We carried out a review of the data available to us about Orchard House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Orchard House, you can give feedback on this service.
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.
At a previous inspection in November 2015 we found the provider was not meeting the requirements of the legislation by not undertaking robustly the local audits and quality checks carried out by the registered manager and staff within the service. We asked the provider to send us an action plan of how they intended to address this shortfall which they did. At this inspection we checked if these actions had been sustained.
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.
People were not consistently safe due to organisational failings that failed to provide assurance that all checks on staff suitability were in place prior to them commencing work at the service. At local level service quality monitoring and audits had improved but organisational systems for monitoring the service quality on behalf of the provider were not sufficiently robust. They had not highlighted the shortfalls we identified in recruitment or the organisational delays in progressing maintenance work some of which was in relation to fire safety improvement.
Staff understood how to keep people safe from abuse and felt any issues they raised in relation to the conduct of other staff would be managed confidentially. In the event of emergency situations staff knew how to evacuate people safely, they practiced this through fire drills on a regular basis and we have discussed with the registered manager the need to keep under review the number of drills each staff member attends to ensure that all staff have participated during the course of any single year.
People lived in a well maintained environment that was decorated and furnished to a high standard, it was visibly clean and tidy and people were enabled with staff and relatives support to personalise their own personal space. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. Fire detection and alarm systems were maintained. Remedial works to address issues however were delayed and we have addressed this elsewhere in the report.
There were enough staff available on each shift to be able to spend time with people and to enable and support people out into the community for activities they enjoyed. People enjoyed a range of activities that were suited to their individual needs, abilities and wishes. Risks to individuals from their environment or from their own behaviours or health conditions were assessed appropriately. These assessments helped staff to understand how to protect individuals from harm and these were kept updated or amended whenever changes occurred. Accidents and incidents were monitored by the provider to see where improvements could be made to prevent future occurrence.
Staff were trained to meet people’s needs and they discussed their performance during one to one meetings with their supervisor, records of these discussions were kept. Staff said that they felt listened to and supported; they received regular staff meetings and felt able to raise and discuss issues that arose.
People were calm and relaxed; staff were attentive and supportive to ensure everyday needs were met and showed interest in the things people wanted to show and tell them about. Staff showed understanding in managing challenging situations and took action to ensure people’s dignity was not compromised as a result of their behaviour; people were given space and time to calm down. Individualised guidance was available to staff to help them understand how to work proactively with those people whose behaviour could be challenging to others. People told us about their experience of living in the service and said they were satisfied with where they lived and were happy with all aspects of the support they received from staff. The complaints procedure was available in a format suited to people’s needs.
Staff understood people’s individual communication needs to enable them to spend time with them and give them opportunities to meet and talk about their care and support and anything they would like to change or new goals they would like to achieve. Relatives told us that they were kept well informed and were consulted in regard to their relative’s care and treatment plan. Staff monitored people’s health and wellbeing and supported them to access routine and specialist health when this was needed. People ate a varied diet suited to their preferences and dietary requirements.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Eight people had been referred for or had received DoLS authorisations and the registered manager had a clear understanding of the criteria for making an application and ensured the service was meeting the requirements of the Deprivation of Liberty Safeguards.
Medicines were managed safely by trained staff. People and their relatives were routinely asked to comment about the service and action was taken to address any areas for improvement.
We have made one recommendation for improvement:
We recommend that a competent person checks that all the radiators on the top floor are functioning properly specifically the one we have highlighted. Additionally a check of the ambient temperature of the room in question should be recorded to ensure this is maintained at a suitable level.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We carried out this unannounced inspection on 5 November 2015. Orchard House is a service for up to 10 people with learning disabilities or autistic spectrum disorder that may also have a physical disability. The service is divided into two units. At the time of inspection both units were full. People had their own bedrooms. The service was fully accessible for those people who used wheelchairs and a passenger lift was in place to access the first floor. This service was last inspected on 19 November 2013 when we found the provider was meeting all the requirements of the legislation.
There was a registered manager in post. 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.
Several people were able to tell us about coming to live at Orchard house, and confirm that they felt safe and happy there. Other people had limited communication and so we used a number of different methods to help us understand their experiences. We observed that people were happy, comfortable and relaxed in the presence of staff, who interacted well and showed they understood people’s individual communication styles and needs.
Internal audit processes were not implemented effectively to assure the registered manager that all aspects of delivery of care were being carried out. People were not consistently asked for their views and the frequency of house meetings and individual meetings with keyworkers needed to be improved.
Recruitment procedures for new staff ensured people were protected from the appointment of staff who were unsuitable.Relatives told us that they were happy with the care their family members received, they felt informed and involved and found the registered manager and the care staff supportive and approachable. Staff monitored people’s health and wellbeing and supported them to access routine and specialist health care input when this was needed.
People were given support to participate in activities in the community that they were interested in or to pursue personal interests and hobbies both in-house and when out. Risk assessments were completed for each person regarding their interactions with their environment and the activities they participated in. This helped staff to understand how to protect people from harm. These assessments were kept updated. Accidents and incidents were monitored by the provider to see where improvements could be made to prevent future occurrence. Individualised guidance was available to staff to help them understand people’s behaviour and specific health conditions; this helped them respond appropriately to people with these needs.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider understood when an application should be made for a DoLS authorisation and two referrals were currently waiting processing by the DoLS team. The service was meeting the requirements of the Deprivation of Liberty Safeguards.
Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed.
People were safe and protected from harm because there were enough staff available to support them in the service and when out in the community. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings with their registered manager.
People lived in a well maintained environment that was decorated and furnished to a good standard. The service was visibly clean and tidy. People were enabled with staff support to personalise their own personal space. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. Fire detection and alarm systems were maintained; staff knew how to protect people in the event of a fire as they had undertaken fire training and took part in practice drills. Guidance was available to staff in the event of emergency events so they knew who to contact and what action to take to protect people.
People ate a varied diet and were consulted about the development of menus which took account of their personal preferences. Medicines were managed safely by trained staff. Relatives were routinely asked to comment about the service and action was taken to address any areas for improvement.
We have made two recommendations:
The provider should consult with the Fire Service as to whether evacuation plans for people on the first floor meet the requirements of the current fire legislation contained within the Regulatory Reform (Fire Safety) Order 2005.
We recommend that the registered manager review and implement fully the company policy with staff with regard to the frequencies of individual key worker and “Our meetings” for people in the service.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.
The interactions we observed between staff and people using the service were friendly and relaxed. The relatives we spoke with were mostly positive about the service. They said they could visit when they wished. They said their relative got on with the staff, and had a programme of activities. One visitor told us they believed their relative was listened to and that the staff 'support [person using the service] well'. They added 'it's a lovely place, I couldn't praise them enough.'
People had sufficient food to eat and drink, which was prepared by staff. The kitchen was adapted so that people could be supported to cook.
Medication was administered, recorded and monitored appropriately by staff.
People were supported by staff who received adequate training and support.
Records were maintained of people's care, which were stored securely.
We observed that people were comfortable in the presence of staff and that the atmosphere at the home was friendly and relaxed.
We saw that staff offered people choices, respected their dignity and privacy and supported them to be as independent as they could.
One person we spoke with told us that they liked living at the home, they were happy with their bedroom and they were looking forward to some outings that were being planned.