This was an unannounced inspection which we carried out on 15 November 2016. We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

We last inspected Orchard Mews in August 2015. At that inspection we found the service was in breach of its legal requirements.

Orchard Mews is a purpose built care home that provides personal and nursing care to a maximum of 36 older people, including people who live with dementia.

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.

We found improvements had been made to ensure the safe care and treatment of people. People told us they felt safe and there were enough staff on duty. Staff had more time to interact and spend time with people and not just when they carried out tasks. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Regular checks took place to ensure the building was safe and well-maintained. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Most records were in place that reflected the care that staff provided. We have made a recommendation about care plans.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

Staff and people who used the service said the registered manager was supportive and approachable. People told us they felt confident to speak to staff about any concerns if they needed to. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The environment was being refurbished and it was bright and promoted the orientation and independence of people who lived with dementia. The provider undertook a range of audits to check on the quality of care provided.

This was an unannounced inspection carried out on 26 August 2015.

We last inspected Orchard Mews in April 2014. At that inspection we found the service was meeting all legal requirements in force at the time.

Orchard Mews is a 36 bed care home that provides personal and nursing care to older people, including people who live with dementia or a dementia related condition.

A registered manager was not in post but a relief manager had applied to be registered with the Care Quality Commission in July 2015. They were running the service until the new manager started in October. 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 said they were safe and staff were kind and approachable. We had concerns however there were not enough staff on duty to provide safe and individual care to people.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Systems were in place for people to receive their medicines in a safe way.

People had access to health care professionals to make sure they received appropriate care and treatment.

Orchard Mews was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Best interest decisions were made appropriately on behalf of people, when they were unable to give consent to their care and treatment.

People received a varied and balanced diet to meet their nutritional needs. However people who lived with dementia were not all encouraged to make choices with regard to their food.

People who lived with dementia were not encouraged to remain involved with their surroundings due to the design of the service.

Appropriate training was provided and staff were supervised and supported.

Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected.

There were some activities and entertainment available for people.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We considered our inspection findings to answer 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?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to meet the person's support requirements.

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

We saw there were enough staff on duty at the time of inspection and we were told staffing was kept under review as people's needs changed.

Is the service effective?

People we spoke with were positive about the service provided. People commented how helpful and friendly the workers were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One person we spoke with commented how pleased they were with the care provided by staff at the home.

Staff we spoke with were knowledgeable about people's care needs. They had received training to help them understand the different care and support needs of people they worked with.

Staff were observed to be patient and supportive as they worked with people.

Is the service caring?

People and relatives spoken with talked well of the level of care provided by staff. We found people were encouraged to be involved in daily decision making. Staff were helpful and offered people information and support about their care. We saw there was good interaction between staff and people who used the service. We observed the interaction and noted the kind and caring way staff supported people, especially people with dementia. Staff allowed sufficient time for people to respond. It was evident that staff had developed a good understanding of people’s communication needs and how best to communicate with them.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in all decision making with regard to their care. They were kept informed and given information to help them understand the care and choices available to them.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. It helped with the provision of social activities people may wish to be involved with.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

There was a focus from management on the provision of individual care and support to people who use the service. Staff were knowledgeable about the support needs of people.

Staff received regular supervision and commented they felt supported by the manager and advice and support was available from the management team.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues.

The reason for this visit was to check if improvements had been made in areas of care and welfare, the premises and staffing following a previous inspection. We spoke with some people who received care but, due to their needs, some were unable to communicate with us.

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found staffing levels had increased which ensured there were enough qualified, skilled and experienced staff to meet people's needs.

The premises were better maintained so people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We used a number of different methods to help us understand the experiences of people using the service, including observation, because most of the people who used the service had complex needs which meant they were not able to tell us their experiences.

Staff were observed to be polite and respectful to people they worked with and there was a good rapport between them.

We saw the provider had taken action since the last inspection to increase staffing levels. This meant there were sufficient staff to provide care to people living in the home.

We used a number of different methods to help us understand the experiences of people living at the home, because most of the people living there had complex needs which meant they were not able to tell us their experiences.

The six people we spoke with said they were happy staying at the home and that staff were kind.

Comments included:

"I'm happy living here."

"The staff are great."

"It's like a five star hotel."

"I can go out when I want."

"My room is very comfortable."

We spoke with people who use the service and with relatives. They said staff respected their privacy and dignity. They told us staff knocked on their bedroom doors before entering. One relative spoken to said that she had been "very impressed by the care that their relative had been given.”

We decided to visit the home Sunday to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time

We used a number of different methods which included observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

We saw records to show and observed before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We observed staff were very busy as they provided care and support to people who used the service. We spoke to four people who lived at the home who told us staff were kind and helpful.

Due to the low staff numbers on duty at times and the high dependency of some people care and support was not provided in a timely way as people had to wait for staff support. At times they were at risk due to inadequate observation.

We saw the provider had some systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.