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

Orchard House Residential Care Home accommodates 35 older people in one adapted building. The home is divided into units, one of which specialises in providing care to people who live with dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

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

Staff knew how to respond to possible abuse and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely and regular cleaning made sure that infection control was maintained.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received a choice of meals, which they liked, and staff supported them to eat and drink. They were referred to health care professionals as needed and staff followed the advice professionals gave them. Adaptations were made to ensure people were safe and able to move around the home independently.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records guided staff in how to do this. There was a variety of activities for people to do and take part in during the day, and people had enough social stimulation. Complaints were investigated and responded to and people knew who to speak with if they had concerns.

Staff worked well together and felt supported by the management team, which promoted a positive culture for staff to provide person centred care. The provider’s monitoring process looked at systems throughout the home, identified issues and staff took the appropriate action to resolve these. People’s views were sought and changes made if this was needed.

Further information is in the detailed findings below

Orchard House is a service providing accommodation and personal care for up to 35 people, some of whom are living with dementia. There are three units called Pippin, Bramley and Russett. There are external and internal communal areas for people and their visitors to use.

The service had a registered manager in place. 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.

Our last inspection took place on 12 August 2014 and as a result of our findings we asked the provider to make improvements to their record keeping. We received an action plan detailing how and when the required improvements would be made by. During this inspection we found that the necessary improvements had been made and that satisfactory records were kept.

There were 32 people living at the service during this unannounced inspection, which took place on 2 November 2015.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well trained, and well supported, by their managers. There were sufficient staff to meet people’s assessed needs. Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines appropriately and medicines were stored in a safe way. People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The CQC monitors the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We found people’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process. DoLS applications were in progress and had been submitted to the authorising body.

People received care and support from staff who were kind, caring, friendly and respectful. Staff supported people to meet their religious and cultural needs and supported people to maintain relationships.

People and their relatives had opportunities to comment on the service provided and people were involved in every day decisions about their care. Care records were detailed and provided staff with sufficient guidance to provide consistent care to each person. Changes to people’s care was kept under review to ensure the change was effective. There were organised activities for people to be involved in. However, there were limited opportunities for people to develop hobbies and interests.

The registered manager was supported by senior staff, care workers and ancillary staff. People, relatives and staff told us the service was well run. People and their relatives said that staff of all levels, including the registered manager, were approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

We used a number of different methods to help us understand the experiences of people using the service. We spoke with five people who lived at the home and the relative of another person. We observed staff interactions and care being provided. We also spoke with eight staff and the manager, reviewed five people’s care records and looked at other documents relating to the management of the home.

Is the service safe?

There were effective systems in place to reduce the risk and spread of infection. We saw the home looked clean and smelled fresh. The people that lived at Orchard House, and a visiting relative, told us this was always the case. One person said, “It is clean here, very clean.”

Is the service effective?

People told us that the felt their care needs were met by the staff at the home. They told us that when the need arose, staff supported them to access appropriate health care. We spoke to two health care professionals who have regular contact with the people who live at the home. Both health care professionals gave us positive feedback in relation to the way the staff at the home supported people to access health care. They told that the staff at the home acted on advice they gave in relation to meeting people’s health care needs.

We found that records relating to the management of the home were accurate and fit for purpose. However, we found that this was not the case for some people’s care records. We looked at the records of people who required their fluid intake to be monitored. Although staff assured us people were receiving sufficient fluids, none of the records we looked at showed this to be the case. In addition we found the record of one person who required their position to be changed at least two hourly to prevent pressure ulcers was incomplete and inaccurate.

Is the service caring?

People told us they were very happy with the care that they, or their family member, received. One person told us the staff “look to make sure I’m comfortable. They’re all nice. They’re all good to me, anything I need doing I don’t really have to ask.” Another person told us, “The staff are good. They’re just wonderful, smashing.” A relative we spoke with told us the staff were “caring and sensitive in their approach.” They told us that staff didn’t rush people and that they had “seen a lot of kindness” at the home.

We found that people’s care and support needs were assessed and care was planned and delivered in line with each person’s individual care plan.

Is the service responsive?

People who used the service and their representatives were asked for their views about the care provided and these were acted on. People told us they felt confident any concerns they raised would be addressed. One person said, “Any of the carers would help you. They’re all very kind here.” A relative told us, “The carers are fantastic. I have my groans but they always respond. When I’ve raised things it’s tended to be because the carer is not very experienced. They always listen and address things quickly. I know they provided one carer with additional training after I mentioned something.”

Is the service well led?

A registered manager was in post at the service and had been so for several years. There was a comprehensive quality assurance system in place to audit and monitor the quality of the service provided. We saw that various checks were carried out regularly and that action plans were put in place and monitored where deficiencies were found. Staff told us that the manager was approachable and addressed any concerns that were raised.

We found that the provider was compliant with the regulations in four of the five areas we assessed. We have asked them to tell us what action they will take about the area where they were not compliant. If you wish to see the evidence supporting our summary please read the full report.

We found that the home provided safe care to people who used the service. The care was delivered in an effective manner that met the needs of those people who required it.

We spoke to eight people who used the service and each person said they felt happy, safe and well cared for. One person told us “All the staff are wonderful and care for me in a kind way.”

All the people we spoke with told us they enjoyed their meals and were always given a choice.

We found that appropriate checks had been carried out prior to staff commencing employment. Staff were suitably trained and supported by an effective style of leadership which was responsive to the needs of the people who used the service.

We also found that there was an appropriate and effective system in place to manage complaints.

During our inspection on 13 September 2012, we spoke with the administrator, area manager, staff and people who use the service. As some people had complex needs and were unable to tell us their experience, we used a number of different methods to help us understand the experiences of people using the service.

We observed and talked with staff who were very knowledgeable about the people who lived at Orchard House and were able to understand their needs. Care records and the training offered by the provider enabled staff to meet people’s health and care needs.

All the people we spoke with told us they felt safe living at the home.