The inspection took place on 22 February 2017 and was unannounced.

Orchard House provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington’s disease. There were 12 people living at the service at the time of inspection. They had complex communication and mobility needs.

The service is a large detached house and a bungalow in a residential area of Herne Bay. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased. Other people were more independent, able to make decisions for themselves and go out independently.

There was a registered manager working at the service and they were supported by an assistant manager. They were also the registered manager of another service close by. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service was last inspected in January 2016 when it was rated requires improvement overall with five breaches of regulation identified. The breaches of regulations related to staff training, recruitment and supervision, staff not having the guidance they needed to keep people safe, care plans not being updated and audits at the service not identifying the issues found at the inspection. There were improvements found at this inspection. The registered manager had made changes based on the last inspection report and a recent inspection at another nearby service that they managed.

On the day of the visit the registered manager supported us throughout the inspection. The registered manager had been in charge at the service for a long time. They knew people and staff well. People’s care plans had been updated with them or their loved ones, they showed the support people needed, what was important to them and how they preferred to be supported. Staff were now continuing to review and update the plans on a regular basis.

Risks to people had been assessed and staff now had detailed guidance relating to minimising risks and keeping people safe. The safety of the premises was maintained by regular and routine checks of the environment and equipment.

Staff were now recruited safely using all the checks required and had access to training which enabled them to support people confidently. Staff had more regular one to one meetings with their line manager. There were enough staff to meet people’s needs.

The registered manager and provider had improved the auditing systems they used. Audits were completed regularly and action was taken to address any shortfalls. Opinions and feedback about the standard of care were sought from people, loved ones and visitors, any issues were addressed and the results of the feedback were shared.

Staff knew people and their families well; they had developed positive and caring relationships. Staff changed the way they interacted for each person but all interactions were empathetic and caring. People’s family and friends could visit whenever they wanted and told us they felt like they were all part of one big extended family.

Staff supported people in a way which respected their dignity and privacy such as knocking on people’s doors and giving them private time with their families. Staff talked to people about what was happening and what they were doing at all times. People were supported to retain their independence for as long as possible.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

People were offered a selection

This inspection took place on15 January 2016, was unannounced and was carried out by two inspectors.

Orchard House is situated in a residential area of Herne Bay. It provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. The service comprises of a large detached house where 10 people can live and a separate three bedded bungalow. At the time of the inspection there were nine people living in the main house and the extra room was used for people who needed respite care. There were two people living in the bungalow and the third room was used for respite care. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. Some people had complex communication and mobility needs. Some people were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own.

The main house was set out over two floors. The first floor could be accessed by stairs or a passenger lift. On the ground floor were communal areas and bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them.

There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of another service close by. 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 the visit the registered manager, staff and the provider supported us throughout the inspection.

The registered manager had been in charge at the service for a long time. They knew people and staff well. The deputy manager spent more time at the providers other service, managing it on a day to day basis.

The registered manager and some staff knew how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. They considered people’s abilities to give consent to complex decisions and held best interest meetings when people were unable to give consent. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

The care and support needs of each person were different and each person’s care plan was personal to them. Parts of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. People indicated they were satisfied with the care and support they received. However, some parts of the care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible.

Staff were caring and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people

Most people who used the service were unable to tell us their views on the quality of care due to communication difficulties. Two people who used the service were able to tell us about their care and treatment, both people told us they were satisfied with the service they received. However, through observations during the visit we were able to observe staff supporting people who used the service in a respectful way. We found that staff took time to explain where possible the options available and supported people to make choices.

People told us that they were asked for consent before any care or treatment took place and their wishes respected.

We found the home to be clean and tidy and free from unpleasant odours. There was a system in place for infection control to protect people from the risk of infection.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people. Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

We made an unannounced visit to the service and spoke to people who use the service, some visitors, the manager and to staff members. We brought the date of the scheduled inspection forward as some concerns had been raised to us by a relative. There were eleven people using the service. We met and spoke to most of them and everyone we spoke to said or expressed that they were very happy living at Orchard House.

People told us or expressed that they felt safe and well looked after.

People said they could talk about any problems to the manager and to the other staff. People said that they would be listened to and any problem would be sorted out.

People who use the service told us or expressed that that they were happy living at Orchard House. People looked happy and relaxed in the company of each other and staff.

People said that the home was clean and that their bedrooms were kept clean.

One person said that the food was good and the staff “were alright”. We asked if the staff were kind and respectful and the person said “Yes”.

A visitor told us that they were made welcome when they visited and that they felt their relative had the care and supported they needed.

Most of the people who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. However we did speak to two people who use the service and they expressed satisfaction of the care received and stated “I love it here” and “the staff are good to me” another person said when asked if she new how to complain “I would talk to staff and the manager if I was unhappy”.