Archived: Home Orchard

Updated 1 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8 December 2015 and was unannounced. One social care inspector carried out this inspection.

Before the inspection, the provider completed a Provider Information Return (PIR). This was a form that asked the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

At the time of our inspection, seven people were using the service. We used a range of different methods to help us understand people’s experience. We spoke with two people who used the service, three members of staff, the manager, the registered manager and one visiting healthcare professional. During our inspection people were coming in and out of the home going about their daily lives and taking part in activities. Due to this we did not conduct a short observational framework for inspection (SOFI) but we used the principles of this framework to undertake a number of observations throughout the home. This helped us understand the experiences of people when they were not able to communicate with us.

We looked at two care plans for people who lived in Sunset Cottage and one care plan for a person who lived in Palace Farm. We also looked at medicine records, staff files, audits, policies and records relating to the management of the service.

Updated 1 April 2016

Home Orchard is registered to provide personal care and accommodation for up to eight young adults who may have a learning disability or an autistic spectrum disorder. The service was also registered to provide personal care to people in their own homes. However, the provider was no longer providing this service and was in the process of deregistering. The service was made up of two separate houses, Sunset Cottage and Palace Farm, which were located on a rural road within a short walk of each other. Sunset Cottage can accommodate five people and at the time of our inspection there were five people living there. Palace Farm can accommodate three people and at the time of our inspection there were two people living there.

This inspection took place on 8 December 2015 and was unannounced. The service was last inspected on 26 November 2013 when we found the regulations we inspected were being met.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Palace Farm is located on the grounds of a small working farm. People who lived in both houses were able to visit the farm at any time and take part in animal care. The animals included horses, sheep, chickens, ducks and geese. Also located on the farm was a large vegetable garden and a workshop area which offered woodwork and mechanics.

People benefited from a large number of meaningful activities which met people’s individual interests. For example, people took part in horse riding, swimming, cooking, gardening, shopping and cycling. Where people had specific interests the provider had funded staff members to train in these areas in order to better support people take part in their interests. For example, one staff member had been trained in bee keeping and another in archery. On the day of our inspection people were in and out of the houses taking part in various activities. We saw people enjoyed the activities they were involved in.

People’s relatives and healthcare professionals were complimentary about the care provided. Comments included “I wouldn’t want him living anywhere else”, “I’m very happy with it” and “They really look after their residents. It’s really really good. They know what they’re doing”.

Staff treated people with kindness and respect. People enjoyed pleasant and affectionate interactions with staff which demonstrated people felt comfortable in their presence. Staff knew people’s preferences and spent time speaking with each person individually whilst using different communication methods. Staff communicated with people using pictures, photographs and Makaton (a language using signs and symbols).

Staff received training that was specifically related to the needs of the people who lived at Home Orchard in order to support them to lead fulfilling lives. Staff told us they felt skilled to meet people’s needs and had received regular training. Staff comments included “Staff have enough training, if you want more training you just ask” and “We are offered loads of training”.

People were supported by staff who knew them well. Staff knew people’s routines, preferences and histories and knew how best to communicate with people.

People’s needs had been assessed and support plans had been put in place to meet those needs. Where people’s needs had changed, staff had taken action to ensure people received the care they needed.

Where people were not able to make decisions for themselves staff involved people’s relatives and appropriate professionals to make sure people received care that was in their best interest. People were supported to be involved in as many decisions as possible and were always asked for their consent and given options. Some people were being deprived of their liberty as they were under constant supervision and were not able to leave the home on their own for their own safety. The registered manager had made the appropriate Deprivation of Liberty Safeguard (DoLS) applications to the local authority and a number of these were still awaiting approval.

There were sufficient staff to meet people’s needs. Staff spent time chatting with people individually and helping people to take part in individual and group outings. Staff comments included “There are always enough staff”.

People were supported to have enough to eat and drink. Mealtimes were a sociable experience with staff eating alongside people. People were supported to help prepare their meals and could choose what they wanted to eat. People’s mealtimes were relaxed and flexible to meet people’s activity commitments and routines.

People’s relatives were involved in the home and always felt welcome. Relatives told us they could visit the home at any time and could contact staff whenever they wanted. One healthcare professional told us they also felt welcome anytime. They said “I never feel uncomfortable turning up unannounced. I always get a warm welcome”. Relatives felt involved in people’s care and support and told us they were kept regularly informed.

People were protected against the risks associated with medicines because the provider had appropriate systems in place to manage medicines. Staff had received training and competency evaluations in relation to medicines.

People’s needs and abilities had been assessed and risk assessments had been put in place to guide staff on how to protect people. For example, where one person’s behaviours presented challenges and risks to themselves and others, staff had discussed the behaviours and created a specific plan. This plan included specific routines to follow in order to ensure the best outcome for the person. Staff had sought advice from healthcare professionals such as speech and language therapists, the person’s GP and a consultant psychiatrist. This minimised the risk to the person and staff.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to ensure the risk to people was minimised. Premises and equipment were maintained to ensure people were kept safe and there were arrangements in place to deal with foreseeable emergencies.

People were protected by staff who knew how to recognise possible signs of abuse. Staff told us what signs they would look for and the procedures they would follow to report these. Safeguarding contact numbers were accessible to staff and people who lived in Home Orchard were also provided with information for reporting concerns. There was a disability hate crime poster in the kitchen which contained contact information for reporting concerns.

Recruitment procedures were in place to ensure only people of good character were employed by the home. Potential staff underwent Disclosure and Barring Service (police record) checks to ensure they were suitable to work with vulnerable adults.

The two owners of Home Orchard managed the service and one was the registered manager. A third manager had been employed to assist with day to day management. There was an open culture in the service and the management team were available and approachable. Staff members said “They are all really supportive” and “Every single one of the managers is supportive and approachable”. One healthcare professional said “The owners are always around and have a good grip and know what’s going on”.

Relatives told us they felt comfortable speaking with management and felt they would be listened to. They felt confident if they made a complaint this would be dealt with. Relatives said “If I had a complaint there would be no problem with that and they would put it right” and “I would feel comfortable to make a complaint”.

There were systems in place to assess, monitor and improve the quality and safety of care. The registered manager and the manager undertook regular spot checks to ensure people’s care needs were being met, staff were displaying the home’s philosophy of care and documentation was being maintained. The home’s philosophy of care was to treat each person as an individual and enhance people’s independence and living skills through meaningful activity. Staff and management carried out weekly and monthly audit which looked at the care provided, medicines management, fire safety and the environment.