said, ‘‘Everyone is so lively and considerate. Nothing is ever too much trouble. I would give the all the staff here an A1 plus.’’

People were treated with kindness, respect and compassion and their privacy, dignity and independence were promoted.

People’s communication needs were not always met as communication methods for people living with dementia had not been fully explored.

People had a limited choice of activities which they could take part in.

The environment at the service needed some development to make it more supportive to people living with dementia. Plans were in place to improve upon this.

We have made recommendations to the service about improving communication methods and the premises for people living with dementia.

Systems and process in place at the service kept people safe in all areas of their care including the administration of medicines.

There were enough staff on shift to support people and robust recruitment checks were carried out before staff started working at the service.

Staff received induction, training and supervision to ensure that they had the right skills and abilities to support people.

People were supported to eat and drink enough to maintain a balanced diet.

Staff referred people to health professionals where necessary and supported people to lead healthy lives.

Complaints were responded to appropriately by the registered manager.

People were supported with dignity and respect at the end of their lives.

The registered manager had a system of audits in place that were used to monitor and improve the quality of the service.

Regular feedback was collected from people and their relatives about the best way to support people.

People, their relatives and staff felt well supported by the registered manager.

Rating at last inspection: Good (report published 21 September 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. During this inspection we found evidence continued to support the rating of good. One KLOE (Responsive) has now been rated as Requires Improvement. More information is in the full report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Orchid Lawns provides nursing care and support for up to 24 older people living with dementia and needs relating to their mental health. At the time of our inspection there were 23 people who lived at the home.

The home had a registered manager, as is required by the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

During our inspection we found that people were safe at the home. Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments in relation to the running of the home. These were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. There were effective processes in place to manage people’s medicines and referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being.

There were enough skilled, qualified staff to meet people’s needs. Staffing levels had been based on the dependency levels of the people who lived at the home. There were no permanent staff vacancies at the home, although the registered manager was recruiting for bank staff to cover when permanent staff were absent. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. Staff were trained and supported by way of supervisions.

People or relatives acting on their behalf had been involved in determining their care needs and the way in which their care was to be provided. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met. Relatives were involved in the regular review of people’s care needs and were kept informed of any changes to a person’s health or well-being.

People had a choice of good nutritious food that they liked and their weight was monitored, with appropriate referrals made to other healthcare professionals when concerns were identified.

There was an up to date complaints policy in place and a notice about the complaints system was on display at the entrance to the home. The registered manager had introduced more informal methods of gaining feedback form visitors and healthcare professionals who attended the home. Actions taken as a result of any feedback were shared with people. A number of leaflets on the notice boards around the home included information about the service and organisations that could be contacted for support or to report concerns.

There was a very friendly, family atmosphere at the home. People, relatives and staff were able to make suggestions as to how the service was provided and developed. The home had forged links with a number of local organisations which provided support to the development of the service.

An effective quality assurance system was in place.

Further allegations included concerns about the accurate completion of care records and the training staff received to enable them to undertake their roles effectively. Whilst we had no information relating to any specific harm caused to people, it was suggested the systems in place and the care provided could pose a risk to people.

People told us they were happy and we observed they were calm and relaxed in the presence of staff. We did however find that the care records were not always reflective of the current care needs.

Although there was manual handling equipment within the home, staff reported there was not sufficient available for the amount of people required to use this. We found out of three bathrooms, only one of the baths was in working order, with parts being required for two of them.

We found staff had received appropriate training but were not always supported with regular supervision or staff meetings.

During our last inspection, we found that although people's personal preferences for daily living had been detailed within the records, these were not always considered when care was delivered. Therefore to ensure this took place, we observed the engagement and interactions between staff and people who used the service. We found these were achieved in a relaxed and calm manner. Staff considered people's choices, took their time to explain what they were going to do and respected people's decisions. Staff were observed to be attentive to the needs of people and could tell us about individual likes, dislikes and preferences within people's daily routines.

Staff told us that since our last visit, the home had made improvements which had benefitted people. We found that all care staff on duty had been provided with training to use the bath equipment safely and effectively.

On arrival we found there was insufficient staff available to protect the health safety and well being of people at Orchid Lawns, because two of the three staff on duty were asleep.

As part of this inspection we reviewed the care documentation for four people in this home. We found care plans and risk assessments were detailed and kept under review and reflected people's changing needs. We noted people's personal preferences and wishes had been sought and were recorded, however we observed these were not always considered when care was delivered.

We spoke with two people who used the service, and observed staff interactions with people throughout this inspection. We observed staff were respectful and treated people with dignity. One person told us, "I came here not expecting friendship, but it's alright here."

This home provided a safe and secure premises for the people who lived there. The manager told us a refurbishment programme was due to commence, which would replace furniture and fittings which were old or damaged.