Orchid House is a residential home that is registered to provide accommodation and personal care for up to six adults. The home specialises in meeting the needs of people with an autistic spectrum disorder. The home has five large bedrooms all with en-suite bathrooms and a separate self-contained flat where one person lives. The home is situated close to local amenities which people are supported to access as part of their daily activities.

The inspection took place on 25 October 2017 and was announced. 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.

Because of people’s complex needs they were unable to tell us verbally about their experiences of living at Orchid House. We therefore contacted relatives who were keen to be involved in the inspection to tell us how wonderful the service was at providing support to their family members. They were fully confident that their family members were safe, well cared for and treated extremely well by the staff team. We heard from a healthcare professional that they felt the service was ‘one of the best’ and offered ‘outstanding care’.

The registered manager (who is also the provider) provided strong leadership and led by example leading to an outstandingly caring and responsive service for people. Relatives spoke in highly positive terms about the way the service was managed and how this had ensured that their family members received high quality care. The registered manager and staff spoke with passion and a real drive to constantly improve the quality of the service in order to meet people’s needs. This was reflected in the staff team who felt inspired by the manager to constantly achieve the best outcome for the people in the service.

When staff assessed people to see if the service could meet their needs, an in-depth and thorough transition process took place to ensure that as much information as possible was captured to enable the person to be supported with individual and personalised care. We received feedback that this process had been highly effective and had resulted in people receiving high quality and person-centred care.

We observed that the young people were extremely well supported on the day of the inspection. We also had feedback from family members and a professional about how people were supporting by staff that knew them very well. The atmosphere in the service was calm and relaxed and staff clearly understood the needs of the individuals they were supporting. We saw choices were offered and that communication was calm and respectful. Relatives spoke of how caring the staff were and staff felt they were given the time and support to offer people care and kindness on a daily basis. Relatives consistently told us staff treated their family members with respect and supported them in a way that completely preserved their privacy and dignity.

Relatives had confidence in the ability of staff to keep people safe. Staff had received training on safeguarding adults and understood their responsibilities. Risks had been appropriately assessed and control measures in place to minimise the risks. People received their medicines as prescribed. Staff had training and were checked to ensure they continued to be competent when administering medicines.

An effective system was in place to monitor and audit the quality of the service being provided. We saw that records were analysed in detail in order to identify any changes needed for a person’s support. Accidents and incidents were investigated thoroughly and 'lessons learnt' were shared with the staff to promote improvement.

Recruitment processes were designed to ensure only suitable staff

The inspection took place on the 24 March 2015. This inspection was unannounced. During our last inspection in April 2013 we found the provider was meeting all the essential standards and satisfied the legal requirements in the areas that we assessed.

The home had 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 2008 and associated Regulations about how the service is run.

Orchid House is a specialist provider of residential care for adults who are 18 and over and who have autism, learning disabilities and other associated health needs. They provide accommodation and personal care for up to six people. At the time of our inspection there were six people living in the home. The home has five large bedrooms all with ensuite and a separate self-contained flat where one person lives. The home is situated close to local amenities which people are supported to access as part of their daily activities.

Autism affects people in different ways. The aim of the service is to accept each person for who they are and put together a bespoke package of care to ensure that each person has their individual needs met. This includes learning about the way each person communicates, what routines they have and looking at creative ways to support people to live their lives safely, protecting them from harm. Where required they involved other health and social care professionals to provide additional guidance and advice to the staff team. This included psychologists, occupational therapists and specialist nurses.

Because of people’s complex needs they were unable to tell us verbally about their experiences of living at Orchid House. From our observations staff members’ approach to people who use the service was kind and compassionate. We saw choices were offered and that communication was calm and respectful. People were encouraged to make their rooms at the home their own personal space where they could choose to spend time should they not want to be in the communal areas.

Relatives we spoke with confirmed they were involved in planning and reviewing their family members care and support. They told us whilst they had not had any reason to complain they felt they could raise any worries or concerns they had and that they would be listened to by the registered manager and staff and appropriate actions taken.

We were told by the registered manager the home focused on the different sensory processing difficulties people with autism may experience. Many people with autism have difficulty processing everyday sensory information such as sounds, sights and smells. We found the care therefore focused on the needs of the individual and that the home had looked for creative ways to support people to manage these difficulties.

Staff we spoke with were passionate about the job they did and told us how they looked to find ways that improved the service and the lives of people living there. The registered manager and staff had exceptional understanding of people’s needs and how to deliver care respectfully.

People were supported to stay well. Staff monitored their health and well-being daily. Medicines were administered safely and at times when people required or wished to have them. Nutritional needs were considered and people were supported to make healthy food choices whilst still enjoying their favourite foods.

Staff had access to a robust training programme to ensure they had the correct skills and knowledge to support people. Individual meetings with the manager or senior support workers gave staff the opportunity to reflect on their performance and identify any future training needs. Staff had a good understanding of how to keep people safe and felt confident to act on any concerns they should have.

There was a management structure in the home that provided staff with clear lines of responsibility and accountability. The provider had an effective system to regularly assess and monitor the quality of service that people received and an effective complaints system. Staff and family members spoke positively about the support they received from the registered manager and felt that there was a real culture of openness whereby they discuss any suggestions or concerns they may have.

The complex needs of the people living in the home made it difficult for them to comment directly about the care and support they received. We found that staff received training in developing appropriate communication skills and techniques to involve people in making choices about their daily lives and activities.

We saw that people were supported to undertake a range of activities in the community and had varied and individual routines.

The home had an appropriate and safe system in place for the recruitment of staff. All staff were receiving training and supervision. Staff were completing training on safeguarding and information about how to report concerns was displayed in the home.

The provider had systems and checks in place to audit and monitor the quality of care and support that was provided.