We visited The Orchard on 25 May 2017 and this was an unannounced inspection. This meant the provider and staff did not know we were going to visit.The Orchard provides personal care and accommodation for up to six adults who have a learning disability and associated complex needs. The service is a large modern detached house in the village of Wistow, a few miles from Selby town centre. At the time of the inspection six people used the service.
We last inspected the service in December 2015 and found that we had not been notified of incidents that had occurred in the home, as is required by legislation. Also we found that improvements could be made to the recruitment and auditing systems within the home and made recommendations about these in the report. We rated the service as ‘Requires Improvement’ overall and two domains required improvement.
At this inspection we found that the team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.
The registered manager had been in post since 2015. 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 told us they found the staff supported them to lead fulfilling lives. We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle.
People who used the service required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff provided consistent responses and took appropriate action when people’s needs changed, which had ensured staff could continue to meet the individual’s needs. We found that the actions staff had taken led to marked improvements to how people responded to the world and greatly increased their quality of life.
We saw pre-assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create the initial support plans but no comprehensive assessment documents were in place and this meant staff could not reflect upon and update the global information about how people had changed since admission. Also we found that support plans were not used to capture what actions staff had found worked well when working with people. The registered manager had captured information about people in various documents but this was disjointed and they outlined how they would ensure a central assessment document would be developed.
People were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.
There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.
Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities and autistic spectrum disorders.
Staff had also received training around safeguarding vulnerable adults and clearly understood how to implement these procedures. We observed that staff consistently maintained people’s privacy and dignity. We found that staff treated people with respect and compassion.
Staff had also received training around the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The staff we spoke with understood the requirements of the MCA and were ensuring that where appropriate this legislation was used.
People and the staff we spoke with told us that there were enough staff on duty. We found there were sufficient staff on duty to meet people’s needs.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety and relevant infection control procedures were followed by the staff at the service. We found that action was taken to minimise known risks.
The registered manager had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service.