Orchard Views Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk people could be harmed.

The provider was in breach of legal regulation in relation to managing risks posed to people.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

Accidents and incidents were not robustly recorded or appropriately monitored, to enable the service to learn lessons from these. For example, falls were not effectively monitored for themes and trends and behavioural incidents were not appropriately recorded. The manager had recognised this concern and was in the process of formulating new systems to enable them to have effective oversight. This required embedding into practice at the time of our assessment.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care.

The service was not receiving care packages from the local authority at the time of our assessment, due to previous concerns about safety and quality of the care provided. The service was not currently receiving private admissions as they were in the process of embedding new systems and procedures, this included working towards an agreed set of actions. Care records required some improvements, to ensure where information would need to be shared with partners, this was up to date. People received support from external health professionals as needed, such as district nurses and chiropodists. The service held weekly multi-disciplinary team meetings, which included the G.P.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

Staff understood their responsibilities about how to spot signs of abuse and how to keep people safe from the risk of harm. However, several staff were overdue refresher training relating to safeguarding, the manager had recognised this and was taking action to ensure all staff could complete this training. Staff told us they felt comfortable to report concerns and felt the manager would take action to address any concerns. A staff member said, “I have not seen any safeguarding concerns, but could definitely report things if needed. I have respect for the residents and treat them how I would want my relatives to be treated.” At the time of our assessments there had been no recent safeguarding concerns which were notifiable, however the manager understood their responsibilities to report notifiable incidents.

Where people required Deprivation of Libert Safeguards (DoLS) appropriate authorisations were in place. However, people who were able had not signed to consent to their care and treatment. People told us they felt safe living at the service. One person said, “I have no complaints, I enjoy living here.”

The provider did not always work well with people to understand and manage risks. Some improvements had been made since our last assessment of the service and whilst we found no harm to people, some records required improvements. For example, care plans relating to pressure care and nutritional risk required more detail to guide staff about how people required support. Another person's care plan did not contain enough detail about how staff assist them to move. Improvements had been made regarding monitoring people's weight and food and fluid intake, this required further improvement, to evidence action was taken when people did not intake enough food or fluids. People had access to fruit, snacks and fluids in their own rooms and people told us they enjoyed the food and were offered choices. One person said, “If I don’t like what is on the menu, I can choose an alternative.” Another person said, “The food is beautiful, couldn’t wish for anything better.” Improvements had been made in relation to managing people at risk of choking, appropriate records were now in place to guide staff about people's needs. We also found where people had pressure wounds, this was appropriately managed, and a person's wound had healed whilst living at the service.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Improvements were required to ensure the environment maintained people's safety. At the time of our assessment refurbishments were taking place in several areas of the service, to improve people's living spaces. While this was positive, there were no appropriate risk assessments in place to ensure people remained safe during maintenance. We found several contractors tools in communal areas, this was brought to the attention of the manager on the day of our assessment and immediately rectified. We also found a broken radiator cover, this was rectified on the day of our assessment. Some staff were overdue fire safety training and evacuations. The manager had recognised this and was planning to undertake fire safety evacuations and ensure all staff could complete this training. Other maintenance checks were in place such as checks of lifting and electrical equipment and people were protected from the risk of legionnaires disease. Business continuity plans were in place and detailed how the service responds to untoward events, such as a loss of heating.

The provider did not always make sure there were qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

Enough staff were in place to support people. The service was currently recruiting, to ensure people were supported by regular staff and reduce the need for agency staffing. We observed enough staff in place to meet the needs of the people currently living at the service. People told us there was enough staff and staff were kind, caring and offered them choices. One person said, “There is enough staff at the moment. I am grateful, they help me to have a shower. I choose when I have a shower, I have the freedom with that.” A staff member said, “I love it here, I love all the people and the staff. The team is good now and we all work together.” Some senior staff had recently undertaken training to enable them to deliver face to face training to the staff team. Staff training had been identified as a concern by the manager and training was being undertaken by staff at the time of our inspection. Competency assessments of staff practice were lacking, as were supervisions and appraisals. The manager had recognised this and had plans in place to implement new systems. At our last assessment we made a recommendation to the provider to review staff DBS checks. At this inspection we found this continued to be a concern.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Whilst improvements had been made since our last assessment, some improvements were still required to ensure people were protected from the risk of infection. We found PPE to be well stocked and staff wearing appropriate PPE, however several staff were observed to be wearing jewellery. There was a malodour in the service, and we found 1 person with a urine bottle placed on a side table. Whilst refurbishments were ongoing, at the time of our assessment, several areas of the home had exposed wood which required painting, to ensure this could be effectively cleaned. We also found people did not always have bedding fitted onto their mattresses. The kitchen area was much improved since our last assessment and was clean and well organised.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. During the inspection, medicines stock levels checked were correct and no missed doses were recorded on people’s medication administration record (MAR) charts. People that were prescribed patches had rotation charts in place to ensure they were being applied in line with guidelines. If people needed their medicines to be given ‘covertly’, hidden in food or drink, relevant paperwork was in place with GP and Pharmacist input.

In regard to administration of topical medicines such as creams, some were applied by staff and some residents applied these independently however people’s MAR charts were not always filled out to reflect this.

When people were given ‘when required’ (PRN) medicines, the reason was documented on the back of the MAR chart. PRN protocols were in place for these medicines, however, they needed to contain more person-centred information to ensure staff know when to give which medicine, if two or more similar drugs were prescribed.

Some handwritten MAR charts were not always double signed, and the home manager acknowledged improvements were needed in this regard. An electronic MAR system was due to be implemented to mitigate this risk and improve pharmacy relationships.