This unannounced inspection took place on 3 March 2016. At our last inspection in January 2015 the provider was rated as “good.”

Orchard House Nursing Home provides accommodation, nursing and personal care for up to 72 people who have mental health needs and people who have a diagnosis of dementia. On the day of our inspection 72 people were living at the home.

The home had two registered managers and both were present for 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 who lived at Orchard House told us they felt safe. Staff knew how to keep people safe and how to recognise signs of abuse. Risks to people’s safety were managed by staff. People and staff told us and we saw that there were sufficient staff numbers to meet people’s needs. People were given their medicines on time and when they needed it.

People were supported by staff who had appropriate training to meet their needs. Where people lacked capacity to make decisions for themselves assessments had been completed which ensured they got the right support and decisions made on their behalf were in their best interests. People told us they enjoyed the food at Orchard House and they got a choice. People’s nutritional needs were being met. People had access to outside health professionals when their health needs changed.

People told us staff were kind and considerate. Staff knew the care needs of the people in Orchard House. People and their relatives told us they were involved in their care. People’s privacy and dignity was respected by staff.

Staff understood people’s individual care needs. People’s likes, dislikes and preferences were taken into account by staff when supported them with care. People had access to leisure activities. People and their relatives told us they knew how to make a complaint. Systems were in place to monitor complaints made by people and their relatives.

People, their relatives and staff told us that the home was well-led. Staff were supported by the registered manager’s which resulted in a positive culture in the home. People and staff told us they were involved in the running of the home and that they were listened to. Robust systems were in place to monitor the quality of care across the home.

This inspection took place 28 January 2015 and was unannounced. At our previous inspection no improvements were identified as needed.

Orchard House Nursing Home provides accommodation, nursing and personal care for 72 people who have mental health needs and people who have a diagnosis of dementia. On the day of our inspection 70 people were living at the home.

The home had two registered managers in post. One registered manager was present for 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’s right to make their own decisions was respected and encouraged by staff. Where people could not make their own decisions these decisions were made on their behalf. Staff followed people’s care plans which informed them what support people needed to ensure their rights were protected. Not all staff were clear on how to support people safely without restricting their movements but action was taken at our inspection to address this.

People we spoke with were complimentary about the support they received from staff. They were supported by staff who had the skills to meet their needs. We saw that there was enough staff to meet people’s needs. Staff had access to a variety of training which was relevant to their role. Staff felt supported in their roles by the managers at the home although some felt more one to one time with their manager would benefit them. However, all staff agreed they could request extra support if they needed it.

People enjoyed the food they were given and had choices offered to them. Risks associated with eating and drinking had been assessed and plans were in place to reduce these risks. People did not always receive the support they needed to eat their meal, drinks were not always in reach and napkins were not provided until after their meal.

People felt safe living at Orchard House and said they were able to speak with staff if they had concerns about their own or other’s safety. Staff knew how to protect people against the risk of abuse or harm and how to report concerns they may have. Information was available to staff on the processes they must follow if they had concerns about people’s safety.

People’s medicines were given when they needed them by staff who had been trained to administer it. Where we found that some information provided for staff could be more detailed the registered manager took prompt action and addressed this. Arrangements for meeting people’s health care needs were in place and people saw health care professionals when they needed to.

People were supported to maintain their identities and received care and support that was individual to them. People received care when they needed it and staff knew their preferences in relation to their care. People were treated with dignity and were offered choices in a way they could understand.

People and staff found the management approachable and open. People’s opinions were sought and they were involved in what happened at the home.

Procedures were in place which monitored the quality of the service the home provided. Action was taken promptly when issues were identified or improvements needed. Managers were receptive to feedback from outside organisations in making changes that would improve the quality of care they provided.

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 safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

At the time of our inspection 52 people lived at the home. We spoke with eight people who lived in the home and two relatives. We spoke with four members of staff, two registered managers and the provider.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted inline with the providers policies and procedures. This meant that people would be safeguarded as required.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private. They also told us the staff were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions and acted upon them.

The registered managers told us they regularly provided refresher training for the staff. The registered managers told us that training is specific to the people that they care for. The staff we spoke with confirmed they received specific training that related to peoples individual care needs.

The registered managers had robust audit tools in place. This ensured that people received appropriate care that met their needs.

Is the service caring?

We asked people for their opinions about the staff that supported them. What people told us was positive, one person said, “All the staff are lovely”. A relative told us, “They (staff) are fabulous, my X really loves them”.

People were supported by staff who demonstrated a clear understanding of their needs and preferences. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people’s preferences and interests and found that care and support had been provided in accordance with people’s wishes. We saw that the care people received reflected what we read in their care records.

Is the service responsive?

The registered manager was responsive to people’s needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service. People told us they were supported by staff with activities that they enjoyed.

Is the service well-led?

Staff told us the registered managers listened to them. Staff were clear about their roles and responsibilities. This meant that the registered manager listened to staff views and acted upon them where appropriate.

The registered manager told us that they had sent out questionnaires to the people who lived in the home and their relatives. Where comments had been made these had been acted upon. This meant that the provider had taken appropriate steps to gather people’s views on the running of the home and had acted upon them.

The provider had quality assurance systems in place. This would ensure that people who used the service were not placed at risk of receiving inappropriate care.

We found that where people had raised complaints they had been responded to in line with the providers policies and procedures and ensured that the complainant was happy with the outcome.

On the day of our inspection 51 people were in residence. Due to people’s mental health needs and their lack of capacity, we were unable to talk with them about their experiences of using the service. We observed staff interacting with people, spoke with the provider, registered manager, two nurses and three care staff.

We found that care plans provided staff with relevant information about people's care needs and how to meet them. One care staff said, “We have access to care plans and it tells us how to care for people.”

Appropriate arrangements were in place for the management of people’s prescribed medicines to ensure they received them as directed by the prescriber.

Major building works were in process and we saw relevant measures had been taken to ensure people’s safety and comfort whilst this work was being carried out. We observed that environment provided adequate space and essential furnishings to ensure people’s comfort.

Staff had access to regular training to ensure they had the skills and competence to deliver an effective service.

We carried out an unannounced inspection at Orchard House Nursing Home on 19 and 20 July 2012; this meant the provider did not know we were visiting. During our inspection we used a number of different methods to help us understand the experiences of people living at the home.

We spoke with three people who use the service, the provider, registered manager, a nurse, four care staff, one visiting relative and a staff training consultant. We also looked at care records and other records related to the management of the service.

The people who lived at Orchard House had complex care needs and due to their health condition most people were unable to tell us about their experiences of living there. We observed care practices and staff’s interaction with people.

We found that care plans provided staff with sufficient information to support their understanding of people’s care needs and how to meet them.

Care records contained a risk assessment; this promoted people’s right to independence and ensured their safety whilst doing so.

Where people had capacity they were involved in their care planning and this was confirmed by one visiting relative we spoke with. They also said, “I’m touched with the staff’s kindness.”

The home provided a service for people from various ethnic backgrounds and provided menus to reflect their cultural dietary needs and also for people who required a special diet due to their health condition. One person who used the service said, “The food here is quite alright.”

Discussions with staff confirmed they had a reasonable understanding of safeguarding people from potential abuse and were aware of their responsibility of sharing information of concern with the registered manager and other agencies.

The staff we spoke with confirmed they had access to regular on going training but we found gaps where staff had not received essential training. The absence of staff training could compromise the service provided to people.

The home had robust quality assurance monitoring systems in place to ensure people received a safe effective service.