We carried out a review of the data available to us about The Orchards 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 The Orchards, you can give feedback on this service.
‘The Orchards’ residential care service consisted of two homes on the same site; providing accommodation and personal care to up to 20 people aged 16 and above. People living at the service have a range of needs relating to learning disability and/or autism, physical disability and/or sensory impairment. Some people living at the service also have complex health needs. The Orchards (home) provides residential care for up to six people and Offa's Dyke provides residential care for up to 14 people. At the time of our visit six people were living at The Orchards and 13 people were living at Offa's Dyke.
The service was developed and designed before Registering Right Support came into existence. Despite this, the service was run in line with the principles and values that underpin Registering Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was large, both homes were located on a single site on the outskirts of Lydbrook in an area of outstanding natural beauty. The site had a fully accessible woodland walk, small-holding, sensory garden, activity park, learning centre and therapy centre with swimming pool and floor trampoline (rebound therapy). The on-site facilities were used by many local providers, for example for dementia walks, which brought the local community in, creating a dynamic and stimulating environment. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate there were care homes on-site. Staff wore everyday clothes when supporting people at home and when accessing the wider community with them.
Offa’s Dyke was bigger than most domestic style properties, providing accommodation for up to 14 people. This is larger than current best practice guidance. However, the size of the home having a negative impact on people was mitigated by the design of the home, which was made up of two distinct houses (Silver Birch and Oak House), joined by a common entrance hall. Offa’s Dyke was purpose-built and provides accommodation for up to seven people in each house. Offa’s Dyke and its garden are fully wheelchair accessible. The houses are equipped with hoists and other specialist equipment suitable for people with profound and multiple disabilities. Accommodation is provided on the ground and first floors with a passenger lift to the first-floor bedrooms.
The Orchards are located five to 10 minutes’ walk from Offa’s Dyke. This consisted of two adapted semi-detached cottages, (The Orchards 1 and The Orchards 2), joined by an internal connecting door. Each cottage housed three people, with accommodation provided over two levels. Ground floor bedrooms were suitable for wheelchair users. Two bedrooms, with en-suite bathrooms, were located on the first floor in each house. The first floor was accessed via stairs.
People’s experience of using this service and what we found
The provider and registered manager had created a positive, caring, person-centred culture where innovation was encouraged and fostered. People were cared for by staff who felt supported and valued and loved their role. Staff knew people exceptionally well and showed insight into their needs, they were able to use their knowledge to assist in developing the service as their ideas were welcomed and encouraged.
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 service was fully inclusive, people were involved in deciding who worked with them. Staff recognised people’s strengths and people were enabled to use these. For example, to improve services for themselves and others.
People felt safe and knew their needs would be met with respect and dignity. They were confident in the staff who supported them, describing them as “friends”. Staff were trained to meet their needs and had been recruited safely. Risks to people were managed through detailed person-centred support plans, timely involvement of health professionals and regular reviews of their needs.
People benefitted from a service which was effective in meeting their complex needs and in promoting their health and well-being. The staff team had formed working partnerships with specialist teams and other health professionals to achieve positive health outcomes for people with significant health challenges. The quality of the service and staff contributions to successful outcomes, were commended by commissioners and health professionals alike.
People were cared for by a staff team who worked flexibly to meet their needs, both in times of ill-health and to improve their everyday lives. One person said, ‘‘Sometimes I need to have a chat with the staff about personal things and they are really, really understanding. It’s quite special to feel that I can do that.” Staff were sensitive and responsive to people’s relatives, other people living at the service and to each other, when people reached the end of their life. One relative said, “They [people using the service] are looked after so well you can’t believe it.”
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. Staff used a variety of techniques to communicate with people, enabling them to make their wishes and goals known. People were supported to have a good quality of life, to experience activities they enjoyed and to maintain relationships with people who were important to them. Staff were proactive in overcoming barriers related to people’s disabilities. People’s feedback about the service was sought regularly and they were confident their views would be respected and responded to positively, including complaints.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills, become more independent and enjoy life. Support was tailored to the person’s needs and abilities. For example, increasing their independence through assisted technologies and supporting them to learn, work and follow interests that were meaningful to them. One person said, “I really do enjoy the fun I have here.”
For more details, please see the full report which is on the CQC website at www.cqc.co.uk
Rating at last inspection
The last rating for this service was ‘Good’ (published 21 January 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.
We last inspected in October 2013 and found the provider was meeting all of the requirements of the regulations at that time.
There was a registered manager in post on the days of our inspection. The registered manager is also one of the providers of the service. 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 living at The Orchards were kept safe. Support workers ensured people were protected from the risks associated with their care. People were supported with their independence and to take positive risk. People received their medicines as prescribed.
People enjoyed living at the home. They were supported by a kind, caring and compassionate support team. Support workers clearly knew people’s needs, wishes and preferences. People enjoyed the time they spent with support workers and other people in their homes. They were supported by support workers to enjoy a range of activities and one to one stimulation.
People told us they felt safe with support workers and safe in the home. Staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.
People's needs were assessed. Where any risks were identified, management plans were in place. They were supported in a way that recognised their rights to take risks. The care and support people received was personalised to their needs.
There was a positive caring culture, promoted by the registered manager. Support workers were passionate about providing high quality personalised care and support. They spoke confidently and positively about people.
Support workers were knowledgeable about the people they supported. They had access to professional development. Support workers received the training they required to support people with individual needs and had access to effective supervision (one to one meetings with their manager).
People and their relative’s views on the service sought. The registered manager ensured the views of people, their representatives and healthcare professionals views mattered. People and their relatives told us the management was approachable and felt confident in their ability to complain. Quality assurance systems were in place to enable the service to identify areas for improvement and ensure people received a good quality service.
We have followed up to make sure that the necessary changes have been made and found the provider is now meeting the standard included within this report. This report should be read in conjunction with the full inspection report.
We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences in relation to the records the service held about them.
We found that care plans were detailed and accurately reflected the support needs and care provided to individual people who used the service. Care records were regularly updated and the systems in place meant that the right information was available to staff to assist them in meeting the needs of the people they supported.
People who use the service were routinely involved with recruitment. We found that standards for recruitment had been met by the provider but some areas for improvement were identified. The service had experienced some staffing difficulties due to a number of staff leaving the service. All three people we spoke with told us that their needs were being met by staff. We saw that people's needs were met promptly and that people appeared content and well cared for.
Systems to provide training and supervision were in place but some staff had outstanding training needs. One person said 'staff have the right training, I am confident they know how to meet my needs'. People were able to make complaints, one person said, 'I do say what I think which is good. I feel that I am listened to'.
Some actions taken by managers to address people's complex needs had not been recorded in care records and some care plans needed to be reviewed and updated.
Offas Dyke was a new, spacious, purpose built environment. The Orchards had been adapted to meet the needs of the people living there. Staff were highly thought of by relatives who said 'As far as we can see they are doing an excellent job'. Staff demonstrated caring and knowledge in the way they interacted with people but had some training needs which had not been met. The provider had appropriate systems in place to monitor the quality of the service and was particularly strong on their approach to health and safety.