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Disabilities Trust - 4 Pages Orchard Outstanding

Reports


Inspection carried out on 30 January 2019

During a routine inspection

About the service:

Disabilities Trust - 4 Pages Orchard is a ‘care home’. This service supported people living with learning disabilities and/or autism and was registered to support up to three people. Three people were being supported at the time of the inspection.

People’s experience of using this service:

The provider has demonstrated they successfully focused on continuous improvement since our last inspection. We found the service met the characteristics of a Good service in safe and effective and improved to an Outstanding service in caring, responsive and well-led domains. We received exceptional feedback on how staff supported people and went the extra mile to get care just right for people.

People were valued and respected as individuals with staff continuously evaluating ways to improve people’s lives. People were at the centre of the service delivery and the provider and staff were passionate and committed providing a high-quality service. Feedback from all relatives reflected staff were very kind, caring and committed. Staff exceeded in recognising what was important to people and ensured individually tailored approach that met people's personal needs, wishes and preferences was delivered.

People received an outstanding service that was tailored to meet their individual needs and delivered to ensure flexibility, choice and continuity of care. The outcomes for people using the service reflected the principles and values of national registration guidance, Registering the Right Support, and were evident in people’s promotion of choice and control, independence and community inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills.

The service ensured that people accessed many interests and activities important to them and staff supported people to attend these which helped reduce social isolation. People were an integral part of the local community

Staff were motivated by and proud of the service. One staff member said, "This place is so friendly and supportive. We support each other in every way". There were high levels of satisfaction and a sense of belonging demonstrated by the team at the service. The emphasis on continuous improvement and ongoing reflective practices meant the provider effectively implemented new ways of care delivery that were based on best practice and innovation.

The service continued to provide safe care to people. Staff had received training in safeguarding adults and understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place, these included completing checks to make sure new staff were safe to work with vulnerable adults. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely and people received their medicines as prescribed.

Rating at last inspection: Good (report published 4 August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service met the characteristics of Good in safe, effective and well led and Outstanding in caring and responsive providing an overall rating of Outstanding.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

More information is in Detailed Findings below.

Inspection carried out on 14 June 2016

During a routine inspection

The inspection took place on 14 June 2016 and was announced.

Disabilities Trust - 4 Pages Orchard provides accommodation with personal care for up to three people with learning disabilities or autistic spectrum disorder.

There was no registered manager in post at the time of our inspection. 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. The provider had appointed a manager who was due to start at the service in July 2016. The new manager would be applying to register with CQC.

Relatives were extremely complimentary about the support provided by staff and the management team. There was a person-centred culture that ensured people were treated as individuals. Support was provided in a caring, compassionate way.

People were safe and staff knew how to raise concerns relating to abuse of vulnerable people. There were safe recruitment practices to ensure suitable people were employed. Where risks assessments identified risks to people, there were plans in place to manage the risks. People's medicines were managed safely.

People were supported by a consistent staff team who had the skills and knowledge to meet their needs. Staff were well supported through supervisions and had access to training and development opportunities. Staff received training relating to specific conditions to ensure they had the necessary skills to support people.

Staff had a clear understanding of their responsibilities to support people in line with the principles of the Mental Capacity Act 2005 (MCA) and ensured that support was always in people's best interests and was the least restrictive option.

The service promoted people's independence and ensured people had access to activities that interested them. People were supported to maintain and develop relationships that were important to them.

There were systems in place to obtain feedback about the service from people, their relatives and staff. Relatives knew how to complain and complaints were managed in line with the provider's complaints policy.

There were effective systems in place to monitor and improve the quality of the service.

Inspection carried out on 17 July 2014

During a routine inspection

4 Pages Orchard is a care home registered for up to three adults with learning disabilities, and is situated in a residential area of Sonning Common, South Oxfordshire. On the day of our inspection three people were living at the home. During the inspection we were unable to communicate directly with people that used the service but we observed the care people received and interactions with care staff. We also conducted a SOFI (Short observational framework for inspection). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also spoke with 2 people�s relatives and looked at three peoples care files. We spoke with four staff including two care workers the registered manager and a visiting senior staff member. We reviewed documents made available by the provider. One inspector carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and/or what we observed as well as records we looked at.

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

Is the service safe?

We found this service was safe. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in safeguarding. Some staff had been on SOVA (Safeguarding of Vulnerable Adults) training the day before our visit.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that one person�s behaviour would on occasion �present behaviours of concern�. We saw a detailed care plan which identified this behaviour and provided staff with strategies to support this person

Is the service effective?

We found the service was effective. People who used the service were given appropriate information and support regarding their care. We saw that care guidelines were clearly explained in people�s files and families were actively encouraged to participate in maintaining this information. The service had regular �interaction meetings� throughout the week. These meetings were held for the people that used the service in order to support them in making key decisions about their immediate environment and the running of the home.

People�s independence and community involvement were promoted. One person�s relative told us, �it�s a great relief to me that they are so accepted by the community, they are very involved it�s a great relief as we get older to see that level of support, we have seen more achieved than we ever thought possible�.

Some people didn�t have the mental capacity to give informed consent. The provider had ensured that arrangements were in place to ensure that decisions made in relation to consent were lawful. Every person using the service lacked capacity to make decisions in relation to some aspect of their daily living for example, making important decisions about their care and welfare, along with managing their own finances. We saw that capacity assessments had been completed on admission and were reviewed annually. Capacity assessments were conducted by the organisations psychologist. All decisions were made as a result of best interest meetings which involved family members and other professionals.

People�s files contained goals to ensure they had continued access to the community and maintained their independence. These goals were created with the person and their relatives and were reviewed monthly. One person�s care file identified that they wanted to keep fit and remain active. We saw this person went for regular walks and was a member of the community walking club. People that used the service were encouraged to help with daily tasks such as cooking, cleaning and gardening. We saw people being encouraged to make their own drinks and prepare meals.

Staff we spoke with felt supported and that they received regular training. Staff received appropriate professional development. One care worker we spoke with had just completed their Level 3 Care qualification and felt, �if I said I wanted to keep going to the Level 4 I could�.

Is the service caring?

We found the service was caring. We observed a number of warm and caring interactions during our SOFI. We observed that people were happy and comfortable. Some people were a little anxious because the inspector was unfamiliar to them. Staff provided support and reassurance to these people, reassured and given options to distract them. Which means that people�s needs were put above the inspection. People�s relatives felt people were well cared for. One person�s relative told us, �they have never been happier, they are the happiest I have ever seen them, on visits home, they ask to go back�. Another relative told us, �staff are very caring, it took time to settle but there is such a caring culture�.

We looked at the care file of one person who had �limited speech� and �repetitive behaviour�. We saw that a speech and language therapist had been involved with creating their communication support plan. This included guidance on how to communicate to ensure this person could understand and be understood. We observed care staff adhering to this throughout the day.

People were supported in promoting their independence and community involvement. One person�s relative told us, �it�s a great relief to me that they are so accepted by the community, they are very involved it�s a great relief as we get older to see that level of support, we have seen more achieved than we ever thought possible�.

Is the service responsive?

We found the service was responsive. People expressed their views and were involved in making decisions about their care and treatment. People and their relatives were involved in developing support plans and attending regular reviews along with a multi-disciplinary team that included key care staff and a psychologist. One person�s relative told us, �we enjoy attending the meetings, we get to see progress and just how much they are thought about, the service puts so much effort into people�. We saw that one person�s relatives wanted to encourage this person to continue practising their religion. We saw that this person was supported to say their prayers before going to bed.

We saw that when this person�s care needs changed the service responded. For example, we saw that it had been reported that one person had been having difficulties swallowing some foods. Records showed that a speech and language therapist had been involved and recommendation put in place based on risk assessment. Care staff spoke with us about these recommendations and support plans had been updated.

Is the service well led?

We found the service was well led. People�s relatives told us the service was well led, one person�s relative told us, �the manager has created an atmosphere of complete acceptance and involvement that is a very rare thing�.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The home had a series of audits carried out by a number of different staff within the organisation. Monthly Provider audits were conducted by other service managers within the organisation. These audits audited care files, people finances, medication and staff training. Where issues were identified the manager took appropriate action.

Inspection carried out on 7 February 2014

During a routine inspection

At the time of our inspection the provider did not have a registered manager in post.

We used a number of different methods to help us understand the experiences of people who use the service. This was because the people who use the service had complex needs which meant they were not able to tell us about their experiences. We spent time observing what people did during the day. We also used observations of the interactions between people who use the service and the care workers to inform the judgements reached within this report.

We found people were actively involved in the local community and their independence was encouraged. On the day of the inspection, people went out as we arrived to one of their planned activities. We saw people had a large range of community involvement that was specific to their preferences.

The provider ensured the safety of people, workers and others related to the premises. The provider ensured maintenance was undertaken regularly and that risks from the premises were identified, assessed and managed promptly.

We saw there were suitable recruitment and selection methods used in the employment of new care workers. The provider ensured that the necessary checks were conducted prior to new staff employment. The provider must ensure that available agency worker information is also in line with the regulatory requirement.

People did not have any complaints about Disabilities Trust - 4 Pages Orchard. Relatives gave us complimentary feedback about the location and told us they would feel comfortable raising any concerns. There was a suitable complaints management system in place.

Inspection carried out on 15 November 2012

During a routine inspection

We were told three people had lived there for twelve years. Peoples needs had changed over the years and care plans and risk assessments reflected this. The three people living in the service had limited verbal communication skills, but responded positively by facial expressions and body language.

Staff had a good understanding of safeguarding adults from abuse and how to report them appropriately. There had been no safeguarding referrals made since the service was registered.

Medication was seen to be stored securely and medication administration records had been seen to be well maintained and up to date.

There was always at least one member of staff on day duty and one on sleeping night duty. We saw evidence of staff flexibility when evening or week- end activities took place.

Written comments made during reviews, demonstrated that family members were confident about the management of the service, the experienced staff, and care provided.

Reports under our old system of regulation (including those from before CQC was created)