The Orchards

Updated 4 October 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

Our inspection was completed by one inspector.

Service and service type

The Orchards 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. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service and two people’s relatives about their experience of the care provided. We spoke with ten members of staff including the chief executive, registered manager, deputy manager, three team leaders, three care workers and a member of the administrative team. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We sought feedback from the local authority and professionals who work with the service. We looked at training data and quality assurance records.

Updated 4 October 2019

About the service

‘The Orchards’ residential care service consisted of two homes on the same site; providing accommodation and personal care to up to 20 people aged 16 and above. People living at the service have a range of needs relating to learning disability and/or autism, physical disability and/or sensory impairment. Some people living at the service also have complex health needs. The Orchards (home) provides residential care for up to six people and Offa's Dyke provides residential care for up to 14 people. At the time of our visit six people were living at The Orchards and 13 people were living at Offa's Dyke.

The service was developed and designed before Registering Right Support came into existence. Despite this, the service was run in line with the principles and values that underpin Registering Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was large, both homes were located on a single site on the outskirts of Lydbrook in an area of outstanding natural beauty. The site had a fully accessible woodland walk, small-holding, sensory garden, activity park, learning centre and therapy centre with swimming pool and floor trampoline (rebound therapy). The on-site facilities were used by many local providers, for example for dementia walks, which brought the local community in, creating a dynamic and stimulating environment. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate there were care homes on-site. Staff wore everyday clothes when supporting people at home and when accessing the wider community with them.

Offa’s Dyke was bigger than most domestic style properties, providing accommodation for up to 14 people. This is larger than current best practice guidance. However, the size of the home having a negative impact on people was mitigated by the design of the home, which was made up of two distinct houses (Silver Birch and Oak House), joined by a common entrance hall. Offa’s Dyke was purpose-built and provides accommodation for up to seven people in each house. Offa’s Dyke and its garden are fully wheelchair accessible. The houses are equipped with hoists and other specialist equipment suitable for people with profound and multiple disabilities. Accommodation is provided on the ground and first floors with a passenger lift to the first-floor bedrooms.

The Orchards are located five to 10 minutes’ walk from Offa’s Dyke. This consisted of two adapted semi-detached cottages, (The Orchards 1 and The Orchards 2), joined by an internal connecting door. Each cottage housed three people, with accommodation provided over two levels. Ground floor bedrooms were suitable for wheelchair users. Two bedrooms, with en-suite bathrooms, were located on the first floor in each house. The first floor was accessed via stairs.

People’s experience of using this service and what we found

The provider and registered manager had created a positive, caring, person-centred culture where innovation was encouraged and fostered. People were cared for by staff who felt supported and valued and loved their role. Staff knew people exceptionally well and showed insight into their needs, they were able to use their knowledge to assist in developing the service as their ideas were welcomed and encouraged.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The service was fully inclusive, people were involved in deciding who worked with them. Staff recognised people’s strengths and people were enabled to use these. For example, to improve services for themselves and others.

People felt safe and knew their needs would be met with respect and dignity. They were confident in the staff who supported them, describing them as “friends”. Staff were trained to meet their needs and had been recruited safely. Risks to people were managed through detailed person-centred support plans, timely involvement of health professionals and regular reviews of their needs.

People benefitted from a service which was effective in meeting their complex needs and in promoting their health and well-being. The staff team had formed working partnerships with specialist teams and other health professionals to achieve positive health outcomes for people with significant health challenges. The quality of the service and staff contributions to successful outcomes, were commended by commissioners and health professionals alike.

People were cared for by a staff team who worked flexibly to meet their needs, both in times of ill-health and to improve their everyday lives. One person said, ‘‘Sometimes I need to have a chat with the staff about personal things and they are really, really understanding. It’s quite special to feel that I can do that.” Staff were sensitive and responsive to people’s relatives, other people living at the service and to each other, when people reached the end of their life. One relative said, “They [people using the service] are looked after so well you can’t believe it.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff used a variety of techniques to communicate with people, enabling them to make their wishes and goals known. People were supported to have a good quality of life, to experience activities they enjoyed and to maintain relationships with people who were important to them. Staff were proactive in overcoming barriers related to people’s disabilities. People’s feedback about the service was sought regularly and they were confident their views would be respected and responded to positively, including complaints.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills, become more independent and enjoy life. Support was tailored to the person’s needs and abilities. For example, increasing their independence through assisted technologies and supporting them to learn, work and follow interests that were meaningful to them. One person said, “I really do enjoy the fun I have here.”

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

Rating at last inspection

The last rating for this service was ‘Good’ (published 21 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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