We inspected The Orchard on 26 October 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The Orchard - Care Home Physical Disabilities is a purpose built care home for 27 adults. People living at the home have a range of needs including physical or learning disabilities. The home provides a residential service and is located in a quiet area of south Liverpool.

The registered manager had worked at the home for over 18 years and been the registered manager for 12 of those years. 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.

At the time of the inspection 27 people lived at the service and we met nine of the people who used the service. They told us that they were very happy with the service and found it met their needs.

Most of the people we met had lived at the service of a number of years and some had been there for 20 years. We found that the registered provider, registered manager and staff consistently ensured people were supported to lead an independent lifestyle. We found that most of the people did not require support with personal care and led independent lifestyles.

We saw that staff were very skilled at meeting people’s needs. We found that the staff’s extensive knowledge of people had enabled them to readily spot changes in people’s presentation. People spoke highly of the staff and felt they were a good support.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

Care staff cooked meals for people and encouraged them to eat a healthy diet. The kitchen had recently been refurbished and adapted to enable disabled access, which assisted both the people and a chef who used a wheelchair to prepare and cook at ease.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff were aware of how to respect people’s privacy and dignity.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who had various physical health conditions.

Staff had also received training around the application of the Mental Capacity Act 2005. The staff we spoke with understood the requirements of this legislation. When people had capacity staff correctly did not complete capacity assessments or make best interest decisions but for those people who lacked capacity this was in place.

People and the staff we spoke with told us that there were enough staff on duty. We found that on the whole there were sufficient staff on duty to meet people’s needs. The home had a programme in place whereby two placements were offered to oversee volunteers, which were constantly filled. The activity co-ordinator had also established a pool of volunteers who regularly visited to provide befriending services, take people out on trips, provide one-to-one time or be drivers for people.

The activity co-ordinator ran charity challenge programmes whereby local business bid for and then completed specific tasks such as enhancing the garden or decorating parts of the home. The businesses used the activity as team building

We had previously inspected The Orchard in August 2013 and found a number of areas of non-compliance. During this inspection visit we found that there had been improvements at the service since our last inspection.

The Orchard care home provided people who used the service and their families with sufficient and appropriate information about their support and treatment to enable them to make informed decisions about their care. People's needs were assessed and, where appropriate, people were consulted and involved in the planning of their care.

People who used the service, staff and visitors were protected against the risk of unsafe or unsuitable premises. There was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

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 the Registered Manager for this service on our register at the time.

During our visit we spoke with five people who use the service and three members of staff. At the time of our visit we noted that people who use the service have varying needs due to their complex physical condition. During our visit we noted that people who used the service were well presented and we observed staff interacting with people appropriately throughout our visit.

People who use the service gave us positive feedback relating to the staff, one person told us “They [the staff] are good. Very good.”

We found that people’s care and treatment was not planned and delivered in a way that ensured people’s safety and welfare.

People who use the service, staff and visitors were not protected against the risk of unsafe or unsuitable premises. There was no effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We spoke with four people who live at The Orchard, one visitor and five staff during our visit. People who used the service told us that staff were kind and caring and that they supported them to be as independent as possible. People said "My privacy is always respected", "The staff are very good and helpful" and "I am looked after very well."

Staff told us that the training was very good and the support they had from the management team was good. Comments included "I am well supported by the manager", "The staff team work well together" and "The volunteers are amazing." Staff also commented "I get satisfaction enabling people to achieve their goals", "I love my job", "Its a rewarding job" and "Its very rewarding to assist people to achieve what they want to."