The Orchard

Updated 22 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.

The inspection team

This inspection was carried out by an inspector.

Service and service type

The Orchard 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:

The inspection was announced. This was because the service is small and people are often out and we wanted to be sure there would be people available to speak with us.

What we did before inspection

We completed our planning tool and reviewed information we had received about the service since registering with CQC. This included notifications we had received from the provider, about incidents that affected the health, safety and welfare of people supported by the service. We looked at previous inspection reports. We also sought feedback from partner agencies and health and social care professionals. 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 lived at The Orchard and five relatives. We spoke with seven members of staff including the registered manager, head of care and care staff. Five people were on holiday in Lancashire with staff support, when we inspected. We met up with them in Blackpool before later visiting the home in Wem, Shrewsbury. We also spoke with the registered manager when they returned from the holiday.

To gather information, we looked at a variety of records. This included medicines records and one person’s care records. We looked at information in relation to staff training and supervision. We also looked at other information related to the management of the service including audits, surveys and meeting minutes. We did this to ensure the management team had oversight of the service and they could respond to any concerns highlighted or lead in ongoing improvements. We walked around the building to check the home was clean, hygienic and a safe place for people to live. The home was being redecorated while people were on holiday.

Updated 22 October 2019

About the service

The Orchard is registered to provide accommodation with personal care, to a maximum of six people who have a learning disability, physical disability, sensory impairment or autistic spectrum disorder. Six people lived at The Orchard. Five people were on holiday when we inspected. We met with them at their holiday destination. The Orchard is a large adapted bungalow with single en-suite bedrooms and shared communal areas. There is outdoor space for people to enjoy and car parking available.

The service has been developed and designed in line with the principles and values that underpin Registering the 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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the provider and manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

People were safe and protected from abuse because staff assessed and managed risk. There were enough staff to meet people’s care and support needs. Staff were recruited safely. People received their medicines as they needed. The home was clean and maintained and staff practised good infection control.

People had complex care needs and limited verbal communication and relied on other ways of communicating their needs and preferences. Staff had assessed people’s specific communication needs and were familiar with the ways people communicated. People were able to get involved in a variety of activities with staff support. Staff observed people’s reactions which indicated whether they enjoyed particular activities. Staff encouraged families to tell them about any concerns or complaints. People could remain at The Orchard when heading towards the end of life, with familiar people to support them.

People were helped 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 assessed people's capacity to make decisions and supported them with decision making. People saw healthcare professionals promptly to assist their health and wellbeing. Staff supported people to receive sufficient nutrition and were familiar with people’s dietary needs. The design of the home met people’s needs. Staff had been appropriately trained and supported and had the skills, knowledge and experience to provide good care.

The service applied the principles and values of Registering the Right Support and other best practice guidance. 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 as many opportunities as possible for them to gain new skills and become more independent.

Staff provided care that met people’s different needs and preferences. People and their relatives were involved in planning their care and encouraged to make decisions. People indicated they were happy with their care. Relatives said their family member was treated with respect and consideration.

People indicated staff involved them in decisions and asked them for their views. Relatives told us staff listened to and acted on these. The registered manager worked in partnership with other services and organisations to make sure they followed good practice and people in their care were safe. The management team monitored and audited the service to check on the quality and make sure staff were providing good care. They understood and acted on legal obligations, including conditions of CQC registration and those of other organisations.

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

Rating at last inspection:

At the last inspection with the previous provider the service was rated good (published 17 March 2017).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

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.