The Orchard

The Orchard is a care home which is registered to provide care (without nursing) for up to ten people with a learning disability. The home is a large detached building situated on a village style development together with other similar care homes run by the provider. It is situated some distance from local amenities and public transport. At the time of the inspection there were eight people living in the home.

There was a manager for the service who was in the process of registration. 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 recruitment and selection process undertaken by the provider organisation ensured people were supported by staff of good character. The number of qualified and trained staff was sufficient to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. Medicines were managed and administered safely. Routine health and safety checks were completed in accordance with legislation and guidance. Infection control procedures were followed.

People were provided with effective care from a core of dedicated staff who had received support and guidance from the management team. Care plans were detailed and included how people wanted their needs to be met. Risk assessments identified risks to people associated with personal and specific behavioural and/or health related issues. They supported staff to promote people’s independence whilst minimising the risks. Staff treated people with kindness and respect. The service had regular contact with people’s families and representatives to make sure they were fully informed about the care and support the person received.

The provider was meeting the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Consent to care and support was sought in line with legislation and guidance. When appropriate mental capacity assessments had been completed and where people had been assessed as not having mental capacity to make a decision, a best interests meeting had taken place. 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 provided with the training and development they required to care for and support people’s individual needs through regular supervision, meetings and updating their training. The provider had taken steps to periodically assess and monitor the quality of service that people received. This was undertaken by the home manager and delegated staff within the home. The process was carried out through internal audits, care reviews and requesting feedback from people and their representatives. There was evidence that any required actions that resulted from quality monitoring had been identified and undertaken in a timely manner.

The manager received consistent praise and positive feedback from staff, relatives and professionals. They uniformly expressed the difference his leadership had made to the service. We found an open and positive culture in the service and the staff team was supported to bring forward suggestions to better the service. There was a strong emphasis on team working and staff confirmed they worked well together. Standards of care were high as a result of the example set by the management team and their expectations. The staff worked hard to meet the standards and expectations set and took pride in achieving positive outcomes for people. There were strong links built with the community which benefitted people. The provider valued and developed staff. They involved people in contributing to all aspects of the service and sought views and feedback in order to improve and develop.

The Orchard is a care home which is registered to provide care (without nursing) for up to ten people with a learning disability. The home is a large detached building situated on a village style development together with other similar care homes run by the provider. It is situated some distance from local amenities and public transport.

There was a registered manager for the service. 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 recruitment and selection process ensured people were supported by staff of good character. There was a sufficient amount of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

People were provided with effective care from a core of dedicated staff who had received support and guidance from the management team. People’s care plans detailed how they wanted their needs to be met. Risk assessments identified risks to people associated with personal and specific behavioural and/or health related issues. They helped to promote people’s independence whilst minimising the risks. Staff treated people with kindness and respect and had regular contact with people’s families and representatives to make sure they were fully informed about the care and support the person received.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care.

Staff were not always provided with the training and development they needed to care for and support people’s individual needs through regular supervision, meetings and updating their training. Despite this people received good quality care. The provider had taken steps to periodically assess and monitor the quality of service that people received. This was largely delegated to the home manager through internal audits, care reviews and requesting feedback from people and their representatives. However, there was a lack of evidence to support that required actions in relation to safe practices had been adequately identified and robustly undertaken in a timely manner.

The location did not have a registered manager at the time of our inspection. This is a requirement for registration with the Care Quality Commission (CQC). The service manager told us they had started the application process for becoming a registered manager with the CQC, and we saw this recorded in our records.

The Orchard is one of a group of residential homes providing care and support to people within a village environment known as Ravenswood Village. It was run primarily for those of Jewish faith, but people and staff did not have to be Jewish to live or work there. People were supported to practice their faith, and the village celebrated Jewish rituals and festivals. People had the choice of whether they wished to attend the synagogue or follow Jewish rituals.

We considered all the evidence we had gathered under the outcomes we inspected, which related to consent to care, people's care and welfare, cleanliness and infection control, staffing, and assessing and monitoring the quality of service provision. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

The service was caring. We saw there was a bond between people and care workers. People appeared to enjoy the company of those who cared for them. One care worker told us 'This is a special job, it needs your heart in it. We learn every day'. Another said 'I love it here, I love the guys [people we support]'.

People were supported to achieve the goals they set for themselves, and encouraged to be as independent as they could be. Three people lived as independently as possible in purpose built flats within or adjoining the service, where they developed life skills with support from care workers.

Is the service responsive?

The service was responsive to people's needs. People had monthly meetings with their keyworker to review their care needs and wishes. As people's needs altered staff promptly identified these changes, and considered appropriate actions to support them. Advice and guidance was sought from health professionals where this was appropriate.

Care workers monitored people's engagement in activities. This ensured people continued to enjoy the activities they attended. Opportunities to change activities and participate in new experiences were encouraged. For example, care workers provided choices for annual holiday destinations, and supported people to make their preferred choice.

Is the service safe?

The service was safe. We found it clean and tidy at the time of our inspection. Staff understood the principals of infection control, and ensured people were protected from potential harm through good practice of personal hygiene processes. All staff felt responsible for maintaining the cleanliness of the home, and checks were in place to ensure this was satisfactory.

We asked one person 'do staff make you feel safe?' They responded 'Yes they do'. We saw risks were identified and assessed. Staff were not risk averse, but ensured people were at reduced risk of harm due to control measures in place. For example, when people were supported to use the hydrotherapy pool on site, staff understood the risks this posed and followed the provider's guidelines. This included the moving and handling procedure, occupational therapy guidance and safe bathing procedure.

Care workers had appropriate experience and skills to support people safely. The management understood people's support needs and ensured staffing was sufficient to meet these. The manager explained staff hours were assessed in agreement with people's funding authorities. Discussions were planned at the time of our inspection to increase staff hours and equipment funded for one person as their health needs changed.

Relatives, care workers and management all told us they were reliant on agency staff to support people. They all recognised the impact this had on people, as consistency of care was important to support people safely. The manager explained they mitigated the risks from this by using the same agency staff.

Care workers told us they sometimes felt staffing levels were not sufficient to meet people's needs and promote their wellbeing. We looked at a staff rota for the month of May 2014, and saw that the funded hours were met or exceeded for all bar four days. Management staff were available to offer additional support daily, including the four days identified as short-staffed. This meant people were supported appropriately.

Is the service effective?

We found the service was responsive to people's needs. One relative told us that staff had been working on a long term project with their loved one to develop improved communication methods. This increased the person's independence and assisted them to indicate their wishes more effectively.

One care worker told us 'I like to put myself in their shoes, I ask myself what choices I would make. It takes time to understand people. People's choices and behaviours change, if they did something yesterday it doesn't mean they want the same thing today. It's about trying new things'.

People's health and support needs were discussed with people and their relatives. Staff understood the requirement to liaise with health professionals to promote people's wellbeing. We saw this provided effective support for staff as, for example, they gained confidence to manage behaviours that challenged the service. This ensured people's wellbeing was promoted and people and others were protected from potential harm.

Is the service well led?

We found the service was well led. The provider sought feedback from people, relatives and staff through meetings, surveys and informal chats. They were responsive to issues raised and promptly addressed identified issues. For example, the manager explained how they had trialled a new vehicle to meet the needs of one individual with reduced mobility.

One person told us 'I like all the things [in my home]. There's nothing I don't like'. A relative stated 'I wouldn't like to move X anywhere else'. Another relative told us they had been concerned with the management changes in the service over the past two years, but 'Things are settling down now with the manager [in post]. Things are getting better'.

One care worker told us 'I can approach the manager'. We saw staff were expected to attend staff meetings, and minutes indicated that discussion and debate was encouraged.

There were checks in place to ensure the service delivered appropriate care. For example, we saw managers carried out night checks to ensure people were supported appropriately, and a medicines administration audit had been completed by the provider. This meant the provider ensured care and support was provided in accordance with their procedures and compliant with the Health and Social Care regulations.

Staff appeared motivated and said that they had a "responsibility to show respect for the people they supported". Most staff felt well supported; valued and listened to.

The home was clean and the decor was in a reasonable state. There was equipment available to ensure that people's physical needs were met.

People were encouraged to make choices and staff were available to support them in this. We saw people spending time away from their home taking part in leisure activities and some people were attending the college and working on courses of their choice.

Staff were observed to interact with people in a friendly and respectful way and the home appeared calm.

People and staff felt safe, and staff demonstrated a good understanding of their responsibilities in respect of safeguarding.

Support plans were detailed and personalised but some had not been updated and reviewed and some records were not easily accessible.

There were various arrangements in place on the day of our visit. People using the service were excited about the activities planned for them and were seen to have a good relationship with the carers. Everyone we spoke to was happy with the care at The Orchard. One said 'My [name] gets the best care possible'. Another told us it had been a long search to find the facilities available at The Orchard and [name] was really happy there. Some of the areas of the home needed refurbishment especially the bathrooms. We were advised that maintenance on these areas is to be carried out shortly.

We saw evidence of a system in place to audit the quality of care. There was a complaints process in place and families knew how to complain if needed. However, policies were not always updated as planned or signed by staff. Fire evacuation plans required updating and heath action plans although in progress were not completed. Processes were in place to recruit staff, provide support and training. However it was very difficult from the training matrix in place to see what training was completed and we were advised that this issue was currently under review.