This unannounced inspection took place on 8 March 2017.

Orchard House is registered to provide nursing and personal care for up to 22 people. It provides rehabilitation and care services to people with acquired brain injuries, other neurological conditions and complex physical disabilities. At the time of this inspection there were 17 people living in the home.

There was a registered manager in post at the time of 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.

People were supported to develop and maintain life and social skills and regain as much independence as possible, using individually created rehabilitation programmes. The support for this was provided by a skilled, multi-disciplinary staff group, who shared a strong person centred ethos.

People felt safe in the home and received safe care and support. Relatives said that they had confidence that people living in the home were safe and we observed that people were comfortable in the home. Staff had an in depth understanding of their role in safeguarding people and they knew how to report concerns. Staffing levels ensured that people received the support they required at the times they needed it.

The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service. Staff received the training and support required to enable them to understand and meet the care needs of each person.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed.

People were fully involved in decisions about their care and support needs and this had a positive impact on their ability to be as independent as possible. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information in the most appropriate way to enable them to make informed decisions and encouraged people to make their own choices.

Staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and relatives consistently spoke about the positive impact living in the home had made to people’s lives.

People and their relatives were fully involved in the planning of their care and felt included in discussions, being able to have their say at each step of the way. Staff listened and respected people's views about the way they wanted their care, treatment and rehabilitation to be delivered

People participated in a large and varied range of activities within the service, the local community and further afield. The atmosphere in the home was very positive and people were enthusiastic about past and future activities.

Staff were aware of the importance of managing complaints promptly in line with the provider’s policy. People living in the home, their relatives and staff were confident that any issues would be addressed and that if they had concerns they would be listened to.

The service was well led and people’s relatives and staff had full confidence in the leadership of the registered manager and management team. The provider ensured that the service was well supported and effective systems were in place to assess and monitor the quality of service.