The Orchard

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID pandemic, including the management of people with a COVID positive diagnosis.

There were sufficient supplies of personal protective equipment (PPE) available for people. Hand sanitiser was readily available throughout the home. Staff had been trained in infection prevention and control (IPC) and the use of PPE.

Daily cleaning schedules were in place. All cleaning was undertaken by the staff, which included touch point cleaning.

A programme of COVID testing for both people living in the home and staff was undertaken in line with current government guidance. Appropriate procedures were in place should anyone display any symptoms or test positive. All visitors, including healthcare professionals, were subject to a range of screening procedures. This included showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

We were informed that residents did not receive many visitors. However, staff supported the social and emotional wellbeing of residents, which included access to a range of activities based on the individual need of each resident.

About the service

The Orchard is a care home providing personal care for up to six people with a learning disability and associated complex needs. The service is a large modern detached house in the village of Wistow, a few miles from Selby town centre. At the time of the inspection six people used the service.

The service has been developed and designed in line with the principles and values that underpin Registering the 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.

People’s experience of using this service and what we found

Everyone we spoke with was positive about The Orchard. We observed people and staff had developed good and caring relationships built on trust and mutual respect.

The provider had systems in place to safeguard people from abuse. Staff understood how to keep people safe. They recognised and reported any safeguarding concerns. Risk assessments were in place and medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.

Staff were recruited safely and had the appropriate skills and knowledge to deliver care and support to people in a person-centred way.

People told us they found the staff supported them to lead fulfilling lives.

Care plans contained relevant information about how to meet people's needs and were regularly reviewed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice.

People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks. People were treated with kindness and supported to express their opinion wherever possible.

People had access to a varied and balanced diet. Where required, staff monitored people's weights and worked with healthcare professionals to make sure people received medical attention when needed.

People and staff spoke positively about the registered manager. They felt able to raise concerns and were confident these would be addressed. Staff told us they were well supported by the registered manager and senior management team.

Checks of safety and quality were carried out to ensure people were protected from harm. Work took place to support the continuous improvement of the service and the registered manager was keen to make changes that would impact positively on people's lives.

No one was in receipt of end of life care. The registered manager told us they were well supported by health professionals and should the need arise, would make the necessary arrangements to enable people to remain at home at this time.

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

Rating at last inspection

The last rating for this service was good (published 30 June 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.

The Orchard provides personal care and accommodation for up to six adults who have a learning disability and associated complex needs. The service is a large modern detached house in the village of Wistow, a few miles from Selby town centre. At the time of the inspection six people used the service.

We last inspected the service in December 2015 and found that we had not been notified of incidents that had occurred in the home, as is required by legislation. Also we found that improvements could be made to the recruitment and auditing systems within the home and made recommendations about these in the report. We rated the service as ‘Requires Improvement’ overall and two domains required improvement.

At this inspection we found that the team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

The registered manager had been in post since 2015. 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 told us they found the staff supported them to lead fulfilling lives. We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle.

People who used the service required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff provided consistent responses and took appropriate action when people’s needs changed, which had ensured staff could continue to meet the individual’s needs. We found that the actions staff had taken led to marked improvements to how people responded to the world and greatly increased their quality of life.

We saw pre-assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create the initial support plans but no comprehensive assessment documents were in place and this meant staff could not reflect upon and update the global information about how people had changed since admission. Also we found that support plans were not used to capture what actions staff had found worked well when working with people. The registered manager had captured information about people in various documents but this was disjointed and they outlined how they would ensure a central assessment document would be developed.

People were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities and autistic spectrum disorders.

Staff had also received training around safeguarding vulnerable adults and clearly understood how to implement these procedures. We observed that staff consistently maintained people’s privacy and dignity. We found that staff treated people with respect and compassion.

Staff had also received training around the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The staff we spoke with understood the requirements of the MCA and were ensuring that where appropriate this legislation was used.

People and the staff we spoke with told us that there were enough staff on duty. We found there were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety and relevant infection control procedures were followed by the staff at the service. We found that action was taken to minimise known risks.

The registered manager had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service.

The Orchard was first registered in Spring 2011 and provides personal care and accommodation for up to six adults who have a learning disability and associated complex needs. The service is a large modern detached house in the village of Wistow, a few miles from Selby town centre.

On the day of the inspection 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.

We found that we had not been notified of incidents which had occurred in the home, as is required by legislation.

We found that improvements could be made to the recruitment and auditing systems within the home and we have made recommendations about these in the report.

People told us they felt safe and staff were aware of the actions to take should a concern be raised. There were risk assessments in place to help reduce the risk of harm to people. This included assessment and maintenance of the home.

People told us they were supported to receive their medicine and we found records for this were correct.

People told us they were happy with the staffing levels in the home. We observed there were fluctuating staff hours in order to meet the individual needs and preferences of people.

People were supported by caring staff who knew people’s needs well. We observed staff offer choices and respect people’s independence throughout our visit. Staff had been trained to understand people’s rights around decision making and people told us they were supported with this.

People were supported to whenever possible be involved in the planning of their care and had care plans which reflected their individual personalities. These were regularly reviewed with people and kept up to date to help ensure staff were aware of people’s latest need and choices.

People were supported to undertake activities of their choice including accessing to their local community and maintaining important relationships. People told us they liked the food in the home and were able to participate in the preparation of this.

People’s health needs were clearly recorded and people had access to a range of professionals to help ensure these were met.

Staff knew their roles well and felt able to raise any concerns. Staff meetings and meetings for people who lived in the home took place regularly to help with consulting and supporting people about any changes in the home.

You can see what actions we told the provider to take at the back of the full version of this report.

We used a number of different methods to help us understand the experiences of people using the service, including talking with staff and people who lived at the service, and by observing the care provided. We spoke with six members of staff and the manager of the home.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. We observed that staff and people who used the service had positive relationships, and staff had the knowledge and experience to meet people's needs. People told us they liked the staff and liked living at the home.

There were systems in place to reduce the risk of people coming to harm. Staff had a good understanding with regard to safeguarding, whistleblowing (telling people), restraint and supporting people to manage their own money

The provider had a robust recruitment process in place which meant that only suitable people who had appropriate checks carried out on them worked for the service.

There were sufficient staff available to meet people's needs; staffing was arranged flexibly in order that people could be supported in activities of their choice.

The provider had systems in place to audit and monitor the quality of service

Staff had received training in safeguarding adults and the home had ensured that certificates were in place to evidence this training. Non violent crisis intervention training had also been updated and the home had applied for a Best Interest Meeting for an individual.

We looked at medicines and found that these were administered safely. There were some minor issues with recording which were discussed with the manager during our visit. People told us they received their medicines safely.

Staff training had been provided and staff were now receiving regular supervision. The training matrix would still benefit from some updating but the certificates we saw evidenced that regular updated training was being provided to staff.

We found that there was insufficient evidence to demonstrate that people were able to consent to their care and treatment. People had not signed their agreement to their care records and Mental Capacity assessments and Best Interest Decisions had not been made. One person said 'I have not seen my care records.'

People said they were well cared for although some people expressed concerns about the behaviour of some people and how this impacted on others living at the home. One person said 'The staff are kind, it's other people living here, they shout and I don't like it.'

Although the home had policies and procedures which helped to protect people we found that they had insufficient systems in place to manage challenging behaviour and there were insufficient records to demonstrate that staff had received proper training in the use of restraint. One person told us 'Staff do protect me.'

People received their medicines safely but records in this area need to be improved.

Not all staff had received sufficient training to enable them to meet the needs of people living at The Orchard. One person said 'I can't talk to them (the staff) about things which upset me as they can't do anything about it.'