This inspection took place on 14 September 2016 and was unannounced. Orchard House provides accommodation and personal care for up to 28 older people who may have dementia related illness. Of the 28 places, 10 rooms where people stayed for shorter stay accommodation and care. There were 23 people who were living at the home on the day of our visit.

There was a registered manager in place 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 lived in a safe environment and staff knew how to protect people from risk of harm. We found staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

There were sufficient staff on duty to meet people’s needs. People told us staff helped them when they needed assistance. Regular reviews of people’s care and deployment of staff meant staffing levels reflected the needs of people who lived there. People’s medicines were administered and managed in a safe way.

The registered manager supported staff by arranging training so staff developed the skills needed in order to provide care and support to people that was in-line with best practice. People and their relatives told us of the positive benefits this had on the care and support received.

People received care and support that took into account their needs and preferences. Staff provided people’s care with their consent and agreement. Staff understood and recognised the importance of this. People were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals, such as their doctor when they required them.

We saw people were involved in planning their care. People’s views and decisions about their care were listened and acted upon. People told us staff treated them kindly, with dignity and that their privacy was respected.

People received individual care and support that was in line with their preferences. The provider promoted and encouraged people to carry out their hobbies and interests.

We found people knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last 12 months and found no complaints had been received.

The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant people received care and support which matched their needs and wishes.

We found the checks the provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practice.

On the day of the inspection 26 people were receiving care and support at the home. During the inspection we read three people’s care records and spoke to several people who used the service. We spoke with a visiting relative and staff. We observed people’s care throughout the day.

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were be safeguarded as required.

There were enough qualified, skilled and experienced staff to meet people’s needs. Four weekly staff rota’s were in place. Shortages in staffing were covered through staff working additional shifts, bank staff and occasionally agency staff. This ensured that people were kept safe and their needs met.

One person said, “If I want help they will help me”. Another person said “I feel safe here and I’m happy with how clean it is”.

Safeguarding procedures were in place and staff had received safeguarding training. Procedures were in place for the recording of finances and third parties who had the legal authority to manage people’s finances. This meant that people would be safeguarded.

Is the service effective?

People’s health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Some people did not always understand what a care plan was but expressed that staff helped them in the way they wanted.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The building and gardens were secure. A call system was available throughout the home to enable people to request help.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “Staff are good mannered, helpful and polite”, “Staff are alright” and “It’s alright here, I am quite happy”.

People using the service, their relatives and friends completed an annual satisfaction survey. This information had been analysed to identify areas for improvement. The feedback we saw was positive.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw staff that responded quickly to meet people’s needs and ensured people’s safety was maintained. This was also confirmed by people we spoke with. People were able to express their views and these were acted on. People had the opportunity to engage in activities both in the home and within the community.

Most people we spoke with knew how to raise a concern or make a complaint if they were unhappy. Staff told us that they would support people to make a complaint if the person was not able to do this for themselves. The service planned to remind people of the complaints system through residents and relatives meetings. People told us that they had no complaints and were happy with the care they received.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff felt supported in their roles and felt their views were listened too.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We spent time at the home watching to see how staff supported people who were living with dementia. We spoke with several people living at the home. They told us that staff were caring, listened to them and treated them with dignity and respect. One visiting relative described the service as “Brilliant”.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. A good variety of activities were provided to help people engage and maintain their self-esteem. Care plans were detailed and described how people should be supported to remain independent were possible. Guidance was clear where people were at high risk in areas such as falls. There were not always clear records of how decisions had been made when people lacked mental capacity to decide for themselves.

People had received their daily medicines as prescribed by the doctor. Safe systems were in place to manage medicines. There was scope to increase the monitoring of these systems to ensure any problems would be identified more quickly.

We found that the service was being effectively run and was responsive to people’s changing needs. Systems were in place to manage health and safety hazards. The staff team were well led and the staff felt suitably trained and well supported.

We used a number of ways to help us understand the experiences of people who used the service. We spoke with four people who lived at the home and spoke to two people’s relatives on the telephone. We spent time observing daily life in the lounge of both units where people lived permanently. We also visited the area where the respite care service was provided. We looked at three people’s care records and spoke to three care staff, the registered manager and the area manager.

We observed staff supporting people, and saw that people were given choices which enabled them to make their own decisions. We also saw that care staff spent meaningful time with people and that staff were aware of people’s individual needs.

Many people were sitting in the lounges during the day. The activities coordinator who works three days a week held skittles sessions and a quiz which led to some impromptu singing. The majority of people took an active part and people were laughing and engaged with care staff and each other.

The people living at the home that we spoke to said they felt safe in the home and would be able to tell the staff or the manager if they were unhappy. Relatives of two people who were living in the home told us they would feel able to raise any concerns they had but had never felt the need to make a formal complaint

The relatives we spoke to both told us they felt fully involved with decisions about the care and health treatment of their family member. One told us, “we were involved in the assessment and they respect my relative’s right to be independent with his personal care.”