There were 21 people living at the home on the day of this inspection. We met or saw all of the people living at the home and we spoke with six people in depth to hear their experience of living at Orchard Lea. People told us that in the main they were satisfied with the care and support they received. People told us that routines were flexible enabling them to direct the daily care they received. People spoke highly of the staff telling us that staff were polite, respectful and friendly. On the whole people told us they liked the food and that they were always offered a choice. All of the people spoken with knew how to raise any concerns or complaints and they were confident that they would be listened to. Comments from people living at Orchard Lea included; 'Life here is alright', 'staff understand and know me', 'Staff are always thoughtful', 'I can't fault the staff' and 'Everyone here is very nice'.
An area highlighted for improvement by people we spoke with was activities. There was no activities programme in place. We saw that there was little stimulation or social activity for people to engage with. People told us that staff were 'very busy' and had little time to spend chatting with them. One person told us, 'They are there if I need them. I don't like to bother them'. Another person said, 'They put things on for us now and again but I get bored here'.
We spoke with one relative and three visiting health professionals during this inspection. A relative told us that they were happy with the care provided to their family member, comments included, 'The staff are friendly and they understand X. We have no worries'. Three visiting professionals told us that the service works well with them. Their comments included, 'The staff are courteous and they are always available to assist and provide relevant information', 'Staff follow our instructions and requests' and 'Staff recognise problems and refer to us appropriately'.
As part of the planned review external stakeholders were also contacted prior to our inspection so they could contribute. We contacted a manager at Devon County Council along with requests for information from other interested parties such as the community nursing team. Professionals told us they had no current concerns about the service. The community nursing service told us that the service worked well with them, that they were alerted to people's changing needs and that any recommended interventions were acted upon.
During this inspection we found concerns relating to how the service manages some issues relating to consent to care and treatment. We found that some people's care was not adequately planned and some staff delivering care were unsure of the interventions needed to meet people's needs. Staffing levels were not sufficient to ensure that people were having sufficient social stimulation to ensure their psychological and emotional needs were being met.
We also found that the environment was not fully meeting people's diverse needs and preferences. Although improvements needed relating to the environment had been highlighted by the internal audit, no action had been taken to address the majority of the issues and improve the overall environment for people living at the home.