Archived: Orchard House

We spoke with three care workers, the registered manager and an area business manager during our inspection. We were unable to contact relatives of the people who lived at the home to gather their comments.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

We observed care workers were respectful when interacting with people. They took care to ensure people were included in all activities, and proactively encouraged people to make choices and maintain their independence where possible. One care worker told us 'We work as a team and provide them with the best quality of life possible, we keep them happy. They come first in everything'.

Is the service responsive?

Care needs were assessed and reviewed to ensure people were supported as they needed and wished. Support plans reflected people's preferences. Communication passports ensured staff understood effective means of communication with people.

We saw staff liaised with health providers to maintain and promote people's health and wellbeing. Accidents and incidents were reviewed to ensure support plans met people's changing needs.

Is the service safe?

Risks specific to each person were identified and assessed to ensure people were safe. Generic risk assessments ensured people, staff and visitors were not at risk of harm in the home. Risks were reviewed and updated at least annually.

The provider ensured checks and servicing maintained the home in a good state of repair. A maintenance team carried out repairs, and staff told us contractors completed urgent repairs promptly.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. At the time of our inspection no one required Deprivation of Liberty Safeguards. People were supported to leave the home when they wished.

Is the service effective?

We saw there was an assumption that people had mental capacity to make decisions. A decision-making process was followed which considered risks, health promotion and encouraging independence. The views of the individual were paramount. Where it was appropriate, views from relatives and health professionals helped to inform decision-making.

Staff identified activities people may like to participate in. People's responses were recorded to ensure staff were aware of which activities people preferred. When people indicated they did not wish to participate their response was respected.

Support plans reflected the wishes and needs of the individual. We saw people's health and mental wellbeing was monitored through regular reviews. Care and support plans were updated to meet identified changing needs.

Staff received training specific to the needs of the people they supported, as well as completing mandatory topics such as safeguarding and infection control. Some training had been delayed, but the manager showed us a plan to ensure all staff would be brought up to date quickly, prioritising subjects such as health and safety. Staff told us they felt they had all the training they required to support people safely.

Staff were supported through supervisions and appraisals to identify training and developmental needs. One care worker told us 'We get a lot of support, and support each other'. Monthly staff meetings provided a forum to discuss concerns and ideas affecting staff and the people they supported.

Is the service well led?

We saw the provider conducted regular quality assessments to be assured that good practice was maintained. People were involved in decision making, such as choice of menu and activities. Relatives were asked for feedback through informal communication and an annual survey, and comments were acted on.

One care worker told us 'The service has come on a long way. The team has pulled together, it's a good environment to work in'.

Staff had received the training identified in the provider's 'action plan', following the previous inspection. Advice and support had been sought from external healthcare professionals where required.

The range of activities and community access had improved since the last inspection.

People were safe and one concern was reported to the local authority safeguarding team and investigated, although it was not notified to the Care Quality Commission as required.

The recruitment process for new staff was appropriate and records were retained. Management audit and monitoring processes had improved since the last inspection. A cycle of monitoring, review and planned improvement was now in place.

We saw that improvements were about to be made to the care planning system to better reflect the views and wishes of the people supported or their representatives. The existing system was unclear. There was good evidence of increased consultation with people in the home. Support had been sought from external specialists to develop awareness of the most effective ways to communicate with each individual. We saw people being encouraged to make choices in their daily lives.

Improvements were being made to the level and range of activities available and to the risk assessment system. The staff demonstrated awareness of appropriate interventions to support people to manage their behaviour, though some written guidelines were out of date. Training was being provided to all staff on supporting people to manage behaviour.

The service had improved their medication management systems. No errors were noted and improvements had been made to medication recording and procedures.

Staff support through training and supervision had also improved. Staff felt they were supported in their role.

Improvements had been made to management monitoring and review systems and to consultation with people in the service. Some further developments were planned.