This inspection took place on 18 May 2017 and was unannounced.

Orchard Lodge provides long term accommodation to six adults who have a learning disability, autism and/or a physical disability. At the time of our visit there were six people living at Orchard Lodge.

A registered manager was 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. The registered manager was experienced in the care of people with a learning disability.

At our last inspection, carried out on 13 June 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection the service was rated requires improvement.

The concerns were; the lack of personalised risk assessments and care plans meant that people were at risk and not enough action had been taken to mitigate any risks. There was a lack of response in updating people’s individualised needs and risks in their care plans and records that would help staff to monitor people’s health and wellbeing. Whilst there was a monitoring tool and an audit system in place there were concerns about poor record keeping, and the quality assurance system had not identified these concerns, so were not effective. There was a lack of records for person centred care as the lack of good governance meant that the service was not responsive to changes. The provider did not send us an action plan this was because the manager left after the inspection. However at this inspection we found the provider had taken action and was now compliant with the regulations.

Where people had communication needs, staff were aware of how to communicate with people to ensure they could express themselves and make choices. People mainly used body language, gestures or sounds to communicate, some people could use a few key words to communicate their needs.

There were sufficient staff to keep people safe. There were recruitment practices in place to help ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People's medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records.

Care plans were clearly written showing the support people needed. Risk assessments were in place for a variety of tasks such as personal care, use of equipment, health, and the environment and they were updated as needed. The registered manager ensured that actions had been taken after incidents and accidents occurred to prevent a reoccurrence.

People's human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Staff were heard to ask people’s consent before they provided care.

Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink.

People's weights were monitored on a regular basis to ensure they remained healthy. People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was an induction programme in place which included staff undertaking the Care Certificate. Staff were supported in their work and received regular supervision.

Positive relationship

This inspection took place on 13 June 2016 and was unannounced. The home was previously inspected in June 2014, where no breaches or legal requirements were identified.

Orchard Lodge is a care home that does not provide nursing. It provides support for up to six people, with learning and physical disabilities and behaviour which challenges. At the time of our inspection there were five people living at the home. Orchard Road where the home is situated is a quiet residential road near Havant town centre.

A registered manager was 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.

Risk associated with people’s needs had not always been assessed and plans had not always been developed. Some care plans were generic and not personalised.

People told us, and our observations indicated, that they enjoyed living at the home. Staff understood people's needs and preferences well. Whilst staff knew people well, it was not possible to see how staff had involved people and/or their relatives in looking at their support needs and risks associated with those needs. We have made a recommendation about this.

Observations demonstrated people’s consent was sought before staff provided support. Staff and the manager demonstrated a good understanding of the Mental Capacity Act 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made applications for people and there were two authorised DoLS in place.

We found that staff received a good level of training; the provider's own records evidenced this, as did our observations and the staff we spoke with.

Staff demonstrated a good understanding of safeguarding people at risk. They were confident any concerns raised would be acted upon by management and knew what action to take if they were not.

Medicines were mostly managed safely, with some record keeping issues around creams and lotions. We have made a recommendation about this.

Recruitment checks had been carried out and staff received an induction when they first started work which helped them to understand their roles and responsibilities. It was not clear whether the provider ensured there were enough staff to meet people’s needs as staffing was variable.

People and their relatives knew how to make a complaint and these were managed in line with the provider’s policy. Meetings were held weekly to gather people’s views and surveys were sent out yearly to assess and monitor the quality of the service.

There were systems in place to ensure people's safety by monitoring the service provided however they were not fully effective and had not recognised all the issues we found.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we spoke with two of the six people living at the home, the registered manager, a senior member of the staff team and two members of staff.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service told us.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw systems were in place to help ensure the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.

The registered manager was responsible for arranging staff rotas and took people's care needs into account when making decisions about numbers, qualifications, skills and experience of staff required. This helped ensure that people's needs were met.

Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it. This meant people could access additional support when they required it.

People's health and care needs were assessed with them as much as possible and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that care plans reflected people's current needs and wishes.

People's needs were taken into account with appropriate signage. The layout of the service enabled people to move freely and safely around the home. The premises had been sensitively adapted to meet the needs of people who lived there.

Is the service caring?

People were supported by kind and attentive staff. One person was able to tell us the staff were "Kind" to them. We saw staff were patient and gave encouragement when they supported people. Staff engaged and involved people in decision making processes and went about their duties in a relaxed and unhurried and manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had a wide range of daily activities available to them both inside and outside of the home.

Details of the complaints procedure was clearly displayed in written and pictorial format and easily accessible to everyone. We saw there was a complaints log and entries had been recorded in detail and actioned appropriately. We saw there was a comments and suggestions log freely available for people to use. We saw positive comments about the service had been made. This showed us people were happy with the service they received.

Is the service well led?

People who used the service, their relatives, friends and other professionals involved with the service completed a service satisfaction survey twice a year. Comments and ideas were listened to and acted upon in a timely manner.

The service worked well with other agencies and services to help ensure people received their care in a cohesive manner.

The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.

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 which were in place. This helped to ensure people received a good quality service.

We spoke with three of the six people who lived at Orchard Lodge. Due to the nature of people’s learning disability we were not always able to ask direct questions to people. We did however chat with them and were able to obtain their views as much as possible. We also used a range of methods to help us understand people’s experiences. These included; observing how staff supported people, talking to staff, talking to people who used the service and looking at records.

We observed staff supporting people and their privacy and dignity was respected. We saw that staff knocked on people’s doors before entering and took time to explain to people what they were doing. We saw that people and staff got on well together and there was a friendly atmosphere in the home throughout our visit.

We spoke with the registered manager, the deputy manager, a senior support worker and two members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.

We found that appropriate checks were carried out before staff began work at Orchard Lodge. The provider, Dolphin Homes Limited operated a robust recruitment process.

We saw that Orchard Lodge had an effective system to regularly assess and monitor the quality of service that people receive.

On the day of our visit it was not possible to speak with people who used the service. Five of the six people were out at a local day service. The other person had a day off and decided that they would like to stay in bed rather than speak with us.

We did however speak with two relatives of people and they told us that they were very happy with the care and support their relatives received.

Relatives said that they were involved in their relatives care and were kept informed of relevant changes to their care needs.

Relatives told us that they were aware of how to make a complaint and told us that they were confident that any concerns would be quickly resolved.

We also spoke with two members of staff. They said that they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were very supportive and approachable.

Due to the nature of people’s learning disability we were not always able to ask direct questions to all of the people. We did however chat with them and were able to obtain their views as much as possible. We also spoke to family members and they told us that their relatives have been well supported by the staff to receive the care they need.

Relatives said that the home supported people to make choices and supported them to be involved as much as possible in their day to day lives.

We spoke with the families of people who use the service and they told us that they knew what action they should take if they had any cause for concern and they said that they felt that the home would respond appropriately to any concerns that may be raised.

Staff said that they respected people’s wishes and when asked what they would do if they felt there may be a conflict between a person’s wishes and their care needs they told us that they would speak with the manager.