About the service: Quorn Orchards is a residential care home that provide personal care and accommodation for up to 30 people aged 65 and over. There were 26 people using the service at the time of the inspection. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rating at last inspection: Requires Improvement, 9 February 2019

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 16 October 2018 where we found five breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included breach in Regulation 17, Good Governance. We served a warning notice for Regulation 17, Good Governance, to the provider and registered manager and told them they must be compliant by 20 December 2018.

We rated the service as 'Requires Improvement'. The provider submitted information stating what they intended to do to address the shortfalls. You can read the report from our latest comprehensive inspection by selecting 'all reports' link for Quorn Orchards Care Home on our website at www.cqc.org.uk.At this inspection we found the provider had made improvements to meet the requirements of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Our findings showed that improvements were made to provide a well-led service. However, checks were not consistently effective to assure the service that people’s medicines were administered and recorded in a safe manner.

• The environment had been improved to meet the needs of people living with dementia and keep people safe from harm and reduce the risk of falls, burns and contact with hazardous substances.

• People and their relatives were involved in planning their care.

• The registered manager used the feedback they received from people to improve the service.

• The registered manager submitted appropriate notifications as they are required to do by law.

Follow up: We will continue to monitor this service and respond accordingly. We plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

This inspection took place on 16 October 2018 and was unannounced.

This was the second comprehensive inspection carried out at Quorn Orchards Care Home, the last inspection in February 2016 was rated as good.

Quorn Orchards Care Home provides residential care for older people. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 30 people. On the day of our visit, there were 29 people using the service, some people were living with dementia.

At this inspection we found that Quorn Orchards Care Home were in breach of five regulations relating to safe care and treatment, safeguarding, complaints and governance of the home. They were also in breach of one registration regulation.

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 and associated Regulations about how the service is run.

The provider had not ensured there were sufficient processes in place to assess, monitor and to maintain the health, safety and welfare of people. The provider had not carried out environmental audits to identify where repairs and maintenance were required. People living with dementia were at potential risk of harm due to access to the stairs, hot water, hot radiators and hot pipes.

The registered manager did not meet all the requirements of notifying CQC of important events.

The provider had not ensured the fire safety systems and procedures were in place; the provider had not acted upon fire safety recommendations in a timely way.

People were at risk of abuse as the registered manager had not reported unexplained injuries or recorded all incidents where people had altercations.

People did not have all of the required risk assessments or care plans in place to mitigate risks associated with dementia or deteriorating mental health. Staff did not always follow people’s care plans, putting people at risk of acquiring pressure ulcers.

People did not have the opportunity to be involved in the assessment and planning of their care or make their preferences known.

There were not enough staff to provide care to meet people’s needs. People did not always have the opportunities to carry out activities they enjoyed.

People’s complaints were not recorded or responded to appropriately. People did not always receive their medicines in a safe way.

The provider had not always ensured the conditions of people’s Deprivation of Liberty Safeguards were met. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care.

Staff did not always record key events in people’s daily records, making it difficult for health professionals to assess people’s conditions.

Staff did not have all the information they required about people’s dietary requirements. People were supported to have enough to eat and drink to maintain their health and well-being.

People were not always adequately supported to access relevant health and social care professionals.

Staff received supervision and support to carry out their roles. Safe recruitment processes were in place.

We made three recommendations relating to accessible information, dementia friendly environments and end of life care.

Further information is in the detailed findings below.

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

We carried out our inspection on 3 and 5 February 2016. The inspection was unannounced.

Quorn Orchards Care Home provides accommodation and personal care for up to 30 older people with dementia or similar conditions. There were 26 people using the service at the time of our inspection.

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.

People were safe at the home. They felt safe because of their confidence in staff’s ability to meet their needs. They also felt secure in the premises. Staff knew their responsibility to keep people safe from harm and abuse. The provider deployed sufficient skilled staff to meet people’s needs.

The provider completed relevant pre-employment checks which as far as possible assured the provider that only people suited to work at the service were employed.

People received their medicines as prescribed by their doctor.

Staff were provided with the training that they required to carry out their role effectively.

People were supported in accordance to the Mental Capacity Act (MCA) 2005. We observed that staff sought people’s consent before they provided care and treatment.

People nutritional needs were met. They had access to a choice of nutritious meals. Staff provided appropriate additional support to meet people’s nutritional needs where this was required.

People had prompt access to health care services when they needed it. Staff supported people with monitoring their health needs.

Staff were kind and compassionate to the people that used the service. They were knowledgeable about the needs of the people they supported. They respected their dignity and human rights, and promoted their right to privacy.

As far as possible staff involved people or their relatives in decisions about their care and support.

The relatives and friends of people using the service had no restrictions to visiting the home.

People’s care plans reflected their individual needs and preferences. Their care was provided in a person centred manner. The provider listened to feedback from people using the service and their relatives and reflected this in the service they provided.

Staff were supported by the registered manager. People using the service had easy access to the manager. The provider had effective procedures for monitoring and assessing the quality of service that people received.

We inspected Quorn Orchards Care Home on 26 June 2013 and found that there were not sufficient numbers of staff on duty to ensure people were safe and that their health and welfare needs were met at all times.

During this inspection, we spoke with five people using the service and one relative visiting their family member. We also spoke to six members of staff and one visiting professional.

We found that there were sufficient numbers of staff on duty to ensure people were safe and found that their health and welfare needs were met at all times. One person told us: “I am very, very, very well looked after.” A relative told us that “staff appear busy, but not hectic.” A member of staff told us “there are enough staff on duty to meet people’s needs.”

We spoke with seven people using the service, four relatives and one friend visiting. We also spoke to four staff members and one visiting health care professional.

We found people's privacy, dignity and independence were respected. One person told us “all the staff are nice; they are wonderful and you don’t have to wait long if you need assistance.”

We found people experienced care and support that met their needs and protected their rights. One relative of person using the service told us they had “no concerns, worries or problems” relating to the care provided. We found people’s care needs had been assessed. Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

People were protected from the risk of abuse and staff knew how to raise any concerns. We found the provider had policies in place relating to the safeguarding of vulnerable adults, and whistle blowing.

We found there were effective systems in place to reduce the risk and spread of infection.

On the day of our inspection, we found that there were not sufficient numbers of staff on duty to ensure people were safe and their health and welfare needs were met at all times.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.