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Inspection Summary


Overall summary & rating

Good

Updated 25 March 2017

The inspection took place on 22 February 2017 and was unannounced.

Orchard House provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington’s disease. There were 12 people living at the service at the time of inspection. They had complex communication and mobility needs.

The service is a large detached house and a bungalow in a residential area of Herne Bay. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased. Other people were more independent, able to make decisions for themselves and go out independently.

There was a registered manager working at the service and they were supported by an assistant manager. They were also the registered manager of another service close by. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service was last inspected in January 2016 when it was rated requires improvement overall with five breaches of regulation identified. The breaches of regulations related to staff training, recruitment and supervision, staff not having the guidance they needed to keep people safe, care plans not being updated and audits at the service not identifying the issues found at the inspection. There were improvements found at this inspection. The registered manager had made changes based on the last inspection report and a recent inspection at another nearby service that they managed.

On the day of the visit the registered manager supported us throughout the inspection. The registered manager had been in charge at the service for a long time. They knew people and staff well. People’s care plans had been updated with them or their loved ones, they showed the support people needed, what was important to them and how they preferred to be supported. Staff were now continuing to review and update the plans on a regular basis.

Risks to people had been assessed and staff now had detailed guidance relating to minimising risks and keeping people safe. The safety of the premises was maintained by regular and routine checks of the environment and equipment.

Staff were now recruited safely using all the checks required and had access to training which enabled them to support people confidently. Staff had more regular one to one meetings with their line manager. There were enough staff to meet people’s needs.

The registered manager and provider had improved the auditing systems they used. Audits were completed regularly and action was taken to address any shortfalls. Opinions and feedback about the standard of care were sought from people, loved ones and visitors, any issues were addressed and the results of the feedback were shared.

Staff knew people and their families well; they had developed positive and caring relationships. Staff changed the way they interacted for each person but all interactions were empathetic and caring. People’s family and friends could visit whenever they wanted and told us they felt like they were all part of one big extended family.

Staff supported people in a way which respected their dignity and privacy such as knocking on people’s doors and giving them private time with their families. Staff talked to people about what was happening and what they were doing at all times. People were supported to retain their independence for as long as possible.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

People were offered a selection

Inspection areas

Safe

Good

Updated 25 March 2017

The service was safe.

Staff understood how to recognise abuse and who to report any concerns to.

Risks were assessed and guidance was in place to minimise risks.

Staff were recruited safely and there were enough staff to meet people’s needs.

Medicines were managed safely.

Effective

Good

Updated 25 March 2017

The service was effective.

People were supported by staff who were confident in their roles and had the support and training required.

Staff understood that people should make their own choices and knew what to do if people were unable to do so.

People were supported to have food and drink they liked.

People’s health needs were recognised and advice was sought when required.

Caring

Good

Updated 25 March 2017

The service was caring.

Staff knew people and their families well.

People’s dignity and privacy was respected and people were treated with empathy and compassion.

People were supported to remain independent for as long as possible.

Responsive

Good

Updated 25 March 2017

The service was responsive.

People’s care plans reflected their needs and preferences.

People had access to activities they enjoyed and were encouraged to try new things.

There was a system to respond to complaints.

Well-led

Good

Updated 25 March 2017

The service was well-led.

The service had an open and inclusive culture. Staff felt valued and listened to.

People, staff and relatives told us the registered manager was accessible and approachable.

The management team completed regular audits of the service to identify any issues.

Annual questionnaires were sent out to people, their relatives, staff and other stakeholders so they could give their views about the service, responses had been analysed and acted on.