Orchard House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Orchard House is registered to provide accommodation and personal care for up to 33 people. At the time of our inspection there were 24 people living in the home.

When we inspected on 28 September 2017 the service was rated as ‘Requires Improvement’. We found that some improvements were required under the headings of safety, effectiveness, caring, and well-led.

This inspection was unannounced on the 15 October 2018 with a second announced visit on 17 October to conclude the inspection. We found the service to be ‘Good’ The provider had taken timely and appropriate action to put things right and all the required improvements had been made and were sustained.

There was a registered manager but they had applied to voluntarily cancel their registration and were no longer working at the home. A new manager had been appointed and was in post. They were applying to register with the Care Quality Commission (CQC) when we inspected. A registered manager is a person who has registered with the 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 met all relevant fundamental standards related to staff recruitment, training and the care people received. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation and adhered to good practice.

People’s care was regularly reviewed with them and staff were appropriately deployed throughout the home so that people received the timely support they needed. They were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. Staff were friendly, kind and compassionate. They had insight into people’s capabilities and aspirations as well as their dependencies and need for support. They respected people's diverse individual preferences for the way they liked to receive their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People that needed support to manage their medicines received this. People were supported to eat and drink whenever this was part of their agreed plan of care. They were provided with a nutritious diet that took into account their tastes and preferences. Their dietary needs were assessed and monitored and appropriate external healthcare professionals, such as the dietician, were consulted when needed. Where people needed physical assistance to eat and drink this was provided.

Whenever people reached the end of their life and could remain in the home with the support of healthcare professionals they received the care they needed to be kept comfortable and free from pain.

The provider and new manager led staff by example and enabled the staff team to deliver individualised care that achieved good outcomes for all people using the service.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and any improvements that were needed were acted upon.

There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong so that the quality of care across the service was improved.

People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assuranc

This inspection took place on 28 September 2017 and was unannounced. Orchard House Residential Care Home provides accommodation and personal care for up to 33 people. At the time of our inspection there were 24 people living in the home.

There was a registered manager in post who was also the provider of the service. 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.

We inspected Orchard House in June 2015 and rated the service as ‘Good’, during this inspection we found that the service was rated as ‘Requires Improvement’.

Risks to people were not always managed appropriately by staff. People had plans of care outlining their known risks however; staff did not always take appropriate action in order to reduce the known risks to people.

Staff did not always apply the learning from their training effectively when providing people’s care. We observed that not all staff were confident or competent when supporting people with moving and handling.

People’s dignity and privacy was not always maintained by staff. We observed staff entering people’s bedrooms without knocking.

The provider needed to review people’s mealtime experience. We observed that people’s meal time experience was chaotic and took too long resulting in people becoming bored and not eating their main meal.

Staff did not receive supervision and appraisal to assess their competency in carrying out their duties.

The provider had not implemented or utilised a systematic approach to quality assurance. This had resulted in ongoing shortfalls in people’s care and support and a risk that further shortfalls would not be identified or acted upon.

People were supported by sufficient numbers of staff to provide their care and support. People could be assured that they would be supported to receive their prescribed medicines safely.

People were supported by a staff team that knew them well.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately. Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs.

People had detailed plans of care in place to guide staff in providing consistently personalised care and support according to people’s preferences. People’s feedback about the care they received was actively sought and acted upon.

The provider was visible throughout the home and was committed to improving the quality of care and support that people received.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

This unannounced inspection took place on the 11 June 2015.

Orchard House Residential Care Home accommodates and provides care for up to 33 older people, most of whom have dementia care needs. There were 27 people in residence during this inspection.

A registered manager was in post. 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.

People’s needs had been assessed prior to admission to the home. There were appropriate care plans in place for each person that were regularly reviewed and updated. People benefited from receiving care from staff that listened to and acted upon what they said, including the views of their relatives, friends, or significant others.

People were cared for by sufficient numbers of staff were experienced and trained to meet their needs. Recruitment procedures were robust and protected people from receiving care from staff unsuited to the job.

People received care from competent staff that understood their role and knew what was expected of them when caring for older people. Staff were attentive, friendly and enabled people to do things for themselves by providing people with the individualised care that suited their needs.

People’s health and wellbeing needs were met by staff that were supported by community based healthcare professionals as and when required. The advice of healthcare professionals was acted upon by staff and people’s prescribed treatments were provided in a timely way.

People’s individual nutritional needs were assessed, monitored and met. People who needed support with eating and drinking received the help they required. People enjoyed their food, had enough to eat and drink, and the choice of foods available took into account people’s tastes, preferences and cultural backgrounds. They enjoyed a varied and balanced diet to meet their nutritional needs.

People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction. People knew how and who to complain to.

People received care from staff that were supported and encouraged by the provider and the registered manager to do a good job caring for older people. The service provided was effectively quality assured by the audits regularly conducted by the registered manager and the provider.

We looked care records for three people and found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We saw that there was a policy for safeguarding adults. We looked at training records which showed that staff received safeguarding training as part of a planned training programme. We spoke with three members of staff about safeguarding. They were able to tell us about the safeguarding policy and explain how to protect people from the risk of abuse.

We saw that there were systems in place to monitor care records; medication; risk assessments and accidents and incidents. We saw that the manager had a programme of audits that she completed and that where issues were identified actions were taken to address these.

When we visited in August 2012 we found that people's needs were not always appropriately assessed and that care plans did not always contain the relevant information needed by staff to support people appropriately and safely. When we visited 04 February 2013 we found that care plans were being reviewed every month to ensure the information was up to date and accurate.

Although care plans contained most of the information that staff needed to provide appropriate care for people we found that some information was not included. We looked at assessments for seven people including nutrition assessments, pressure care assessments, mental health assessments and falls assessment. We saw that they were not being reviewed regularly.

We spoke with three staff. All had a good knowledge of people’s care needs. We saw that staff treated people with respect and kindness. We spoke with three people who told us they were happy living at Orchard House.

Orchard House was registered for treatment of disease, disorder or injury as well as accommodation for persons who require personal care. As Orchard House is a care home without nursing this regulated activity was not being provided. We notified the nominated individual of this and asked that they review their registration to reflect the regulated activities being provided. This inspection did not include treatment of disease, disorder or injury.

As part of this inspection we checked whether improvements had been made since our last inspection visit 31 January 2012. We spoke with two people about the service they received. They were happy with their support. One person told us they were “treated kindly” and described Orchard House as “home from home”. We saw that staff talked with people in a caring and sensitive manner and gave explanations when assisting people. Although people told us they were happy with their care we found that people’s needs were not always appropriately assessed and that care plans did not always contain the relevant information needed by staff to support people appropriately and safely.

There were 28 people living at Orchard House when we visited on 31 January 2012. We spoke with three people living at Orchard House, two relatives and two staff to ask for their comments. We spent an hour in a communal area of the home, observing and assessing the quality of support people received.