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Inspection Summary

Overall summary & rating


Updated 9 October 2018

We visited Orchard End on the 28 June 2018, the inspection was announced. We gave the provider 24 hours’ notice of our visit, as the service is small and we wanted to be sure the registered manager, staff and the person who lived at the service were available to talk with us. The service is registered to provide accommodation for a maximum of six people with a learning disability. There was one person living at the home on the day of our inspection.

When we last visited the service we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was, at that inspection rated as inadequate.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well led to at least good. At this inspection we found the provider was no longer in breach of regulations, but still required further improvements and these needed to be sustained over a period of time.

There was a registered manager in post who was available throughout the 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 person living at the service was protected from harm as the provider had robust processes in place to ensure their safety. Staff supporting the person were aware of their responsibilities in relation to protecting them from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

The risks to the person’s safety were clearly identified with measures in place to reduce these risks. The environment and essential equipment were well maintained and met the needs of the person who lived there.

The person was supported by well-trained and competent staff in sufficient numbers to keep them safe. Their medicines were managed safely and the person was protected from the risk of infection through good hygiene practices, and staff knowledge of reducing the risks of cross infection.

The person’s needs were assessed using evidence based tools and their rights were protected under the Equality Act. Staff were supported with appropriate training for their roles. The person was supported to maintain a healthy diet, with staff showing good knowledge of their nutritional needs.

The person received support to manage their health needs through well-developed links with local health professionals.

Staff sought consent from the person before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). The person was 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.

The person was treated with kindness and care by staff who supported them with respect and dignity. Staff developed positive relationships with the person in their care.

The person was able to maintain relationships with people who were important to them and relatives felt their views and opinions about their loved one’s care were listened to.

The care the person received was person centred and met their individual needs. However, when treatments had been changed for one of their health conditions the information had not been up dated in their care plan.

The person was supported to take part in a range of social activities to prevent isolation. There was a

Inspection areas



Updated 9 October 2018

The service was safe.

The person was kept safe and the risk of abuse was minimised because the provider had systems in place to recognise and respond to allegations or incidents.

The risks to the person�s safety were regularly assessed and measures were in place to reduce risks and promote their independence.

The person was supported by adequate numbers of staff and they received their medicines as prescribed. Medicines were managed safely and staff administering medicines were provided with training to ensure they were safe to do so.

People lived in a clean and hygienic service.



Updated 9 October 2018

The service was effective.

The person�s needs were assessed using evidence based assessment tools.

The person was supported by staff who received appropriate training and supervision. They lived in a service that met their needs in relation to the premises and adaptions were made where needed.

The person made decisions in relation to their care and support and where they needed support to make decisions, their rights were protected under the Mental Capacity Act 2005.

The person was supported to maintain their nutrition and their health was monitored and responded to appropriately.



Updated 9 October 2018

The service was caring.

The person was supported by staff who were kind and caring, and showed a good knowledge of their preferences and choices.

The person and their relatives were supported to be involved with the development of their care.

The person had access to advocacy information should they require this.

Staff respected the person�s rights to privacy and treated them with dignity.



Updated 9 October 2018

The service was not always responsive.

An aspect of the person�s health care was not updated in their care plan.

The person received individualised care and had access to a range of social activities.

The person had access to information in a form which met their needs.

The person was supported to raise issues and staff knew what to do if issues arose.


Requires improvement

Updated 9 October 2018

The service was not always well led.

Although care had improved we were unable to see the sustainability required at this time.

There was an open and transparent culture in the service where people were listened to and staff were valued.

There were a number of robust governance systems in place to monitor the quality of the service. However these audits had not highlighted conflicting information in the person�s care plan.

The management team worked to improve and sustain the quality of the service and worked with external health professionals to share knowledge to improve the person�s care.