About the service: The Orchards is a residential care home that is registered to provide support to 21 older people, including people living with dementia. The service was supporting 17 people at the time of our inspection.

People’s experience of using this service: Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good. The provider had taken action to rectify issues with the electrical safety of the premises following the previous inspection. We made a recommendation about improving quality assurance systems for monitoring the safety of the environment, to ensure action was taken to drive improvement.

During this inspection, we found systems to assess and monitor the safety and quality of the environment had not been improved sufficiently. They had not always been effective and therefore failed to drive improvement. We found some shortfalls with the safety of the premises and quality of the environment, as well as the suitability of the decor for people living with dementia. We made a recommendation about this. There were also shortfalls in systems to monitor the application of the Mental Capacity Act 2005 and staff recruitment.

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

There was a positive culture within the service and people felt the registered manager was approachable. Staff were knowledgeable about safeguarding and able to raise concerns. Personalised risk assessments were in place for people. Staff supported people to manage their medicines safely. Systems were in place to recruit staff safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were supported through on-going supervision and they accessed training relevant to people's needs, to ensure these could be met. Staff supported people to access healthcare and maintain a nutritious diet.

We saw people were relaxed in their surroundings and felt comfortable around staff. Staff were kind and promoted people’s independence and treated them with dignity and respect.

People’s care plans were kept up to date and reflected their individual needs and circumstances. People were supported in line with their preferences and were supported to engage in social and leisure activities. An activities coordinator was being recruited to help people access more stimulating and meaningful activities. The provider had a system in place for responding to people's concerns and complaints.

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

Rating at last inspection: At the last inspection, on 27 December 2017, the service was rated Requires Improvement (report published 21 February 2018). The last inspection was a focused inspection, which looked at whether the service was Safe, Effective and Well-Led.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

We undertook an unannounced focused inspection of The Orchards on 27 December 2017. We had received concerns about another of the provider’s services and we wanted to be assured The Orchards did not have similar concerns. We 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 two key questions through our ongoing monitoring or during our inspection activity, so we did not inspect them.

The Orchards is a care home which accommodates a maximum of 21 people in one adapted building. The home has two communal lounges and one dining room. There were nineteen bedrooms, two of which may be used as shared rooms, and sufficient bathrooms on both floors. A passenger lift services the first floor. There is a car park, and the home is close to local amenities. At the time of our inspection, 18 people were using the service although one person was in hospital.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The Orchards is registered to provide care and accommodation for older people, some of whom may be living with dementia.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 the provider failed to ensure the premises were safe because electrical safety checks were not always completed in a timely manner. We saw previous certificates had expired and one test had not been completed for over two years.

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

Quality monitoring systems were not always sufficient to identify shortfalls in the service and to drive continuous improvement. We have made a recommendation about the provider ensuring the findings of audit action plans are carried out and to use the results of audits to drive continuous improvements in the service.

There were insufficient plans to guide staff in emergencies, except in the event of a fire. For example, there were no plans for what to do in the event of utility failure or flooding. However, staff were knowledgeable about how to keep people safe and told us the actions they would take in emergency situations. Staff were also clear about their responsibilities to report any abuse or poor care they became aware of. We saw there were systems in place to protect people’s monies deposited within the service. People told us they felt safe and we saw there were risk assessments in place to keep people safe.

At our last inspection, we recommended the provider complete some actions to ensure medication practices were safe. At this inspection, we found these had been completed accurately. People received their medicines as prescribed.

There were few accidents and incidents. These were analysed to identify any patterns or trends, and actions were recorded to reduce reoccurrence.

Staff were recruited safely and staffing levels were sufficient to meet people’s individual needs. People were supported by staff who had a good level of skills and knowledge. Staff received induction, training, supervision and appraisals as required.

The registered manager was aware of their responsibilities for completing notifications and these had been submitted as required to both CQC and safeguarding authorities. They were also aware of their responsibilities regarding the Mental Capacity Act 2005. People had mental capacity assessments in place and when pe

The Orchards is a residential care home situated in the village of New Waltham, close to the town of Grimsby in North East Lincolnshire. The service provides accommodation and personal care for up to 21 people who may have dementia related conditions.

The service is provided over two floors and offers two communal lounge areas, wet room and toilet facilities, bedrooms, nine of which are en-suite, dining area, kitchen, passenger lift, outside garden space and on-site parking facilities.

This unannounced inspection took place on 13 April 2016. The service was last inspected in September 2014 and at that inspection we found the registered provider was compliant with all the regulations we assessed. At the time of our inspection 19 people were living at the service.

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 service understood how to keep people safe, however we found issues with some of the recording of medicines and the temperature of the room where medicines were stored. Although the registered provider offered assurances these would be addressed we recommended they reviewed their medication policy and followed national guidance to ensure medication practices remained safe.

There were policies and procedures to guide staff in how to safeguard people from the risk of harm and abuse. Staff understood how to report potential abuse and had received training to reinforce their understanding.

The registered manager and staff were following the principles of the Mental Capacity Act 2005 (MCA) and had an understanding of the ensuring people were not being deprived of their liberty (DoLS). The registered manager had submitted a number of applications to ensure people were not unlawfully restricted.

We found staff had been recruited safely and appropriate checks had been completed prior to them working with vulnerable people. Staff had good knowledge and understanding of the needs of the people they were supporting and people told us staff were considerate and kind.

People who used the service were provided with a varied diet and people spoke highly of the food they received. Staff monitored people’s food and fluid intake and made referrals to healthcare professionals when required. People who lived at the service were supported to access health care and attend appointments when needed to ensure their health and wellbeing was maintained.

The service offered a range of in house and external activities and people were encouraged to participate. The registered provider had a complaints procedure which people could use to raise any concerns or issues they had.

People told us the leadership at the service was approachable and supportive and people were encouraged to give their views and opinions on the service. The registered provider promoted an open and transparent organisation and staff were supported through regular supervision, team meetings and year appraisals. The service had developed an effective auditing system to assess and monitor the quality of the service provided.

This inspection was carried out by an adult social care inspector. At the last inspection on 11 June 2014 we issued a compliance action in relation to some concerns we identified around the delivery and recording of care. We followed up those issues with this inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Improvements had been made in the way staff moved and handled people who used the service.

Risk assessments were completed so staff had guidance in how to support people in ways that minimised the risks.

The manager and staff were aware of The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); one DoLS application had been authorised and was in place. Training records showed more of the staff had completed courses in MCA and DoLS since the last inspection.

Is the service effective?

People were able to make choices about aspects of their lives and could take part in some activities inside the service.

People’s health and social care needs were assessed with them and there was input from relatives. Specialist needs in relation to diet, falls, mobility and equipment were identified and planned for.

Visitors told us they could see people in private and were made to feel welcome at all times.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People’s preferences, likes and dislikes had been recorded and care and support was provided in accordance with people’s wishes and choices. Staff demonstrated they knew people’s needs and preferences.

Is the service responsive?

We observed staff involved people and offered each one choice in regard to their needs. The staff approach to people who used the service was respectful and friendly.

People had access to a range of health and social care professionals such as GPs, district nurses, dieticians, social workers, dentists, opticians and chiropodists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

Is the service well-led?

Learning from audits took place, there was evidence the manager was continually checking the standard of recording in the care plans and addressing shortfalls when they were found.

Staff were clear about their roles and responsibilities.

What people who used the service, and those that matter to them, said about the care and support they received: -

Comments included, “It is good here, the staff are smashing and will do anything for you” and “Lovely staff, they are very pleasant to everyone. I don’t want for anything and I’m happy to stay here.” A relative told us, “Very friendly staff, I am always made to feel welcome.”

The inspection was carried out by one inspector and an expert by experience over one day. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and relatives, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

In this report the name of the registered manager appeared who was not in post and not

managing regulatory activities at this location at the time of the inspection. Their name appeared because they were still on our register at the time. A new manager had been appointed.

Is the service safe?

The manager and staff were aware of The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); one DoLS application had been authorised and was in place. Training records showed the majority of staff had completed courses in MCA and DoLS.

The service was clean and tidy and measures were in place to protect people from the risks of cross infection.

The manager set the staff rotas and they took into consideration people’s care needs when deciding on the numbers of staff on duty and the skills they required to meet people’s needs. The manager was recruiting further staff to ensure staffing levels could be maintained.

Is the service effective?

People were asked for their consent prior to receiving care and support and were asked for their views about activities of living on a daily basis. Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

People’s health and care needs were not assessed on a regular basis. People who used the service and their relatives had not always been involved in writing plans of care. Care plans were not reviewed and updated appropriately. We saw that some people had behaviours that could be challenging to themselves and other people, but plans were not in place to direct staff on a consistent approach.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare of people who used the service.

Visitors told us they were able to see their relatives in private and visiting times were flexible.

Delays in the provision of adequate storage facilities at the service meant that the newly refurbished wet room was not in use. This had the potential to impact on the choice of facilities people could use.

Is the service caring?

People were supported by kind and attentive staff. We observed staff speaking to people in a friendly and professional way. We saw that staff gave people time to respond to questions and encouraged them to make decisions for themselves.

People’s preferences, routines, likes and dislikes had been recorded in most cases and care and support was provided in accordance with people’s wishes and choices. Staff demonstrated they knew people’s needs and preferences.

People who used the service and their relatives were asked for their views in surveys. We saw the majority of the recently returned surveys had positive comments about the care received by people who used the service.

Is the service responsive?

Care records did not always demonstrate there had been changes in people’s needs.

People had limited access to social activities. During the visit we observed many people spent time sleeping or sitting in their chairs watching TV.

People had access to a range of health and social care professionals such as: GPs, psychiatrist, dieticians, social workers, dentists, opticians and chiropodists. There was evidence the staff team sought appropriate advice, support and guidance both routinely and during emergency situations. Feedback from health professionals we spoke with during the visit was positive.

Is the service well-led?

There was a quality monitoring system in place that consisted of audits and the seeking of people’s views, but we found aspects of the programme had not been maintained in recent months, and therefore not wholly effective in some areas.

Staff had a good understanding of the ethos of the service and told us they enjoyed their work. Staff had policies and procedures to guide their practice and received regular training, supervision and support from management.

What people who used the service, and those that matter to them, said about the care and support they received: -

Comments included: “I am encouraged to be as independent as I can be, I make my own decisions”, “I usually have my breakfast in bed, because I prefer that” and “I made the right choice to come here.”

People we spoke with were satisfied with the care they received. One person told us, “My original doctor won’t come out to this home, so the manager is arranging for me to be registered with the same doctor that my friend has here.”

When we asked people how they spent their day, some of the comments were more mixed. They included, “Not a lot really”, “The staff do not seem very interested”, I would like to go out more, we did go out last year”, “I would like to go into the garden or even to the shops”, “I like music, but that doesn’t happen, just television all day, and then they go to sleep.” A relative told us, “The care is good, but there is no stimulation for the service users.”

People who used the service and their relatives were complimentary about the staff team. They commented on the friendliness of the staff. Comments about the staff included, “The staff are very nice, but they are always rushing, because they are so busy” and “There seems to be enough of them, they always make time for you. Very nice staff.”

At the last inspection on 26 September 2013 we had concerns about some aspects of the environment. The provider sent us an action plan which detailed the action to be taken, with timescales, to address our concerns. This follow up visit was completed to check progress against the action plan. We found some improvements had been made and work was planned for other refurbishment. The majority of the action plan was on target to be met.

We had not intended to inspect outcome 13 (staffing) but we had concerns there was insufficient staff to meet the needs of people who used the service. People who used the service told us they were often kept waiting when they rang the call bell for assistance and staff confirmed that due to sickness, staffing numbers were low. We found staff were trying their best to cover gaps in staffing levels.

We contacted the provider about this and asked them to produce an action plan straight away regarding how they will address the staffing levels.

People's care and treatment was being planned and delivered in line with their individual care plans. They told us they received the care and support they needed and they were very happy with how staff delivered their care. One person told us, “I am very happy and settled here. It is like home but with someone to monitor me.”

People were provided with a choice of suitable and nutritious food and drink. The people we spoke with told us they enjoyed the meals they received and confirmed they were provided with variety and choice.

The premises were clean. The majority of people we spoke with raised no concerns about the general environment but we saw some areas of the home were in need of redecoration. We found the provider did not have a programme in place to address these areas.

We saw appropriate background checks had been carried out on staff before they started to work at the home to make sure they were suitable to work with vulnerable people. One person said, “The staff are all good. Very even tempered and kind.”

People were made aware of the complaints system. Those we spoke with said they had no complaints but would feel comfortable raising any concerns with the staff.

In this report the name of the registered manager appeared who was not in post and not managing regulatory activities at this location at the time of the inspection. Their name appeared because they were still on our register at the time. A new manager had been appointed.

We spoke to three people who used the service. One person told us that “The girls are absolutely brilliant; they treat me like I am one of their family.” Another person said “You can choose who helps you; I only like the girls to help me get dressed and to have bath.”

The four care files we saw included detailed information about the person using the service. We saw evidence that people had access to other healthcare professionals, including GP’s, opticians, occupational therapists and district nurses. People’s needs were assessed then care and treatment was planned and delivered following their individual care plan. We saw that a number of risk assessments had been completed and were updated on a monthly basis.

Staff told us about the different types of abuse that could occur and what they would do if the thought that it had taken place. One person told us “I do feel safe here; I can’t walk you see and once there was a fire in the laundry, alarms going off and everything but they came and got me, yes, I’m safe.”

Appropriate arrangements were in place for the safe obtaining, handling, storing and disposal of medication. The home had a medication policy in place that outlined how to manage medicines effectively.

We were told that staff were able, from time to time, to obtain further relevant qualifications. Three people we spoke to were undertaking National Vocational Qualifications in Health and Social Care.

At our previous visit to the home on 4 October 2011 people we spoke with were very positive about the care and support they received. They told us they were well cared for. Comments included “I have got better since being in here” and “The care couldn’t be better." They also told us there were sufficient numbers of staff to meet their needs. Comments included “There is always someone around”, “The staff are very pleasant and supportive” and “The staff are very good.”

People we spoke to at this visit were aware they had records kept about them. One person was able to explain their care plan and the reasons for the way their care was delivered. They also confirmed that there were sufficient staff to meet their needs. Comments included “I am happy with the care and staff always come when I ring the bell” and “There is always someone to help me.”

People we spoke with were very positive about the care and support they received. They told us they liked living at the home and confirmed they were supported to make choices and decisions about the care they received. Comments included “I like it its very good”, “The care couldn’t be better “, “I am able to say if I want a man or a women carer” and “You can go to bed when you want”.

They told us they felt safe living in the home. Comments included “I feel very safe here” and “I would feel comfortable speaking to the manager about any concerns”.

They told us they liked the staff who worked in the home. Comments included “The staff are very pleasant and supportive” and “The staff are very good”.

People told us that there were not many activities provided in the home since the activities organiser left in the summer 2011. Comments included “They don’t seem to have any activities”, “There is nothing to do” and “They used to have activities in the main lounge but I haven’t really seen anything since the girl left”.