About the service:

Orsett House is a care home that provides personal care for older people, some of whom are living with dementia. At the time of the inspection, 45 people lived at the service. The home was established over two floors, with a range of communal areas included dining spaces, a large garden and smaller lounge spaces.

People’s experience of using this service:

The feedback we received from people and their relatives was consistently good. People told us they were well cared for and safe and typical comments from relatives included, “This place has been life changing for my family” and “This place is absolutely marvellous….. and the staff are amazing.” The service had used a quality improvement plan to drive a number of improvements since the last inspection. Managers had also introduced effective audits so that areas for improvement could be addressed on an ongoing basis.

People told us they felt safe and well looked after in the home. There were sufficient staff around to keep people safe and ensure their needs were met. Improvements had been made to the way medicines were managed and the environment was checked and maintained to ensure risks to people were reduced.

People told us how much they enjoyed the food and they had regular access to drinks and snacks throughout the day. People’s capacity was now routinely assessed and their consent was obtained before care and support was given. People were supported in the least restrictive way possible.

The staff team were vigilant to people’s health needs and now made prompt and consistent referrals to external healthcare professionals when required.

People and their relatives thought highly of the staff team and we saw people being treated with kindness and respect. Relatives were made to feel welcome in the home and arrangements were made to ensure people’s privacy was respected. Staff ensured people had access to equipment which they could use to maintain their independence.

People received care that was in line with their needs and individual preferences. Care plans were now more reflective of people's current needs and staff took time to ensure care plans were amended when people’s needs changed. Concerns and complaints were addressed quickly. Relatives told us they thought the end of life care provided by the home was personalised and dignified.

The registered manager was visible and approachable and relatives and staff were happy with the way the service was being led. The management team had created an open culture where concerns could be raised and areas for improvement addressed.

The service worked well with other services to ensure people’s needs were met and that people received a high-quality service.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement (report published 14 November 2017).

Why we inspected:

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

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 6 September 2017 and was unannounced. Orsett House Retirement Home provides personal care and accommodation for up to 49 older people who may have a dementia diagnosis. At the time of the inspection there were 48 people using the service.

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.

People were not always supported to manage risks to their safety, as staff did not always follow the risk assessments. Accidents and incidents were not always investigated. Medicines were stored safely; however people did not always receive their medicine safely. People sometimes could not alert staff if they needed something as they were left in communal areas without staff support. People told us they felt safe living at the service.

People did not always have their rights protected as the principles of the Mental Capacity Act were not always followed. People did not always receive support from staff in an appropriate way to meet their needs. People were not always supported to monitor their health and seek support from health professionals. People had a choice of meals and drinks and were supported by staff that understood their preferences.

People did not always receive support in a way that maintained their privacy and dignity. People felt the staff were caring. Staff sometimes missed opportunities for interactions with people. People were able to make choices and were supported by staff to maintain their independence.

People’s preferences were understood by staff however staff did not always follow peoples care plans. People had limited opportunities to be engaged in meaningful activities. People understood how to make a complaint and the registered manager had a system in place to investigate and respond to concerns.

There were systems in place to monitor the quality of the service; however these were not always effective in identifying areas which required improvement. People and staff could approach the management team. The registered manager and staff understood their roles and responsibilities.

There was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding need for consent, good governance and safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 9 September 2015 and was unannounced.

The service was registered to provide accommodation and personal care for up to 49 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 44 people were using the service. The home was divided into two separate annexes. The larger of the annexes was occupied by people who were living with Dementia.

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.

At the last inspection on 3 June 2014, we asked the provider to take action to make improvements to the way that risks to people’s safety were assessed, monitored and reviewed. We also asked them to make improvements to the way that people were supported to eat and drink sufficient amounts for their needs. These actions had been completed and improvements had been made.

However, people’s experiences at meals times were mixed. There was no choice of meal offered at lunch time. Although staff explained that people could have something else if they wanted to, some people were not aware of this as there was no menu for them to see or options offered.

People’s risks were assessed and reviewed to keep them safe and we saw that care was delivered as planned. People were protected from unnecessary harm by staff who knew how to recognise signs of abuse and how to report concerns in line with local safeguarding adult’s procedures.

Medicines were managed safely to ensure that people received their medicines as prescribed. There were sufficient numbers of staff to meet peoples need.

Staff were equipped with the skills and knowledge to support people effectively.

People’s consent was sought before care was delivered and people’s rights were respected.

People were treated with kindness and compassion by staff who knew them well. People were given time and explanations to help them make choices. People’s privacy and dignity was respected.

People told us that their preferences were met by staff. People enjoyed activities in the home and told us they were involved in planning and reviewing their care.

People knew how to make complaints and felt that the registered manager was approachable. Complaints were managed in line with the provider’s complaints procedure.

Staff felt well supported by the registered manager and provider. Regular quality checks were completed by the registered manager and improvements were made to the service following feedback.

We visited Orsett House Retirement Homed on a planned unannounced inspection, which meant that the service did not know we were coming.

As part of the inspection, we spoke with three people who used the service, six relatives of people who used the service, four staff members, two deputy managers and the proprietor of the care home.

On the day of the inspection, people who used the service told us they were happy with the care they received. We saw that people looked happy and well cared for. People who used the service, their relatives and visiting professionals were complementary about the care people received at the homes. They told us that the home was, “fantastic”, “brilliant”, and “excellent”.

Is the service safe?

Systems were in place to ensure that the premises were safe and secure. The required health and safety checks and servicing were completed.

Sufficient staff were provided to deliver people's care needs and they received the training they needed to provide the necessary care and support.

All the staff we spoke with had worked at the home for a significant length of time. The proprietor said, “Fortunately, we do not have a big turnover of staff and we do not use agency staff”. This meant that continuity in care was ensured because people who used the service were cared for by staff who knew them and understood their needs.

Is the service responsive?

We saw staff were available in all areas of the home. Relatives of people who used the service told us that the provider responded to the needs of people in a timely manner. One relative said, “She [her mother] only has to have a cold and they bring the doctor out to her”.

We noted that other visiting professionals came to the home on a regular basis. A doctor was at the home on the day, to see a person whom the staff had expressed concerns about. Another visiting professional we spoke with on the day told us that they visited the home at least twice a week to review the care of people who used the service. They told us that staff contacted them as soon as they were concerned about the health of people who used the service.

People had choice of food and drinks. Food, drinks and snacks were provided regularly to the people and were always available to them if they requested them outside of set times. However, people who required support during mealtime did not often receive the support they required in a timely and sensitive manner.

Is the service caring?

People who used the service told us that the staff were very good and they were satisfied with the care and support provided. One person who used the service said, “The girls are very nice to you”. All the relatives we spoke with told us that the staff were very caring. One relative said, “The care staff are brilliant, you couldn’t have it any better”.

We observed that staff provided care in caring, compassionate and professional manner. People who were unable to comment or did not wish to speak with us looked comfortable, clean and well cared for. One relative we spoke with said, “When mum was very ill, the doctor wanted her to go into hospital but the staff knew that I didn’t want her to go in. If she had gone into hospital, she would have died; but they [the staff] fed her back to what she’s now”.

Relatives of people who used the service told us that staff demonstrated care towards the relatives too. One relative said, “As a visitor, they make a fuss of me”. They told us that the proprietor had told them that provision could be made for them to stay overnight if they were worried about returning at night following a visit. This meant that the provider demonstrated care towards people who used the service and their relatives.

Is the service effective?

People who used the service told us they were able to do whatever they wished to do each day. Records indicated that people’s likes, dislikes and preferences were recorded. We saw that staff obtained people’s consent in relation to the care they received and respected their wishes.

Staff encouraged and supported people to make choices and decisions. When people did not have the capacity to make certain decisions, family and medical professionals were involved.

People's health and care needs were assessed. We saw that mostly the plans were up to date and corresponded with the discussions we held with staff. People’s care plans, risk assessments and management plans in relation to their health, welfare and safety did not always reflect changes in people’s care needs.

Is the service well led?

Relatives of people who used the service told us that they felt that the service was well led. A relative of a person we spoke with said, “The management is on top of everything and that is the most important thing. There’s always somebody who’s in charge”. Staff we spoke with were clear about the management structure and felt supported by the managers.

The provider had a quality assurance system in place to ensure that the necessary checks were in place to provide and maintain a good service. The provider obtained that views of people and their relatives about the services provided and took action where necessary.