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Inspection carried out on 3 January 2019

During a routine inspection

Orchard Lea is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Orchard Lea can accommodate up to six people and at the time of the inspection there were six people living at the home. The accommodation is two-storey, with four bedrooms and a bathroom on the ground floor. Bedrooms were spacious and personalised. The ground floor had a kitchen, dining room, living room and access to a fenced back garden.

The service has been developed and designed within the values of the ‘Registering the Right Support’ principles. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any other citizen.

There was a registered manager in post who was on maternity leave so the registered provider’s nominated individual, who was a company director, was in charge of the service and available throughout 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 home was found to be safe and secure. Visitors had to wait for staff to answer the door, identify themselves and sign in and out.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

The administration of medicines was safe. Staff had been trained in the administration of medicines.

The service was clean, tidy and homely in character. Staff were trained in the prevention and control of infection to help protect the health and welfare of people using the service.

Potential risks to people had been identified in their activities of daily living and action taken to minimise the risk whilst encouraging and maintaining their independence.

There were suitable numbers of trained staff available to support people's needs.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could apply them to the people they supported. People's capacity to consent to specific decisions was assessed when required.

Information was provided to people in accordance with the Accessible Information Standard 2016. People and their relatives knew how to raise concerns.

We observed good interactions between staff and people who used the service. People and their relatives told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to support people using the service. Plans of care were person centred and reviewed regularly to help people meet their health and social care needs.

Relatives told us that when their family member moved in, they settled quickly, said only good things about the service and grew in confident.

Activities at the home and in the community were based on what people wanted do, achieve, and be involved in. The sessions included being part of community groups, shopping and visiting relatives.

Audits were completed, and the nominated individual had a clear overview of what was happening in all areas of the service. Staff were involved in discussions about the quality of people’s support and care and took a team approach to promote improvements to people's lives.

There was an ‘open door’ policy by the managers, which was identified by people, relatives and staff. The management team believ

Inspection carried out on 29 April 2016

During a routine inspection

This inspection took place on 29 April 2016 and was unannounced.

The service is registered to provide accommodation and support for up to six people with a learning disability or autistic spectrum condition. At the time of the inspection there were six people living in the home with a range of moderate learning disabilities and other associated physical or sensory needs. People had a range of verbal communication skills, some were unable to speak due to difficulties associated with their learning disabilities. People were able to carry out most of their own personal care with prompting and occasional support from staff. People generally needed staff support to go out into the community to help keep them safe from avoidable harm or abuse.

The service had a registered manager. 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.

On the day of inspection the registered manager was on leave but the provider’s nominated individual, who was a company director, was present throughout. The nominated individual was passionate about improving people’s life experiences. She said the service philosophy was “To provide a nice family home environment. Staff respect it is the people’s home. We support people to do what they want to do and to lead the kind of life we would want for ourselves. We want to up-skill people if they are able to learn new things and above all for them to be happy”.

There was a very friendly and caring family style environment within the home and everyone got on really well together. All of the interactions we observed between people and staff were caring and supportive. It was clear from our discussions with people, relatives and staff that both the nominated individual and the registered manager were focussed on achieving the very best for people who lived in the home.

People exercised choice and control over their daily routines to the extent they were able to. Staff encouraged people to express their views and respected and acted on the decisions people made. Where people lacked the mental capacity to make certain decisions the service knew how to protect people’s rights. The views of close relatives and professionals involved with people’s care were actively sought and listened to.

People were encouraged and supported to regularly access the community, maintain relationships with their friends and relatives and to participate in a wide range of activities to suit their individual needs and preferences.

People, relatives, staff and outside professionals all said the nominated individual and the registered manager were very open, caring, accessible and supportive. They could speak with either of them whenever they needed help or advice.

Staff were very affectionate toward the people who lived in the home and they spoke in glowing terms about the provider’s management team. The service employed a small close knit team of dedicated staff who were highly motivated and knowledgeable about people’s individual needs and preferences. There were always sufficient numbers of staff to meet people’s needs and to keep them safe. Staff received training and supervision to ensure they had the knowledge and skills to provide the care and support people needed.

The provider had a comprehensive and thorough quality assurance system which ensured the service maintained high standards of care and promoted continuing service improvements.

Inspection carried out on 22 May 2014

During a routine inspection

Our inspection team was made up of an inspector who spent one day at Orchard Lea. We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

This was the first inspection of this service since registering with the Care Quality Commission in August 2013. The summary is based on conversations with the four people currently using the service, and four staff members, including the registered manager and the company�s representative. Following the inspection we contacted health and social care professionals involved in the care and support of people living here. We spoke with a learning disability nurse, a speech and language therapist and care manager. During the inspection we toured the building, reviewed a variety of records and spent time observing the care and support provided to people.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who were able told us they felt safe living at Orchard Lea. One person told us, �I am happy here. I am well looked after�. Health and social care professionals told us they had no concerns about the service. One professional said, �There is a nice ethos there. They are person centred and always very welcoming�.

There were risk assessments in place where required for people using the service in relation to their support and care. People were not put at unnecessary risk, but where possible they had choices and remained in control of their own decisions. This meant that people's independence was promoted and they were not restricted from engaging in and accessing the wider community.

People who used the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements.

We found the provider had effective recruitment and selection processes in place with the appropriate checks being undertaken before staff began work. This ensured people were protected from unsuitable staff.

Systems were in place to make sure that manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service caring?

People who were able told us they were well cared for and that staff were kind and friendly. One person said, �The staff are nice and caring. I couldn�t ask for anything better�.

We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere. We also observed staff responding to people and picking up cues from body language and behaviours when they needed assistance or reassurance. Staff provided support and encouragement in a sensitive way to people as they got ready for the planned activities of the day.

Health and social care professionals told us, �There is a will to ensure best practice within the home�. Another told us, �They are very caring. They seem to love X to bits�.

Staff spoken with had a very �person centred� approach. They knew the people using the service well; they understood their needs and characters and we saw that care was delivered respectfully, promoting and maintaining people�s privacy and dignity.

Is the service effective?

We found that people were supported to lead full and interesting lives of their choosing. People were supported to stay healthy and well and they were supported to access a range of health and social care professionals to meet their needs.

People using the service told us they were happy with the care and support they received. One person told us, �I like it here and I have friends here�. Another person said, �I couldn�t ask for anything better.�

People's health and care needs were assessed with them, and they were involved in compiling their individual support plans where possible. We saw that a range of care needs assessments had been carried out, and appropriate and up to date care plans were in place.

People living at the service had access to advocacy services which meant that when required, people could access additional independent support.

Specialist needs had been identified in care plans where required, for example how to support a person to eat safely. A speech and language therapist told us the service worked well with them; had implemented their recommendations and had accessed recommended training.

Is the service responsive?

People were involved in a range of activities in and outside the service regularly, which met their individuals� needs and interests. People were assisted to access the community and to undertake college courses.

Visiting health and social care professionals told us the service was responsive to people's changing needs. All professionals told us the home communicated well with them and that referrals were appropriate and timely. This meant people had access to a variety of health and social care professionals to meet their needs.

Is the service well led?

The service worked with other agencies and services to make sure people received their care in a joined up way. Health and social care professionals told us the service communicated well with them. They told us the manager and provider were open and transparent in their dealings with them; one professional told us, �They want to make it work and make it a good service�.

The service was led by an experienced manager with several years of experience working with adults with learning disabilities. Staff had a good understanding of the ethos and the quality of care they were expected to provide. They told us they received �excellent� support and training from the provider and manager to enable them to do their job safely and effectively.

The service sought the views of people who used the service in order to improve. Regular �residents� meetings took place and people felt able to contribute. There was a quality assurance system in place which included six monthly satisfaction questionnaire for family members and external professionals. We found that results were positive, with people confirming they would recommend the service to others. Where necessary the service acted on suggestions made.

The service had well established and effective quality assurance audits in place to promote the continual improvement of the service.