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Inspection carried out on 18 March 2019

During a routine inspection

About the service: Apple Orchard is a residential care home. It provides accommodation and personal care for up to ten adults with a learning disability. At the time of the inspection there were nine people living at the service.

People’s experience of using this service:

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• People were involved in planning their care.

• People were supported to follow their interests, set goals and increase their independence.

• People had good access to their local community and opportunities to meet people and were supported to maintain relationships with friends and family.

People were supported by a small but consistent team of staff who were kind and caring. Staff had good relationships with people and knew them well. People told us they liked living at the service and wouldn’t change anything about it.

Staff knowledge in relation to people’s condition, their needs, and how to support them was thorough.

Care plans were person centred and included people’s personal goals for the year.

There was an open culture where staff and people could raise concerns or issues. People told us they felt safe at the service and felt happy to speak up.

Rating at last inspection: Good (August 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue our on-going monitoring of the service and all information we receive. We will use this information to determine when we next inspect the service.

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

Inspection carried out on 23 August 2017

During an inspection looking at part of the service

Apple Orchard is a care home providing support and accommodation for up to 10 adults with learning disabilities.

At the time of our inspection visit Apple Orchard had 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.

This focused inspection took place on the 23 August 2017 and was unannounced. We previously inspected the service on 31 March 2017, where we found a continuous breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009 in relation to a lack of notifications. We had not been notified of some incidents impacting on the wellbeing of people living at the home. CQC monitors events affecting the welfare, health and safety of people living in the home through notifications that providers are required to send to us.

At this inspection we found an improvement and the provider was meeting the requirements of this regulation. Important events impacting on people using the service had been reported to us through required notifications.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Apple Orchard’ on our website at ‘www.cqc.org.uk’. At the comprehensive inspection in March 2017 the service was rated as overall Good’ with ‘Requires Improvement’ in Well-led to reflect our concerns in relation to notifications not being sent. Our findings at this inspection have not changed the current rating of ‘Requires Improvement’ for the key question Well-led for this service because we did not look at all the areas for the key question Well-led. We will review all areas of the key questions in full at our next comprehensive inspection.

Inspection carried out on 31 March 2017

During an inspection looking at part of the service

The inspection took place on the 31 March 2017 and was unannounced. We previously inspected the service on 15 and 16 July 2015 and 4 August 2016 where we found a breach of regulation 18 of the Care quality Commission (Registration) Regulations 2009 in relation to a lack of notifications. We had not been notified of some incidents impacting on the wellbeing of people living at the home. CQC monitors events affecting the welfare, health and safety of people living in the home through notifications that providers are required to send to us.

Apple Orchard is a care home providing support and accommodation for up to 10 adults with learning disabilities.

Important events impacting on people using the service had not been reported to us through required notifications.

At the time of our inspection visit Apple Orchard had 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.

We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 4 August 2016

During a routine inspection

This inspection took place on the 4 August 2016 and was unannounced. The home was last inspected on 15 and 16 July 2015 where we found breaches of regulations in relation to staff recruitment and deprivation of liberty safeguards

Apple Orchard is a care home providing support and accommodation for up to 10 adults with learning disabilities. At the time of the inspection there were 10 people using the service.

Apple Orchard did not have a registered manager in post. 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.

We had not been notified of the outcome of an application to deprive a person of their liberty. CQC monitors events affecting the welfare, health and safety of people living in the home through notifications that providers are required to send to us.

Audits were completed to check the quality and safety of the service provided, however the medicines audit was not robust enough to identify medicines recording issues.

Risks to people’s safety were identified, assessed and appropriate action taken. We found improvements to how people’s medicines were managed. People’s individual needs were known to staff who had achieved positive relationships with them. People were treated with kindness, their privacy and dignity was respected and they were supported to develop their independence and keep in contact with relatives. People were involved in the planning and review of their care and took part in a range of activities.

Staff received support to develop knowledge and skills for their role and were positive about their work with people. The acting manager was accessible to people using the service and staff.

We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 15 & 16/07/2015

During a routine inspection

This inspection took place on the 15 and 16 July 2015 and was unannounced.

Apple Orchard is a care home providing support and accommodation for up to 10 adults with learning disabilities. At the time of the inspection there were 10 people using the service.

Apple Orchard had a registered manager although this person was not in post at the time of our inspection. A new manager was in post although they had not applied for registration. 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.

Some aspects of the management of people’s medicines were unsafe. People were not protected against being supported by unsuitable staff because robust recruitment procedures were not applied.

Although there was an understanding and correct use of the Mental Capacity Act 2005, the associated Deprivation of Liberty Safeguards (DoLS) had not been used correctly to uphold people’s rights.

Although quality checks were in place did not always seek and act on feedback from people or their representatives on the services provided or identify areas for improvement.

We had not been notified of some incidents affecting the wellbeing of people living at the home. CQC monitors events affecting the welfare, health and safety of people living in the home through notifications that providers are required to send to us.

There were sufficient staff to meet people’s needs and people were protected from the risk of abuse by staff who understood safeguarding procedures.

People were consulted on a range of topics including meal choices, their choices of activities and wishes for the future. This resulted in people receiving individualised support.

People received support from caring staff who respected their privacy, dignity and the importance of independence. There were arrangements in place for people and their representatives to raise concerns about the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 14 May 2013

During a routine inspection

We found that the provider was ensuring that the service respected the privacy and dignity of people who lived at the home. We were able to speak with three people living at apple Orchard. They told us that "we go on lots of good trips" and "i like it here and don't want to live anywhere else". Assessment and reviews conducted by the service had consulted with people who used the service and recorded how they wished to be supported. Each person living at the home had set goals for the coming year. Almost all of the goals, which they had set for the previous year, had been met. Monitoring by the manager had ensured that staff followed support plans and respected the wishes of people using the service. There were sufficient skilled and experienced staff to safely meet the needs of people who used the service.

In summary, this inspection found that Apple Orchard was providing a good standard of care and support to the people who were using the services.

Inspection carried out on 13 February 2013

During a routine inspection

We found that the provider was providing a service which had respected the privacy and dignity of people who used their service. We were not able to speak with any of the people living at the service as those people with verbal communication were out at the time of the inspection. Assessment and reviews conducted by the service had consulted with people who used the service and recorded how they wished to be supported. Monitoring by senior staff had ensured that staff followed support plans and respected the wishes of people using the service. There were sufficient skilled and experienced staff to safely meet the needs of people who used the service. The standard of induction and subsequent training for staff must be reviewed. The building had been reasonably maintained. The premises would however, benefit from a programme of refurbishment and redecoration to benefit people living at the home.

In summary, this inspection found that Apple Orchard was providing a good standard of care and support to the people who were using the services.