Orchard House

Updated 28 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is 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 the 26 February 2018. The inspection was unannounced. The inspection team consisted of two inspectors.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at all the other information we held about the service, including previous inspection reports, complaints and notifications. A notification is information about important events which the provider is required to tell us about by law. We used all this information to decide which areas to focus on during our inspection.

We met all the people that lived at the service. Some people were able to tell us about their experiences of the service. Others had more complex communication needs so we used other tools to help us understand their experiences for example 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.

Feedback from the providers surveys sent to relatives and a health and social care professionals was positive and their comments have been included in this report.

We looked at six people’s care and health plans, risk assessments and medicine records. We also looked at operational records for the service including: staff recruitment, training and supervision records, staff rotas, accident and incident reports, servicing and maintenance records and quality assurance surveys and audits. We spoke with the registered and deputy managers and four care staff.

Updated 28 March 2018

We carried out this inspection on 26 February 2018. Orchard House 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 is registered for 10 people with learning disabilities and autistic spectrum disorder, some of whom may also have physical disabilities. The service is divided into two units one for six people and one for four people; at the time of inspection both were full.

Orchard House has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as and citizen.

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.

At our previous inspection in December 2017 the provider had failed to ensure that all checks on staff suitability were in place and the organisational systems for monitoring the service quality on behalf of the provider were not sufficiently robust. At this inspection improvements had been made and the service was now fully compliant with the regulations.

Staff were recruited safely and all checks on their suitability were in place prior to them starting work at the service. The organisational systems in place for monitoring the quality of service had improved, with timely maintenance work being carried out.

Staff were trained and knew how to recognise signs of abuse. They were confident that any concerns would be dealt with appropriately. People’s finances were protected as there were systems in place to ensure their money was safeguarded.

Risk associated with people’s care had been assessed and managed to enable people to take part in what they wanted to do. There was clear guidance in place for staff to support people in a way that suited them best.

Checks on the environment were completed regularly, including the fire alarm systems. All staff had attended regular fire drills which were checked to ensure that all members of staff were involved. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. The premises had been adapted to meet people's needs.

Accidents and incidents were recorded and monitored by the provider to look for any patterns or trends to prevent future occurrences.

The service was clean and tidy. People were protected from infection with systems in place to check staff followed infection control procedures. Staff were observed wearing gloves and aprons as they went about their duties.

There were sufficient staff on duty and staff were not rushed and had time to spend with people.

People enjoyed a range of their preferred activities and accessed the community when they wanted to.

Staff received the training they needed and had their performance assessed through one to one supervision and observations. Staff told us they were confident to raise issues at their supervision or through staff meetings.

People were relaxed and comfortable with staff. Staff spent time with people and were attentive to their needs. Staff understood how and when they needed to support people with their behaviour should they become anxious or distressed.

People were supported to remain as independent as possible and their privacy and dignity was maintained. Staff spoke quietly and respectfully to people and supported them with their daily activities. They offered them choices and their preferences were upheld.

Although there were no vacancies in the service, there were systems in place to ensure people who may wish to move in received a care needs assessment in line with current guidance.

Care plans were personalised with detailed guidance to hep staff support people with their individual needs and behaviour. These included their choices and preferences of how they liked their care to be provided.

People’s health care needs were monitored and referrals made to health care professionals when further medical advice was needed. People were supported to go to their local GP, hospital out patient’s appointments, dentist and optician.

Staff had received training to give people their medicines safely and people received their medicines on time and as prescribed. People were asked about their end of life wishes and this information had been recorded in their care plans.

People were encouraged to have control of their lives and staff clear guidelines were in place to ensure that people were able to communicate their needs and talk about the support they needed. Relatives were involved in supporting their loved ones with decisions about their care and regularly involved in reviews of care plans.

People were supported to eat a healthy diet be involved in preparing meals and choosing what they wanted to eat. People’s individual dietary needs were catered for.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Referrals to the local authority had been made when needed and authorised.

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

There were systems in place to support people to complain. The complaints procedure was available in an easy read format suited to people’s needs. Staff told us the service was well led. The registered manager and staff had worked hard to ensure compliance with the regulations and this was evidence at the time of the inspection.

Checks and audits from the organisation had improved and the service had been regularly checked to assess the quality of care being provided.

The registered manager worked in partnership with other professionals, such as those from the local authority safeguarding team, and people’s care managers.

Staff understood the visions and values of the service. The provider’s values of ‘person-centred’ ‘friendly’ ‘innovative’ ‘empowering’ and ‘positive’ were displayed on the wall in the service. Staff told us they supported people to have a fulfilled life, upholding their choices and preferences and ensuring they were part of the local community.

People, relatives and other stakeholders had been asked their views on the service. Feedback was positive and complimentary about the service being provided. Staff told us they were supported by the registered manager who was always available for additional support and guidance. They told us that the service was open and transparent and they were confident that any issues raised would be acted upon by the manager.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.

The latest overall rating judgement of the service at the last inspection was displayed in the service.