This inspection took place on 14 March 2018 and was unannounced.

Orchard Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Orchard Court accommodates 63 people in one adapted building. At the time of our inspection there were 52 older people living at the home, some of whom were living with dementia.

There was no 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. A new manager, who had previously been the registered manager at another of Anchor Trust’s services, had commenced in January 2018 and had applied to become registered manager. The new manager (manager) assisted us in our inspection.

Medicines management, infection control and safeguarding processes were not suitably robust. We also found at times staff were not always deployed across the service in a way which meant people received consistent attention. At the end of our inspection the manager and provider’s senior management told us an increase in staffing levels had been approved. Gaps in some people’s care records meant staff may not be using the most up to date information about a person.

People were supported by staff who knew them well and they got along with. Staff displayed kindness, care and empathy towards people and showed people respect. People were given attention by staff and staff adapted their approaches in response to individuals dependent on their need.

People had access to activities both in communal areas and within their individual living areas. Although no one was on palliative care there was evidence that staff discussed people’s end of life wishes with them.

People were cared for by staff who had gone through a good recruitment process and in the event of an emergency there was information and equipment in place for safe evacuation. People’s risks were identified and action taken in response to these. The manager reviewed accidents and incidents and as such had taken action to help reduce reoccurrence.

People’s legal rights were protected because staff were aware of the principals of the Mental Capacity Act (2005). The home environment was adapted for people living with dementia and people’s needs were assessed before moving into the home.

People had access to healthcare professionals where required and staff followed national and local guidance to provide effective care. People told us they liked the food that was prepared for them and their dietary needs were met. We also found that people were being cared for by staff who had access to a range of training to support them in their roles.

The manager had a clear vision for the service and had already started to make a positive impact on the care people received. However, this needed to be sustained and audits being carried out embedded to demonstrate continued improvement.

Staff felt supported by management and took part in staff meetings. There was a good culture within the staff team. People told us they liked the new manager and felt he was visible around the home. This was confirmed by our observations on the day.

People were involved in the running of the home and any complaints or suggestions were listened and acted on. Staff worked alongside other agencies to improve the quality of people’s care.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made a recommendation to the registered provider. You can see what action we told the provider to take at the back of the full version of the rep

Orchard Court is a care home that provides nursing and personal care for up to 63 people. Some of the people living at Orchard Court are living with dementia. The home is divided into seven units, each with their own kitchen/dining and lounge area. There is a communal lounge on the ground floor of the home.

At the time of our inspection 57 people were living at Orchard Court.

This inspection took place on 19 February 2016 and was unannounced. During this inspection we followed up on the two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which we found at our inspection in August 2014. Following that inspection we had received an action plan from the provider telling us what they planned to do in order to ensure there were enough staff on duty and staff treated people with respect and dignity. We found during this inspection the provider had taken the necessary action in relation to the these breaches.

The home had a registered manager. 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

Care plans contained information to guide staff on how someone wished to be cared for. Although we found records held for people were not always contemporaneous and there were some gaps in information.

Where people had risks identified staff were knowledgeable in how to help mitigate these risks. Accidents and incidents were recorded and monitored by the registered manager for trends and action taken when necessary.

People received care from a sufficient number of staff. Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, optician or district nurse. People received their medicines in a safe way as staff followed correct and appropriate procedures in administering medicines. Medicines were stored safely and appropriately.

People were cared for by staff who evidently cared about them. Staff demonstrated they were kind and respectful to people. Care was provided to people by staff who were suitably trained. People and relatives were happy with the care provided and they were made to feel welcome when they visited.

People had access to a range of activities. Staff had worked hard to develop activities which were suitable for everyone living at Orchard Court. People were provided with a choice of meals each day and those who had dietary requirements received appropriate food to ensure they were not at risk of choking.

Staff understood the legal requirements in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The correct processes were followed when people were deprived of their liberty.

Staff received relevant support from their manager. This included regular supervisions and undertaking training specific to their role.

Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home. Staff were able to evidence to us they knew the procedures to follow should they have any concerns about abuse or someone being harmed.

Quality assurance checks carried out by staff to help ensure the environment was a safe place for people to live and people received a good quality of care. People, relatives and staff were involved in the running of the home as regular meetings were held and suggestions made were listened to.

Complaint procedures were available to people and should the home have to be evacuated there was a contingency plan in place which meant people’s care would be uninterrupted.

People's needs were assessed and care and treatment was delivered in accordance with people's need.

People who used the service told us they were visited by the home's staff who asked them various questions about what they liked and about their health.

Relatives told us they were consulted about their family member's needs and two relatives told us they came to look around the home before they made a choice on behalf of their relative.

We saw people were taking part in individual and group activities. Staff were sitting with people and singing festive songs, playing games and having morning coffee. Some people prefered to read the newspaper alone.

We saw the staff were kind and caring and approached people in a friendly manner to undertake specific tasks. Staff told us they enjoyed working in the home and felt they had the appropriate training to undertake their roles.

The home was preparing for Christmas and each unit had a Christmas tree and decorations that they helped the decorate and make.

People were safe and there were appropriate arrangements in place for the administration of medication.

Systems were in place to monitor the quality of service provision, and home meetings were facilitated.

People told us that they were happy living at Orchard Court. They told us that they had chosen the home to be close to family and friends.

We were told that the staff were kind and caring and always there when required. Someone told us that when the weather was nice that staff took them for walks in the grounds.

People who used the service told us that there was always something to do to keep them occupied. They told us that they enjoyed going to the large activities room on the ground floor to mix with people from other units and outside.

There was good feedback regarding the food. We were told that there was always something they liked available to eat and that the food was appetising and tasty.

We saw staff treated people who used the service with dignity and respect. Staff told us that they enjoyed working in the home and felt that they had the support and training to undertake their roles efficiently.

A relative told us that the home was always very welcoming and that they were involved in organised events.

People told us that they liked living in the home. Some people told us that they were from the local area and said it was like home from home. People felt they were included in decisions made about their care and treatment. They told us that there is plenty to do, and it was their choice if they wanted to join in the daily activities provided. Two people spoken to had pets and said it was very important to them to be able to bring them into the home.

One person was very positive about going out in the home’s mini bus. We were told that staff are kind and caring and treat people with respect. There was good comments about the meals provided and people told us that the food is home cooked, tasty, and plentiful.

People told us that they liked living in the home. Some people told us that they were from the local area and said it was like home from home. People felt they were included in decisions made about their care and treatment. They told us that there is plenty to do, and it was their choice if they wanted to join in the daily activities provided. Two people spoken to had pets and said it was very important to them to be able to bring them into the home.

One person was very positive about going out in the home’s mini bus. We were told that staff are kind and caring and treat people with respect. There was good comments about the meals provided and people told us that the food is home cooked, tasty, and plentiful.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection that took place over two days. We last carried out an inspection at this service on 5 December 2013 and found nothing of concern.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Orchard Court is registered to provide accommodation and personal care for up to 63 people, some of whom may be living with dementia. At the time of our inspection there were 61 people living at the home.

Although people told us they felt safe at the service, the provider did not ensure there were sufficient numbers of staff on duty in order people were kept safe and free from harm. Staff told us, “Often at the weekend we only have three or four staff on duty at night.” We looked at the accident and incident book for the service and saw between April and July 2014 there were 67 falls of which a high proportion had occurred during the night shift. We also found staff did not always monitor or respond to changes in people’s health needs which meant they may be left at risk of harm.

The risks of abuse to people was minimised because there were clear policies and procedures in place to protect people and staff had a good understanding of the types of abuse that may take place. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and the registered manager was able to tell us when they would need to make an application.

People told us staff were kind and helpful. One person said, “Staff will do anything you need them to do.” One relative told us, “Staff are professional but give care with love.” Staff received regular training, appraisal and supervision, however staff told us they felt they did not always receive appropriate training for their role which meant they felt they may not be able to meet people’s needs.

We heard how people enjoyed the food and observed staff giving people choice during their meals. We were told, “The food is pretty good” and, “The food is good – it’s very nice.” The service met any specific dietary requirements people had and we found that generally people enjoyed social interaction during mealtimes. However, we did not see any evidence that people participated in choosing what food was on the menu.

People had access to healthcare professionals, such as the doctor, dentist or chiropodist. On one day of our inspection we saw one person had an appointment with a physiotherapist. This meant people were supported by staff both within the service and from outside.

Most people and their relatives told us staff were caring. One person said, “The staff are nice and help you when you need it.” A relative told us, “It’s really very good here.” We saw some good examples of kind care given to people, however we did not feel staff always spent time with people in a meaningful way and we observed some people sitting on their own for periods of time with limited social stimulation. Staff told us this was because, “We are so busy because we have jobs to do and there aren’t enough staff, so we don’t have time to sit and talk to people.”

Although the service held residents meetings, not everyone was aware of them and therefore did not always attend. This may have been because some people living at Orchard Court were living with dementia. However, we were given the results of the most recent satisfaction survey which showed us people were happy living at Orchard Court

We heard from people that they were able to make choices in how they were supported and the care they received. For example, where they liked to eat their meal.

We found bedrooms had been personalised with individuals’ belongings and staff respected people’s privacy when they wished to stay in their room. The home was divided into units. Each unit had approximately eight bedrooms and its own kitchen/dining area and lounge. This meant people could sit quietly if they wished or spend time with their relatives and friends in comfortable surroundings.

The service enabled people to visit the home and spend time there before making a decision to move in as, in addition to permanent residential care, the home offered respite care. We heard how people felt staff responded to their needs. One person told us, “Anything you need, they will do” and, “Staff are good, they come when you call.”

Each person had their own individual care plan which was personal to them. This contained information about their likes, dislikes as well as their care needs. We noted from records we looked at staff provided care in a way that was requested by an individual. For example, checking them at specific times throughout the night. However, we did read in two care plans that specific needs of a person were not completed in relation to guidance for staff.

The service employed two activities staff who provided daily activities in the main lounge/dining area of the home. Each individual unit also had its own activities ‘box’. We saw people sitting doing a jigsaw together and others were reading a paper, doing a crossword or knitting. Although activities were not individualised, people could spend their time as they wished, either participating in the organised activities, or by maintaining relationships with friends and relatives. We saw several relatives visit on both days of our inspection and observed one person going out shopping with their family member.

Everyone told us they would be comfortable making a complaint, but had no reason to do so. We were told they felt they could speak to staff and their concern or complaint would be listened to. We found staff were aware of their role in dealing with a complaint.

The service had a registered manager as well as other senior staff. However, we heard from some staff they felt undervalued and not, “Supported in their role.” Staff told us morale was low and they felt, “Stressed” because they felt management focussed on “Getting jobs done”, rather than allowing them to spend time with residents. Two staff said they were, “Not proud to work for Anchor.” However, three other staff told us, “Feel supported and well looked after. I can go to the team leader.” And, “I can phone the deputy manager and likewise the business (registered) manager. They are both approachable.”  This indicated to us the registered manager did not consistently demonstrate good leadership.

We saw from the information provided to us prior to our inspection that the service had participated in the Investors in People framework and used Skills for Care to develop staff skills and knowledge. We also read staff carried out regular audits to review the safety and quality of the service, however we found two care plans which had not been updated to give appropriate guidance for staff.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of this report.