The Old Orchard Care Home

Updated 2 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection prevention and control measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1inspector.

Service and service type

The Old Orchard is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Old Orchard is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post who was also registered as the manager of an additional care home service operated by the provider. The inspector queried the current management arrangements with the provider. Subsequently, the provider told us they had decided to appoint a registered manager for that other care home service. This meant The Old Orchard’s registered manager would then only be responsible for The Old Orchard care home.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed staff interactions with the 5 people who used the service. As the people were unable to communicate verbally, we spent time observing their body language during their interactions with care staff to help us understand the experience of people who could not talk with us. We used the Quality-of-Life Tool which is designed to support the corroboration of all sources of evidence gathered during inspection.

We spoke with 8 members of staff including care staff, senior carer, and the registered manager. We reviewed a range of records. These included elements of 5 people’s care records and a sample of people’s medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed. We looked at training data and quality assurance records.

We received feedback about the service from 4 external professionals who had recent and ongoing involvement with the service. We received feedback from 4 relatives of the people who lived at the care home. We also received feedback, by phone or email, from 9 staff.

Updated 2 September 2023

We expect health and social care providers to guarantee people with a learning disability, and autistic people, respect, equality, dignity, choices and independence, and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability, and autistic people, and providers must have regard to it.

About the service

The Old Orchard is a residential care home registered to provide personal and nursing care for up to 5 people. The service provides support to people who have learning disabilities and/or autistic people. Nursing care was not being provided at this care home. At the time of our inspection there were 5 people using the service.

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

Right Support

Not enough staff were deployed to meet people’s assessed needs for 1:1 support or to support people to follow their interests and take part in activities outside of the care home. The service gave people care and support in a safe, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community.

People were not always supported to have maximum choice and control of their lives. Limitations in staffing levels prevented that. Within the care home, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People’s care plans did not always accurately reflect their specific care needs in respect of modified diets, which were important to mitigate people’s risks of choking on food. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

The provider had not taken action to ensure people received the level of staff support they were assessed as requiring. Staff knew and understood people well, and wanted to enable people to live their life as they wished, but were limited by the provider’s staffing levels. The provider’s management arrangements also limited the registered manager’s ability to progress the improvements to the service which the provider had identified as being necessary. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity.

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

Rating at last inspection

The last rating for this service was Good (published 5 July 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

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

Enforcement

We have identified breaches of regulations in relation to staffing levels, person-centred care, and the provider’s quality monitoring processes at this inspection. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.