We carried out an inspection of Orchard Manor on the 16, 18 and 20 April 2018. The first and second days were unannounced and on the third day, the registered provider was aware of our intention to visit.

Orchard a Manor 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 Manor accommodates 93 people in one building which is divided into two distinct units: Maple and Willow. At the time of our visit, 85 people were living at Orchard Manor.

The service 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 2008 and associated Regulations about how the service is run. The registered manager was present during the days of our visit.

We previously carried out an unannounced comprehensive inspection of this service on 12 June 2017. At that inspection we rated the service as requires improvement as a track record of a sustained quality of care was required at that time. No breaches in regulations were identified at our last visit.

Initially we found that the premises were not always safe. A cleaner’s cupboard containing chemicals, a sluice room and rooms used for storing equipment were not locked. Staff were observed entering these rooms and then leaving them unsecured. This could potentially pose a risk to people who used the service. Subsequent evidence was provided to us by the registered provider outlining the action taken to ensure people were not at risk of harm.

In addition to this, we found initially that information was not always stored securely. This related to the security of personal, sensitive information relating to people who used the service. Cupboards containing sensitive information located in one communal area were not locked. In addition to this, some confidential information had been left on a desktop. Evidence given to us subsequently by the registered provider outlining the action to ensure that all personal information was kept secure.

Prior to our visit, we received complaints about the service which would suggest that people did not receive positive outcomes. We did not see any evidence during this visit to confirm the concerns raised in the complaints. We referred the complaints to safeguarding prior to our visit and the outcome of the investigations was not available at the time of writing this report.

We observed that the was a delay in serving some people their meals and also an instance where a member of staff feeding a resident had to leave few times without explanation to attend to other tasks in the dining room. This was not a reflection on staffing levels which were maintained to reflect the needs of people who used the service. The registered provider subsequently made arrangements to ensure that mealtimes were enjoyable for all.

People told us that they felt safe and that there was always staff around to attend to their needs. They also told us that they received their medicines when required.

Staff were aware of safeguarding procedures and how to raise concerns. They had received training in this and outlined the types of abuse that could occur. Responses to taking action in the event of safeguarding concerns were not consistent and could compromise any police investigations.

Equipment and other systems in the building were regularly serviced to ensure that they were safe for people to use. The decoration of some areas was beginning to experience wear and tear and the registered provider was aware of this. The premises were clean and hygienic.

New staff coming to work at Orchard Manor were recruited robustly with checks carried out to ensure tha

We inspected this service on 12 and 13 June 2017 and the visit was unannounced on the first day.

Orchard Manor is a care home for older people, set in large grounds off Acres Lane. It is on a bus route from Chester City Centre. There are 93 bedrooms in total divided into two units: One unit provides general nursing and personal care and the other unit provides nursing and personal care for older people with memory impairment. All the rooms are single and most have en-suite facilities. There are also several lounges and dining rooms.

At the time of this inspection visit there were 77 people living at Orchard Manor Care Home. They were supported by a staff team of 125.

There was a registered manager employed to work at the service and they have been registered with the Commission for three months. 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 on 8, 21 and 23 November 2016 we found that a number of improvements were needed in relation to people not being protected from the risk of unsafe, restrictive care and treatment. Medicines management was not robust and people were not protected from the risk of inadequate nutrition and hydration. People were not always supported or treated in a dignified way and consent to care and treatment was not always sought. People were not protected from the risk of receiving inadequate care as the quality assurance systems were not effective. Staff did not always receive appropriate support, supervision, induction or training. We asked the registered provider to take action to address these areas.

After the inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches identified. This inspection found that sufficient improvements had been made.

Staff were able to describe the care and support they provided to people as they knew them well. Care plans and risk assessments had improved. Care plans were person centred, reviewed regularly and were up to date. Risk assessments had been reviewed and reflected people’s current needs. Daily notes were completed in detail and reflected what care and support people received. Notes relating to the night time were highlighted as needing improvement at the last inspection. Although this had improved further requirement was needed and a recommendation was made regarding this. Information relating to nutrition and hydration in supplementary records was not always accurate and analysed. A recommendation was made regarding this.

People were provided with a choice of meals. On the whole people were satisfied with the meals provided. People made positive comments about new ‘dementia café’. However, the mealtime experience required further improvements to be made.

Support for the staff team had improved. Staff received supervision and induction and staff told us the management team were more engaged with them and the people who used the service. Staff recruitment was robust. Staff had access to a range of training and refresher training was up to date. Concerns were raised during this inspection that some people required restraint to assist with personal care and that staff had not received breakaway training to ensure this was completed appropriately. This was discussed with the registered manager who said staff would receive appropriate training.

People spoke highly of staff and said that they were caring and hard working. People and their family members said they were happy with the service and had seen improvements since last year. People told us that staff treated them with kindness and respect. They told us staff were mindful of their privacy and dignity and encouraged them

We carried out an unannounced comprehensive inspection of this service on 8, 21 and 23 November 2016.

Before our inspection we received concerns in relation to low staffing levels and the right mix of staff being available particularly during the night. We were also informed that people had been locked in their bedrooms overnight; staff had been told to undertake tasks which they did not feel confident to do such as administer medication to a person or assist with nursing procedures for which training had not been received; lack of training specifically in fire awareness and evacuation procedures. Other concerns included restrictions on the use of incontinence products. Members of the public had also raised concerns about the poor care people were receiving and anxieties regarding people's safety. This information was shared with the local authority safeguarding team who responded to our concerns and undertook an early morning visit to the service.

Following the concerns raised we carried out an unannounced comprehensive inspection which included a night visit. The first two days were unannounced, 8 and 21 November 2016 followed by an announced visit on 23 November 2016.

The last inspection was undertaken in April 2016 and the service was rated as requires improvement. Breaches of regulations were made with regard to management of medication; cleanliness of equipment, care plans not up to date and ineffective audit systems. An action plan was received from the registered provider and they stated they would be compliant by 31 October 2016.

Orchard Manor is a care home for older people, set in large grounds off Acres Lane. There are 93 bedrooms in total divided into two units: Maple unit has 48 rooms over three floors. Two floors provide care and support for people living with general nursing requirements and dementia care needs and one floor offered residential care. Willow unit has 45 bedrooms over two floors both of which provide care and support for people with nursing requirements and dementia care needs.

The service has 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 2008 and associated Regulations about how the service is run. The registered manager was available during one day of our visits.

During our visits we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and relatives told us that the registered provider used a lot of agency staff and that staff were always very busy and rushed off their feet. Some people said the staff were okay and others said staff were very nice.

Although there were enough staff working within the home, we found that the deployment of some of the staff and their level of knowledge to support the needs of people who lived at Orchard Manor was not sufficient to meet people's needs.

Risks to people’s health and safety were not always identified. Some people required the use of bedrails to ensure that they were safe whilst in bed. There were risk assessments in place for the use of these in some but not all of the care plans. However, the documentation failed to demonstrate why they had to be used or what risks were to be mitigated. We identified the possible entrapment risk of a person using their own headboard and noted that this had not been risk assessed. This meant that people could be left at risk of harm or injury.

We found that medicines were not managed safely. We found that four people were not given the right dose of medicine on some days and medicine administration was not always recorded accurately. Staff did not carry out adequate checks to make sure medicines stored in refrigerators were kept at the right temperature.

Checks on pressure relieving equipment were

We inspected this service on 25 and 26 April 2016 and the visit was unannounced on the first day.

Orchard Manor is a care home for older people, set in large grounds off Acres Lane, near Chester. It is on a bus route from Chester City Centre. There are 93 bedrooms in total divided into five units: Two of the units provide general nursing and personal care and three of the units provide nursing and personal care for older people with memory impairment. All the rooms are single and most have access to en-suite facilities. There are also several shared lounge spaces and dining rooms.

At the time of this inspection visit there were 85 people living at Orchard Manor Care Home. They were supported by a team of 125 staff which consisted of nursing, care and support staff.

There was a registered manager employed to work at the service and they had been registered for 18 months. 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.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We had concerns regarding the cleanliness of some of the equipment and the premises; We found that some areas of the home and pieces of equipment were not clean. For example handrails on corridors were chipped and damaged and walls had dried drinks splashed up them. Toilets and commode seats were dirty on the underside and fridges were unclean and food was not labelled. This meant that people could be at risk of infection or living in an unclean environment.

We saw that medication administration was not safe. Systems were not in place to ensure people received their PRN (when required) medication at appropriate intervals and times, allergy information was not included in the medication record sheets, and temperature checks on medication stock rooms and fridges were not always completed and appropriate guidance was not always followed. This meant that people could not always be confident that medication was accurately administered and processes followed.

We found that care plans contained information about the support people required, however this was not always up to date or accurately followed by staff. Information regarding pressure area care was not accurate, up to date or reviewed. This meant that people were at risk of further deterioration of pressure areas due to a lack of information and monitoring controls.

Although the registered provider did have a quality assurance system in place this had not identified any of the concerns we raised which meant that shortfalls in the service provision were not identified or addressed.

People told us that they felt safe at the service and that the staff understood their care needs. People commented “The staff are lovely”, “The staff are caring and always help me” and “The staff are very good.”

People said they enjoyed the meals. Comments included “The food is good”, “The food is very good” and “The food is good quality and I get a choice of meals.”

The registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Policies and procedures relating to the safeguarding of adults from abuse were available to the staff team. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge or the local authority safeguarding team if appropriate.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was aw

We carried out an unannounced comprehensive inspection of this service on 16th & 17th June 2015. After that inspection we received concerns in relation to low staffing levels particularly during the evenings, reports that staff were under pressure and were not supported by the management team. Other concerns had been brought to our attention with regard to health and safety within the home. As a result we carried out an unannounced focused inspection on 3rd September 2015. This visit was undertaken during the evening. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Orchard Manor Care Home’ on our website at www.cqc.org.uk.

The last inspection was undertaken in June 2015 and the service was rated as requires improvement. A breach of regulation with regard to management of medication was made. An action plan was received from the registered provider and they stated they would be compliant by 30th September 2015. As the timescale had not elapsed we did not review medication administration at this visit. We also made two recommendations around protecting people’s property and maintaining their privacy and dignity and looking at staffing levels and the deployment of the staff team. As a consequence we have not reviewed the rating on this inspection and therefore it remains as requires improvement.

Orchard Manor is a care home for older people, set in large grounds off Acres Lane. It is on a bus route from Chester City Centre. There are 90 bedrooms in total divided into five units: Two of the units provide general nursing and personal care and three of the units provide nursing and personal care for older people with memory impairment. All the rooms are single and most have en-suite facilities. There are also several lounges and four dining rooms.

The service has 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 2008 and associated Regulations about how the service is run. The registered manager was currently on maternity leave and an acting manager was in place.

People told us they felt safe and comfortable in the home. They said that staff treated them well and that when needed staff were available to assist them. During the evening we saw that staff were available to meet people’s needs.

The processes to ensure temperatures of hot water were appropriate were reviewed. Records showed that appropriate checks were undertaken and that thermostatic controls were in place on hot water taps to ensure that the water did not get too hot and that people were not put at risk of potentially being scalded.

Our inspection team was made up of two inspectors and an expert by experience. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home and grounds were well maintained. Regular checks were carried out at the home to ensure people were safe. Risks to people's health, safety and wellbeing had been identified and acted upon as required. People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

The manager set the staff rotas, taking people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Systems were in place to make sure that managers and staff learn from events such as falls, accidents and incidents, which reduced the risks to people who used the service.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people's rights were safeguarded.

Is the service effective?

People were happy with the care and support they received. Comments included: “Couldn’t ask for better”; "I am happy, they treat me well and there’s plenty to do"; "They look after us well".

Staff had all the information they needed to meet people’s needs and they ensured people received the right care and support.

Staff were respectful and polite towards people who used the service and they involved people in their care and the day to day running of the home. People’s preferences and choices were understood and respected.

Is the service caring?

People who used the service and their relatives told us that staff were kind, polite and caring towards them. We spoke with 16 people who were living in Orchard Manor. People told us they were always given choices and had never been forced into doing anything against their wishes. One person who used the service said; “They listen and respond to what I want.” Staff spent time with people and respected their wishes. People's religious and lifestyle choices were understood and respected.

Is the service responsive?

People could regularly take part in a range of activities in and outside the home.

People were given opportunities to put forward their views and opinions about the home and the way it was run. Any ideas people had for improvement were listened to and acted upon.

On the whole people’s requests for assistance were responded to in a timely way, although some people said they had to wait for a while when they requested assistance, particularly in the early morning.

The home had a complaints procedure but not all people were aware of it. The manager said they were in the process of reviewing the procedure and would be sharing it with everyone who used the service and providing staff with further training in handling complaints. We looked at the records of how written complaints had been dealt with, and found that the responses had been open and timely.

Is the service well-led?

The home had a manager who had previously been registered by CQC as the manager of another home and was in the process of applying to be registered as the manager of Orchard Manor.

The provider visited the home one day a week and the area manager visited two days a week. People who used the service, relatives and staff knew who they were and said they were approachable.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We spoke with ten people who lived in the home and five relatives. They told us staff always consulted them about their individual needs and involved them in decisions about their care and treatment. One relative said "Mum's care records are accessible and I am kept informed of any changes in Mum's condition". Another said "I have been to reviews of Dad's care plan".

The people we spoke with said that their needs were met and they were happy with the care provided. One person said "I am pleased with the care". One relative said "It's as good as it can be" and another said "I am very satisfied with the care".

People said that they enjoyed the meals and staff knew their likes and dislikes. Comments included: "The food is excellent"; "The meals are very nice"; "The chef is wonderful". A relative said the food was of good quality with plenty of choice, and that staff gave his wife the appropriate support she needed to eat. We found that people's nutritional needs were met.

People said they were happy with and confident in all the staff working there and that call bells were answered promptly. Some people said the staff were very busy and the home needed more staff but could not give any examples of people's needs not being met.

There was a staff training programme in place and staff said they felt supported by the management.

We spoke with five people who lived at the home and seven relatives. People said they were consulted about the care and that staff met the needs of the people using the service and maintained their privacy and dignity.

A relative told us “A nurse asked us what mum’s usual routines were because they knew we’d been looking after her at home”. A person living in the home

said “It’s a marvellous place and I’m happy here”. Another said “It’s a nice enough place, I’ve no complaints about the care”.

The people we spoke with said that they had been consulted about their dietary needs and care records showed evidence of this. People said that they enjoyed the meals and staff knew their likes and dislikes. One person said “There’s odd things I don’t like, but overall the food is very good”. Another said “I’ve tried some new dishes since I’ve been her and some are quite nice”.

Residents and relatives were very complimentary about the staff, saying such things as: “they’re all very good”; “very nice”; “very caring”; “they do everything for me that I need”.

People we spoke with said that their needs could be met by the number of staff provided and that call bells were answered fairly promptly.

People also told us that the home was always clean.

The people who lived in the service were complimentary about the staff and said they were consulted about the care they receive at Orchard Manor Care Home. The relatives we spoke with believed that the home was meeting their relatives' needs.

We visited this home on 16th and 17th June 2015 and the inspection was unannounced.

The last inspection was carried out in September 2014 and we found that the registered provider was meeting the regulations we assessed.

Orchard Manor is a care home for older people set in large grounds. It is on a bus route from Chester City Centre. There are 90 bedrooms in total divided into five units: Two of the units provide general nursing and personal care and three of the units provide nursing and personal care for older people with memory impairment. All the rooms are single and most have en-suite facilities. There are also several lounges and dining rooms. At the time of our visit there were 85 people living at the home.

There was a registered manager employed to work in the home. 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. However the registered manager was absent due to maternity leave and a manager from one of the registered provider’s other services was overseeing the home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe at the home and that staff understood their care needs. People commented “I am very well looked after”, “The staff are wonderful” and “The staff’s manner is very kind and caring.”

However we identified concerns with the records and administration of medication, which meant that people who used the service may not have received their medication administered as prescribed and this could affect their general health and wellbeing.

The registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Staff had received training and were aware of how to report suspected allegations of abuse. This meant that staff had knowledge and documents available to them to help them understand the risk of potential harm or abuse of people who lived at the home. The registered provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and staff were aware of how and when best interest decisions needed to be made.

Where possible people, were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as GPs, where it had been identified that there were changes in someone’s health needs. The staff team understood people’s care and support needs, and they were kind and treated people with respect.

Care records contained good information about the support people required and were written in a way that recognised people’s needs. Reviews of people’s care were completed and up to date.

Good recruitment practices were in place and pre-employment checks were completed prior to a new member of staff working at the home. Training that staff had undertaken was up to date. Staff had the opportunity to discuss their work at staff meetings and during supervision or appraisals.

The home was clean and hygienic. However, people did not have anywhere to store their property securely. Bedroom, bathroom and toilet doors did not have a facility to lock them. On day two of the inspection the registered provider had started to install locks on the bathroom and toilet doors. We saw that units where people were living with dementia had not been adapted to meet their needs. A recommendation was made regarding this. Following the inspection we had confirmation that the bathroom and toilet doors had locks fitted and that locks had been ordered for bedroom doors and these would be fitted as soon as possible.

During our observations across the two days we found that staff were available to help and support people as needed. However, on one occasion people were left unsupervised for about 20 minutes on one unit which meant that there were no staff available should they need help or support. Also this was not in line with the practice of the home to have a staff member available at all times. We made a recommendation regarding this.

People told us they didn’t have any complaints about the home. The registered manager had received four complaints since the last inspection. The documentation relating to these showed complaints were dealt with in line with the registered provider’s complaints policy. Staff knew what to do if anyone raised an issue or wanted to complain.

The registered provider had a range of quality assurance systems in place. These were completed regularly and when concerns were noted these had been followed up and action noted.

People told us the food was good. We noted some concerns with regard to the temperature of meals on one unit and we discussed this with the manager at the time of the inspection.