Orchard House

Orchard House is a care home providing personal and nursing care to up to 22 people. The service specialises in providing support to people with acquired brain injuries. At the time of the inspection there were 21 people using the service.

People’s experience of the service and what we found:

The service was exceptionally well-led by a team of managers and staff who were focused on providing person-centred care, empowering people to reach their goals and best outcomes. There was a strong emphasis on learning from people’s experiences and any accidents or incidents.

There was an extremely open and honest culture where people were actively encouraged and empowered to raise concerns through innovative ways. Staff were dedicated to providing a safe and nurturing environment and took pride in their work.

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.

People could be assured they were cared for safely by highly trained, committed and competent staff team. Medicines were safely managed and risks to people’s health and well-being were assessed, and measures put in place to mitigate the risks identified. Staff were recruited safely and knew how to protect people from harm or abuse.

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

Rating at last inspection

The last rating for this service was Outstanding (published 04 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the administration of medicines and staff conduct. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Orchard House on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Orchard House is a residential care home providing personal and nursing care for up to 22 people. The service specialises in providing care for adult males who have acquired brain injuries. At the time of inspection there were 21 people living at the home.

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

People received an outstanding, personalised, caring service. People told us they received very kind and respectful support from staff who promoted their abilities, knew them well and genuinely wanted good outcomes for them. Relatives spoke positively about staff and management.

People were safe and were protected by staff who understood their responsibilities and how to keep them safe. People were protected from risks by very detailed, regularly updated risk assessments. Premises and equipment were maintained and serviced regularly. People received their medicines on time and had ready access to healthcare professionals as and when required. The home was well equipped, clean and tidy and good infection control practices were followed.

People had comprehensive care plans which detailed their strengths and promoted their dignity and independence. Their communication needs were assessed and recorded in detail and staff interacted appropriately with people according to their needs. There was a positive collaborative atmosphere and people and staff had good, caring relationships

Care records contained extensive, clear information covering all aspects of people's individualised care and support. 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.

Safe recruitment practices were followed. There were enough staff available to meet people's needs. Staff received comprehensive training to enable them to carry out their roles effectively. The provider encouraged staff to be innovative and empowered them to access additional training and professional development.

Staff were passionate about providing high quality care and supporting people to make progress in their rehabilitation. Staff were happy working for the service and felt well-supported by the management team and colleagues. Staff success was recognised and celebrated. Staff were extremely responsive to people's needs and wishes and provided exceptional person-centred care. People were encouraged and supported to set and achieve goals and ambitions.

People took part in activities they enjoyed and were encouraged to access the community. Visitors were welcomed. People's spiritual and emotional needs were well met by staff. Staff recognised the importance of family relationships in the outcome of people’s rehabilitation.

The home had excellent relationships with health and social care professionals. People were encouraged to be active to help them be healthy. They had a varied diet and ate food they enjoyed.

People and their relatives were involved in the planning and delivery of their care, and regularly asked for feedback which was acted upon when appropriate.

There were systems in place to monitor and improve the quality of the service. When there were problems, the registered manager dealt with them appropriately and worked to reduce the likelihood of recurrence. Staff were supported to be creative in the way they provided support for people and be actively involved in service development.

People, relatives and staff told us the home was extremely well run; the entire management team being open, approachable and focussed on supporting people and staff to achieve their potential.

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

Rating at last inspection

The last rating for this service was Good (published 27 April 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.

Orchard House is registered to provide nursing and personal care for up to 22 people. It provides rehabilitation and care services to people with acquired brain injuries, other neurological conditions and complex physical disabilities. At the time of this inspection there were 17 people living in the home.

There was a registered manager in post at the time of our inspection. 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.

People were supported to develop and maintain life and social skills and regain as much independence as possible, using individually created rehabilitation programmes. The support for this was provided by a skilled, multi-disciplinary staff group, who shared a strong person centred ethos.

People felt safe in the home and received safe care and support. Relatives said that they had confidence that people living in the home were safe and we observed that people were comfortable in the home. Staff had an in depth understanding of their role in safeguarding people and they knew how to report concerns. Staffing levels ensured that people received the support they required at the times they needed it.

The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service. Staff received the training and support required to enable them to understand and meet the care needs of each person.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed.

People were fully involved in decisions about their care and support needs and this had a positive impact on their ability to be as independent as possible. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information in the most appropriate way to enable them to make informed decisions and encouraged people to make their own choices.

Staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and relatives consistently spoke about the positive impact living in the home had made to people’s lives.

People and their relatives were fully involved in the planning of their care and felt included in discussions, being able to have their say at each step of the way. Staff listened and respected people's views about the way they wanted their care, treatment and rehabilitation to be delivered

People participated in a large and varied range of activities within the service, the local community and further afield. The atmosphere in the home was very positive and people were enthusiastic about past and future activities.

Staff were aware of the importance of managing complaints promptly in line with the provider’s policy. People living in the home, their relatives and staff were confident that any issues would be addressed and that if they had concerns they would be listened to.

The service was well led and people’s relatives and staff had full confidence in the leadership of the registered manager and management team. The provider ensured that the service was well supported and effective systems were in place to assess and monitor the quality of service.