Archived: Orchid House

Orchid House is a residential care home for up to three adults with learning disabilities. At the time of our inspection two people were living in the home. The care service 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 any citizen.

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.

At the last inspection in July 2015 we asked the provider to take action to make improvements to staff appraisal arrangements. This action had been completed.

People told us they felt safe living in the home. There were robust systems in place to safeguard people from abuse and risks to people had been appropriately identified and mitigated against. People were supported to take their medicines as prescribed. The home was clean and effective measures were in place to prevent and control infection. There were effective systems in place to ensure lessons were learnt if incidents occurred.

There were sufficient staff deployed to meet people’s needs. Staff received the training and support they needed to perform their roles. The service worked with other organisations and healthcare services to ensure people’s needs were met and they received effective care. People told us they chose their meals and there was clear information for staff to follow about people’s dietary needs and preferences. The service worked within the principles of the Mental Capacity Act 2005 and there was clear guidance about how to support people to make meaningful choices.

People told us they liked the staff and we saw compassionate and caring interactions between staff and people who lived in the home. The home ensured people’s religious beliefs, cultural background and sexuality were explored and supported in a sensitive way. People’s independence was promoted by the service.

People’s needs were assessed and care planned in a person-centred way which ensured people received the support they required to meet their needs. Care plans were reviewed regularly and were up to date. The provider had a robust complaints process and sought feedback from people about their experience of the service. People had been supported to plan the care they wanted at the end of their lives. The service had recently supported people through a bereavement in a compassionate and sensitive way.

The provider had quality assurance systems in place that ensured the safety and quality of the service. People and staff were involved with the plans for the future of the home. The provider was linked to local networks to ensure they stayed up to date with best practice and local developments.

We also gathered evidence against the additional outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

People experienced positive interactions with staff as we saw them spend time talking with people in the lounge area and asking them what they wanted to do during the day. We observed staff speak to people in a kind and caring way and people were relaxed in the home. People who used the service told us they liked the staff and they said "staff help me".

Staff said they were comfortable approaching the manager with any concerns and said they would tell them if they were worried about someone in the service.

Is the service responsive?

The service responded to people by having appropriate care plans that met their needs. People were supported with their individual needs for example if they needed prompting with personal care staff were aware to provide this so that people were able to maintain independence. People regularly went out for the day at the service and did activities that they wanted which meant they were protected from social isolation as they were able to meet with friends from other services or people they knew from the community.

Is the service safe?

The service had reintroduced cleaning rotas for the toilets and a cleaning checklist to ensure the home was a lot cleaner. However we did note that some window sills still had dust on them. Staff observed infection control procedures by wearing appropriate protective equipment which included gloves. Where people had been unwell staff were required to carry a change of clothes so that they reduced the risk of cross contamination.

Is the service effective?

People's needs were assessed with staff at the service and reviewed on a yearly basis unless any changes were identified. The service worked with other professionals well to ensure that people received the right care. For example where people needed support with their diet the service contacted nutritionists and dieticians.

Is the service well led?

The service had a registered manager who was available for support to staff and people. The service sought the views of people at the home through house meetings to find out for example what they wanted to do for activities, holidays and what they wanted to eat at the house. Staff also attended team meetings to ensure they were given an opportunity to discuss any issues at the house and how they could improve the care for people living there.

Staff at the service also carried out weekly quality checks which helped them monitor that the home was running well and that people were safe, these included fire safety checks and temperature checks for the fridge, freezer and water.

We found that people's backgrounds, likes and dislikes had been taken into consideration when planning care and people were involved in choosing activities. People were supported to access the community. We found evidence that care was provided in accordance with care plans and risks to people using the service were assessed and managed appropriately. There were arrangements in place to deal with foreseeable emergencies.

We found that appropriate standards of cleanliness were not maintained, particularly in kitchen and bathroom areas. There were food stains in kitchen cupboards and dried urine on the toilet seat. The manager said they had cleaning task lists but did not check these.

The home is in need of refurbishment. At our last visit, we noted the provider had said this would be complete by January 2013. We found that some carpeting had been replaced but there was a strong urine smell throughout the premises and paintwork on walls was faded and dirty. People said "I'd like it painted" and "I'd like new furniture."

We found evidence that staff were appropriately supervised and supported to access training and qualifications.

There was a system for monitoring the quality of the service and learning from incidents.

Care plans were detailed and person centred. Staff showed a good understanding of people's characters and needs, and people make decisions on their daily activities.

The home is in need of redecoration and some refurbishment. The registered manager said these works are scheduled for completion by January 2013. The home had an unpleasant urine smell indicating a need for carpet deep cleaning.

There was a pest control problem with pharaohs ants and a pest control company had been engaged to deal with this issue.

Records were accurate and fit for purpose.