About the service:

Orchard Lodge is a private residential care home providing personal care for up to 26 people aged 65 and over. At the time of the inspection there were 23 people living at the home.

People’s experience of using this service:

The registered manager was described as supportive and approachable. They demonstrated a good understanding of their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

The home was clean and the environment was well maintained. During the inspection we identified an action the home had highlighted in a recent health and safety audit requiring replacement radiator covers. We asked the manager to send us evidence that these have been ordered which was sent to us the following day.

People had access to appropriate equipment where needed. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received their prescribed medicines at the right time. This was an improvement since our last inspection. Where issues were identified during this inspection, these were immediately addressed by the registered manager.

There were sufficient numbers safely recruited and suitably qualified and skilled staff in place to meet people's individual needs. The manager was proactive in adjusting staffing levels based on the needs of the people living in the home. Staff received a range training and support appropriate to their role and people's needs.

Staff knew the needs and preferences of people living in the home well. People were treated with kindness, compassion and respect. Staff had developed positive relationships with people and were seen to display kind and compassionate support to people. People's needs had been assessed and their health needs were understood and met.

People’s privacy and dignity was respected and independence promoted. People had access to a selection of activities.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. Staff understood and respected people’s right to make their own decisions where possible, and encouraged people to make decisions about the care they received. Consent had been sought before any care had been delivered in line with legal requirements.

People received personalised care and support which was in line with their care plan.

People knew how to make a complaint and they were confident about complaining should they need to.

Rating at last inspection:

At the last inspection, the home was rated “requires improvement” (17 April 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the home until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

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

This inspection of Orchard Lodge took place on 8 March 2018 and was unannounced.

Orchard Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility. The home can accommodate up to 26 people. At the time of our inspection, there were 24 people living at the home.

There was a registered manager in post at the time of our inspection. 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.

We carried out an unannounced comprehensive inspection of this service on 29 August 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 11 and Regulation 17.

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. The team inspected the service against three of the five questions we ask about services: is the service safe, is the service effective and is the service well-led. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Orchard Lodge Care Home on our website at www.cqc.org.uk.

At the last inspection on 29 August 2017, we found that the provider was in breach of Regulation because the principles of the Mental Capacity Act 2005 were not always followed when assessing people’s capacity and arrangements for monitoring standards at the service were not robust.

On this inspection, we found that improvements had been made in relation to the Mental Capacity assessment process and the registered manager had attended training in respect of Deprivation of Liberty Safeguards since our last inspection. The registered manager recognised when someone was potentially being deprived of their liberty and made the necessary DoLS applications to the local supervisory body.

The recording relating to medicine administration was not always accurate. We checked a sample of medications and found that the stock balances did not always correspond to the Medication Administration Record (MAR). We saw that medication audits were not fully effective because they did not cover stock checks of medication. We have made a recommendation regarding this.

Whilst we found that some improvements had been made to how the service was led, we have not revised the rating for this domain. This is because the audit systems required further development to ensure the safety of medicines. In addition, to improve the rating from 'requires improvement' requires a longer term track record of consistent good practice and sustainability of governance. We will check this during our next planned comprehensive inspection.

Our observations and discussions with people confirmed that th

This inspection of Orchard Lodge took place on 30 August 2017 and was unannounced.

Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The house can accommodate 26 people. At the time of the inspection, there were 23 people living at Orchard lodge. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool.

At the last inspection in February 2017, the service was rated ‘requires improvement’ and breaches were identified in relation to Regulation 12 and Regulation 17.

We saw that improvements had been made to the quality assurance processes in place at Orchard Lodge since our last inspection. The registered manager had put in place a series of audits (checks) to monitor aspects of the service and these were completely regularly. This included audits of the premises, medication, daily records and care plans. However, we found that these audits were not robust as they had failed to address some of the concerns identified during this inspection such as the service’s compliance with the Mental Capacity Act. Additionally, there was no evidence of action taken in response to a recently completed consultancy audit which identified that staffing levels at Orchard Lodge were insufficient. This meant that processes in place to monitor the quality and safety of the service were not always effective. The provider remains in breach of this regulation.

The service did not always operate within the principles of the Mental Capacity Act 2005. Consent was not always sought appropriately and capacity assessments were not decision specific. We found there was a lack of knowledge around the Deprivation of Liberty Safeguards as the registered manager was not fully aware of the principals to determine whether someone was being deprived of their liberty. This is a breach of Regulation 11 (Need for Consent).

During our inspection, we observed that there were sufficient numbers of staff to meet people’s needs in a timely manner, however, people told us that staffing levels were inconsistent. We looked at staff rotas and saw that staffing levels fluctuated, particularly at weekends and throughout the summer months. The staffing levels did not meet the provider’s own required levels in accordance with their dependency assessment. We have made a recommendation regarding this.

We saw that medicines were given to people on time by staff that had been appropriately trained and were told that people were happy with their medicine management. We identified some issues regarding storage of medication and the recording of PRN medication. We have made a recommendation regarding this.

At the last focused inspection in February 2017, we found that the provider was in breach of Regulation 12 (Safe Care and Treatment). This breach related to concerns regarding the management of infection control and the laundry provision. On this inspection, we found that improvements had been made in relation to infection control processes and the provider was no longer in breach of Regulation 12.

We found that staff assessed risk to people and information was updated regularly. Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures.

The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Staff were assisted in their role through induction and supervisions and staff told us they felt well supported through the homes training programme.

People told us they were given choice regarding meals. Staff knew, and catered to, people’s individual dietary needs and preferences.

People we spoke with were complimentary about the staff, the registered manager and the service in general. People told us they liked the staff who supported them. We observed interacti

We carried out an unannounced comprehensive inspection of this service in July 2016. We found the home to be rated ‘Requires improvement’ and we found four breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The breaches of regulations concerned; safe care and treatment, because infection control was not being effectively monitored; receiving and acting on complaints; staff training and support; and the overall governance of the home.

We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us the action they would take to meet legal requirements in relation to the breaches.

We undertook a focused inspection on 2 February 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific areas / breach of regulations. This report therefore covers four of the five questions we normally asked of services; ‘Is the service safe, effective, responsive and well led?’ the other question; whether the service is ‘caring’, was not looked at on this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Orchard Lodge Care Home’ on our website at www.cqc.org.uk.

Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The home can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool.

A new manager had started in post in October 2016 and had applied to the Commission for registration. 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.

At the last inspection we identified a concern relating to the management of infection control and environmental hazards. During this inspection we saw that some specific improvements had been made but we saw other environmental hazards that had not been effectively identified and monitored; these related to the management of the laundry and the overall lack of health and safety audit / checks being carried out. The provider was still in breach of this regulation.

During the previous inspection we identified a breach of regulation in relation to the overall governance of the home; there was a lack of guidance for staff through established policies and procedures. On this inspection the new manager had made improvements in many areas of the running of the home; however, we found there was a lack of established and routine audit which meant some areas of the running of the home were not being effectively monitored. The provider was still in breach of this regulation.

At the last inspection we found that the provider was in breach of regulations relating to the receiving and acting on complaints. On this inspection we saw a complaints procedure in place. This breach had been met.

At the last inspection we found that the provider was in breach of regulations relating to the training and support for staff. On this inspection we saw progress had been made by the new manager. Staff were in receipt of planned training and felt supported by the new manager and a regular programme of supervision. This breach had been met.

You can see what action we told the provider to take at the back of the full version of this report.

This unannounced inspection was conducted on 25 July 2016.

Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The home can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. At the time of the inspection 21 people were living at the home.

A registered manager was in post. However, the registered manager was not available on the day of the inspection. 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.

At a previous inspection we identified a concern relating to cleanliness, infection control and environmental hazards. During this inspection we saw that improvements had been made. However, we saw that some improvements to the environment had not been completed. For example, the scheduled refurbishment of the kitchen had not been undertaken. We also saw that previously unidentified risks were present in the home.

During the previous inspection we identified a breach of regulation in relation to the safety of the laundry. We looked at the work that had been undertaken following the previous inspection and found that sufficient improvements had been made with regard to the safety of the physical environment and the risk of infection. This breach had been met.

During the previous inspection we identified a breach of regulation in relation to the assessment and management of risk. This breach had been met.

At the last inspection we found that the provider was in breach of regulations relating to good governance. During this inspection we looked at records of provider visits and saw that they had been completed regularly. We were provided with a schedule of improvements for the home which provided basic information and timescales for completion. However, some important improvements had not been completed. For example, according to information provided a planned refurbishment of the kitchen to reduce the risk of infection had not been completed. Additionally, the Merseyside Fire and Rescue Service made a recommendation to replace the fire alarm system in 2015. The provider had included this as part of the schedule of improvements, but had not completed the work.

Fire safety equipment was tested by external contractors annually and by the home on a regular basis. However, the home had not fully implemented recommendations made by the fire service in November 2015. In particular, the home’s alarm system had not been upgraded as recommended.

Staff were recruited following a robust procedure and deployed in sufficient numbers to safely meet the needs of people living at the home. The provider based staffing allocation on the completion of a dependency tool.

People’s medication was stored and administered in accordance with good practice. A full audit of medicines and records was completed monthly.

Staff were trained in a range of subjects which were relevant to the needs of people living at the home including; infection control, administration of medicines and safeguarding adults. However, not all staff had not been trained in the principles of the Mental Capacity Act 2005 as previously recommended.

The records that we saw demonstrated that the home was operating in accordance with the principles of the MCA. We were told that none of the people currently living at the home had been assessed as lacking capacity. The records that we saw indicated that people’s capacity had been assessed as part of the care-planning process. Some people had indicated their consent to care by signing care plans.

Meals were served in a well presented

At a previous inspection in March 2012 we had found that appropriate arrangements for safely handling medicines were not in place. At this inspection we found significant improvements had been made and overall we found medicines were now being safely and appropriately managed.

We checked the medicines records and stocks of fifteen people who used the service. No-one we spoke with expressed any concerns about how their medicines were handled.

On the day of our inspection of the home, the weather had become noticeably colder. We found all areas of the home to be well lit, warm and free of any draughts. Although the home is an older building, with bedrooms set out over three floors, we found all rooms to be well appointed and the standard of maintenance throughout the home was good. Some rooms which had been occupied for a number of years required minor re-decoration although people we spoke with were happy with their bedrooms. All communal areas were easily accessed and furniture was free from any signs of wear and tear.

We found care records to be well ordered and up to date, with evidence of recent review. We saw people had access to dentists, doctors, chiropodists and opticians. All people we spoke with told us they liked living at the home and felt the care given met their needs whilst respecting their dignity and independence.

When we checked on the standard of meals offered and people's access to fluids throughout the day, we found their dietary needs were met. Meals offered were predominantly home cooked from fresh ingredients but some meals were made up of convenience foods. Drinks were offered throughout the day.

We found the home had a complaints policy that was effective although people we spoke with said they were happy to raise concerns with staff directly. Throughout our inspection, we found staff were responsive to people's needs and displayed a friendly, respectful manner to the people in their care.

We spoke with 18 people living in the home. People told us they felt very happy, comfortable and cared for. They said they knew all about the home before they made their minds up to live there. Comments included “I was give lots of information about the home before I came to stay”, “I was given a brochure about the home and details of how I could make choices about my lifestyle if I came to live here.”;” staff asked me what name I liked to be called so I told them I liked to be called by my nickname. Everyone calls me that now. That is the name they always use now”.” I was told about this home before I came here. I was given details of the care provided and it turned out to be better than I expected”, “good food, good staff, good company”. Relatives of people living in the home told us that they felt staff treated people with respect and made sure people got the social, health care and reassurance they needed. Comments included” this is more like a guest house than a home. Staff treat people with respect and provide good care and stimulation”. “the staff treat people well; they are all happy and think of it as home from home.”

People told us the staff were kind and helpful and were able to provide a good level of care and support. The people we spoke to told us that their needs were being met by the staff members and that they did not have any concerns. Relatives of people living in the home said staff were very supportive and helped people to get the most out of life. One person said that since their relative had moved into the home they had seen very positive changes in their attitude and general wellbeing.

On the day of the site visit we spent some time observing the care and talking to people living in the home. We saw staff attending to people in wheelchairs and assisting with mobility as well as assisting people at meal time. Those we spoke with said that there was good communication and staff were competent when carrying out care and giving general support.

Those people spoken with said that staff supported them with their personal care and hygiene.

People were relaxed and talked freely. One person told us they were not well but said the manager had called the doctor and he was due to attend. We spoke with one person who said, ‘’The staff look after me very well.’’ Another person said, ‘’The staff are very kind and do not rush. They are friendly and the care is good.’’

Another person said they had had an infection not long ago and the doctor had been called but this was after a delay. They said they were ‘’fine now.’’

We spoke with some visitors to the home [relatives] who told us that they had no concerns about care at Orchard Lodge; ‘’My relative is well care for. The staff are very good at keeping us informed if there is any change and they will always get the doctor out if needed.’’

We spoke with a visiting health care professional. They said that the home generally liaised well. The manager and staff sought advice about peoples health care when needed and were proactive in many instances. They felt the ‘family atmosphere’ of the home helped ensure a good quality of life for people.

None of the people we spoke with had any issues with the way medication was managed. Two of the people spoke about how staff were always on time with medications and any changes were communicated and agreed.

We carried out an unannounced comprehensive inspection of this service on 22 April 2015 when six breaches of legal requirements were found. The breaches of regulations were because we had some concerns about the effective recruitment of staff; the need to gain consent to care and treatment; the lack of action regarding the assessing and preventing the risks to people’s health and safety especially the spread of infection in the home, and the overall effectiveness of management systems to regularly assess and monitor the quality and safety of service that people received.

We asked the provider to take action to address these concerns.

We also found that the provider [owner] had not sent us notifications telling us about incidents at the home. These are required by law. We had not been informed about deaths at the home or other incidents such as serious injuries. We served the provider with enforcement notices for these breaches of regulations.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 3&4 December 2015 to check that they had they now met legal requirements. This was an unannounced inspection.

This report only covers our findings in relation to these specific areas / breaches of regulations. They cover three of the ‘domains’ we normally inspect; 'Safe', ‘Effective’, and ' Well led'. The domains ‘caring’ and ‘responsive’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Orchard Lodge Care Home' on our website at www.cqc.org.uk.

Orchard Lodge is a privately owned care home, registered to provide accommodation and care for older people. The home can accommodate 26 people in 20 single bedrooms and three double bedrooms. The property is a large detached house which has been converted for use as a home and is situated in a residential area of Seaforth, Liverpool. There were 20 people living in the home at the time of the inspection.

The service had a 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.

We found that improvements had been made in the areas we had concerns about and two of the the previous breaches had been met; these were the effective recruitment of staff and the need to gain consent to care and treatment.

We also found that the provider had been submitting regulatory notifications to us (the Care Quality Commission) so the enforcement notices we issued were also met.

Although there were improvements we still found concerns regarding assessing and preventing the risk of spread of infection in the home. We also found continued failings in the effectiveness of management systems to regularly assess and monitor the quality and safety of service that people received.

The manager showed us the arrangements in place for checking the environment to ensure it was safe. There were auditing and checking systems now in place and the remedial issues identified on the previous inspection, regarding infection control, had been addressed. However, we found further concerns regarding infection control and identified further environmental hazards that had not been acted on.

You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection we found there was a lack of formal process such as effective audits and systems to ensure the quality and safety of the home was monitored. This included a lack of regular input and support from the registered provider. On this inspection we found improvements had been made. There were improved management audits in place to both monitor and improve the service ongoing.

We were able to improve the judgment rating for the ‘Well led’ domain from ‘inadequate’ to ‘requires improvement’.

We were still concerned however that there were gaps remaining in the current management systems so that some remaining shortfalls in the safe running of the home had not been effectivity identified.

You can see what action we told the provider to take at the back of the full version of this report.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found that necessary checks had been made to ensure staff were suitable.

We reviewed staffing with the registered manager as we had had a concern raised prior to our inspection. The registered manager responded positively to ensure there were enough staff on duty at all times to maintain safe care.

There were improvements to the way the service complied with the Mental Capacity Act 2005. Staff sought the consent of people before providing care and support. When we looked at people’s care files we saw that people had been asked for their consent at various stages of care and that the care plans were signed by people where possible. We saw that the manager and staff were following the principals in the way important information was recorded.

There was a lack of knowledge with some aspects of the MCA and staff had not undergone training in this area.

We made a recommendation regarding this.