We carried out a review of the data available to us about The Orchard 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 Orchard, you can give feedback on this service.
The Orchard is registered to provide accommodation with personal care, to a maximum of six people who have a learning disability, physical disability, sensory impairment or autistic spectrum disorder. Six people lived at The Orchard. Five people were on holiday when we inspected. We met with them at their holiday destination. The Orchard is a large adapted bungalow with single en-suite bedrooms and shared communal areas. There is outdoor space for people to enjoy and car parking available.
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.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the provider and manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
People’s experience of using this service and what we found
People were safe and protected from abuse because staff assessed and managed risk. There were enough staff to meet people’s care and support needs. Staff were recruited safely. People received their medicines as they needed. The home was clean and maintained and staff practised good infection control.
People had complex care needs and limited verbal communication and relied on other ways of communicating their needs and preferences. Staff had assessed people’s specific communication needs and were familiar with the ways people communicated. People were able to get involved in a variety of activities with staff support. Staff observed people’s reactions which indicated whether they enjoyed particular activities. Staff encouraged families to tell them about any concerns or complaints. People could remain at The Orchard when heading towards the end of life, with familiar people to support them.
People were helped 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. Staff assessed people's capacity to make decisions and supported them with decision making. People saw healthcare professionals promptly to assist their health and wellbeing. Staff supported people to receive sufficient nutrition and were familiar with people’s dietary needs. The design of the home met people’s needs. Staff had been appropriately trained and supported and had the skills, knowledge and experience to provide good care.
The service applied the principles and values of Registering the Right Support and other best practice guidance. 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 as many opportunities as possible for them to gain new skills and become more independent.
Staff provided care that met people’s different needs and preferences. People and their relatives were involved in planning their care and encouraged to make decisions. People indicated they were happy with their care. Relatives said their family member was treated with respect and consideration.
People indicated staff involved them in decisions and asked them for their views. Relatives told us staff listened to and acted on these. The registered manager worked in partnership with other services and organisations to make sure they followed good practice and people in their care were safe. The management team monitored and audited the service to check on the quality and make sure staff were providing good care. They understood and acted on legal obligations, including conditions of CQC registration and those of other organisations.
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:
At the last inspection with the previous provider the service was rated good (published 17 March 2017).
Why we inspected
This was a planned inspection based on the rating at the last inspection.
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 is registered to provide accommodation with personal care to a maximum of six people who have a learning disability, physical disability, sensory impairment or autistic spectrum disorder. There were five people living at the home on the days of our inspection and one person was in hospital.
A registered manager was in post and was present during 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 registered manager did not have clear oversight of the management of the home due to moving to another home. Although this had no impact on people or staff we found issues around the completeness and availability of some records. The provider’s quality assurance systems had identified some issues we found but the registered manager was not made aware of these.
People were supported by staff who understood how to recognise and report abuse. The risks connected with people's care and support needs had been assessed and plans introduced to manage these.
The provider assessed and organised their staffing requirements based upon people's care and social needs. Safe recruitment practices were in place which ensured that staff who provided care were suitable to work at the home.
People were supported to take their medicines safely and when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent were able to support people with their medicines.
Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training and staff were also supported in their roles by managers and their colleagues.
People's right to make their own decisions and give their consent to their day to day care and treatment was sought and respected by staff. Staff asked people’s permission before they helped them with any care or support. When people could not make their own decisions regarding their care and treatment the provider made sure decisions were made in their best interests to ensure their rights were upheld lawfully.
People were supported to have enough to eat and drink and risks associated with this were assessed and monitored by staff and other healthcare professionals. Staff followed the guidance of healthcare professionals where appropriate and helped people to access healthcare services. People’s routine health needs were monitored and they had health action plans in place to make sure they received on-going healthcare support.
There was a lively and friendly atmosphere within the home. People were treated with kindness and respect and were involved in making decisions about their day to day care and the support they needed. Staff were attentive to people’s needs and knew them well. Staff supported people in a way that was caring and promoted their right to privacy and dignity.
People received care and support that was tailored to their individual needs and preferences. They were supported to spend their time how they wanted to but within a structured programme of either day opportunities or college. People and their relatives were given opportunities to provide feedback on the care they received including raising concerns or complaints.