Orchard Place is located in Ledbury, Herefordshire. The service provides accommodation and care for up to ten older people. On the day of our inspection, there were ten people living at the home.

The inspection took place on 23 November 2017 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

At our previous inspection on 29 May 2015, we found the service was 'Good' overall, but 'Requires Improvement' in the key question of Effective. At this inspection, we found the service remained 'Good' overall, but 'Requires Improvement' in the key question of Safe.

Medicines had not always been administered in accordance with the prescriber's instructions.

There continued to sufficient staff to meet people's safety needs, as well as their emotional and wellbeing needs. Risk assessments were in place, which set out how to care for each individual safely, and these were adhered to. Measures were in place to reduce the risk of infection.

There was an understanding amongst the staff team of their responsibilities under the Mental Capacity Act. There was an understanding of capacity, and of people's right to make decisions which may appear to be unwise.

People continued to be supported to access a range of different healthcare professionals and services. Changes in people's health and wellbeing were recognised and responded to.

People were encouraged to provide feedback about the service and about any improvements or changes they wanted to see made. This included speaking directly with the provider and arranging to meet with them.

People were able to enjoy their individual hobbies and interests, as well as to try new social and leisure opportunities,

People continued to benefit from respectful and positive relationships with staff, with staff knowing people well and understanding their individual routines and preferences.

There continued to be an inclusive and happy environment within the home. People were involved in the running of the home, as much as possible. Links had been developed with the local community for the benefit of people living in the home.

When we visited Leadon Bank Reablement Service we found that four people used the service and we met and spoke with three of these people. We spoke with two members of staff who delivered care, the registered manager and the deputy manager. We read everyone's care records and four care staff records.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "They are very helpful, it's a good service, I should be able to go home soon."

We found that people's dietary needs were met and that people had a good choice about what they ate. One person told us, "The food is great. There is so much choice."

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service. We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs. One person who used the service told us, "It's so comfortable here. I feel I am improving every day. The staff are marvellous."

We found that the management of medicines by the service had improved and people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

When we last inspected the service on 18 November 2013 we found them to be meeting the requirements of the regulations we assessed them against. This inspection was carried out on 30 June and 1 July 2015 and was unannounced.

Orchard Place provides accommodation and personal care for up to 10 people.

At the time of our inspection there were eight people living at the home and one person was receiving respite care. There was a registered manager in post. 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 and associated regulations about how the service is run.

We saw that people had good positive relationships with the staff. Some people were sharing a joke with staff, while other people were talking about their families. Staff spoke in a way that gave people dignity and respect and the atmosphere of the home was calm and relaxed.

People living at the home were positive about the home, the manager and the staff. People felt that the care was kind that staff knew how to meet their health needs. They told us that they received support when they needed it. People told us that they were supported to take their medicines, and we found that their medicines managed safely and that people received their medicines in line with their prescription.

While people did feel that they were able to make day to day choices about their care and treatment. We found that the provider needed to make improvements to ensure that people were given choice in all of the decisions about their care. DNACPR (Do Not Attempt Cardio Pulmonary Resuscitation) forms were in people’s records and showed that people had not been involved in this process, even though they had the capacity to make this decision.

People said that the food they ate at the home was good and that people were able to make choices about what they wanted to eat. We saw that people had choice of fresh nutritious food, and where recommendations had been made by other professionals regarding their diet or health needs these had been acted upon. For example we saw where additional monitoring of weight had taken place on the recommendation of other professionals.

People told us they found the staff and management approachable, willing to listen to their views and opinions. They said that if they had any concerns they were able to speak with the registered manager. Feedback from the people that lived there and their relatives was gathered on a regular basis and any areas identified for action were acted upon. Also a range of audits and checks were completed regularly to ensure that good standards were maintained.