We visited The Orchard on 25 May 2017 and this was an unannounced inspection. This meant the provider and staff did not know we were going to visit.

The Orchard provides personal care and accommodation for up to six adults who have a learning disability and associated complex needs. The service is a large modern detached house in the village of Wistow, a few miles from Selby town centre. At the time of the inspection six people used the service.

We last inspected the service in December 2015 and found that we had not been notified of incidents that had occurred in the home, as is required by legislation. Also we found that improvements could be made to the recruitment and auditing systems within the home and made recommendations about these in the report. We rated the service as ‘Requires Improvement’ overall and two domains required improvement.

At this inspection we found that the team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

The registered manager had been in post since 2015. 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 told us they found the staff supported them to lead fulfilling lives. We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle.

People who used the service required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff provided consistent responses and took appropriate action when people’s needs changed, which had ensured staff could continue to meet the individual’s needs. We found that the actions staff had taken led to marked improvements to how people responded to the world and greatly increased their quality of life.

We saw pre-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 the initial support plans but no comprehensive assessment documents were in place and this meant staff could not reflect upon and update the global information about how people had changed since admission. Also we found that support plans were not used to capture what actions staff had found worked well when working with people. The registered manager had captured information about people in various documents but this was disjointed and they outlined how they would ensure a central assessment document would be developed.

People were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

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.

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 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 have learning disabilities and autistic spectrum disorders.

Staff had also received training around safeguarding vulnerable adults and clearly understood how to implement these procedures. We observed that staff consistently maintained peopl

The inspection took place on 12 December 2015 and was unannounced. At the previous inspection of 7 January 2014 the service met all of the assessed standards.

The Orchard was first registered in Spring 2011 and provides personal care and accommodation for up to six adults who have a learning disability and associated complex needs. The service is a large modern detached house in the village of Wistow, a few miles from Selby town centre.

On the day of the inspection 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 2008 and associated Regulations about how the service is run.

We found that we had not been notified of incidents which had occurred in the home, as is required by legislation.

We found that improvements could be made to the recruitment and auditing systems within the home and we have made recommendations about these in the report.

People told us they felt safe and staff were aware of the actions to take should a concern be raised. There were risk assessments in place to help reduce the risk of harm to people. This included assessment and maintenance of the home.

People told us they were supported to receive their medicine and we found records for this were correct.

People told us they were happy with the staffing levels in the home. We observed there were fluctuating staff hours in order to meet the individual needs and preferences of people.

People were supported by caring staff who knew people’s needs well. We observed staff offer choices and respect people’s independence throughout our visit. Staff had been trained to understand people’s rights around decision making and people told us they were supported with this.

People were supported to whenever possible be involved in the planning of their care and had care plans which reflected their individual personalities. These were regularly reviewed with people and kept up to date to help ensure staff were aware of people’s latest need and choices.

People were supported to undertake activities of their choice including accessing to their local community and maintaining important relationships. People told us they liked the food in the home and were able to participate in the preparation of this.

People’s health needs were clearly recorded and people had access to a range of professionals to help ensure these were met.

Staff knew their roles well and felt able to raise any concerns. Staff meetings and meetings for people who lived in the home took place regularly to help with consulting and supporting people about any changes in the home.

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

In this report 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 to help us understand the experiences of people using the service, including talking with staff and people who lived at the service, and by observing the care provided. We spoke with six members of staff and the manager of the home.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. We observed that staff and people who used the service had positive relationships, and staff had the knowledge and experience to meet people's needs. People told us they liked the staff and liked living at the home.

There were systems in place to reduce the risk of people coming to harm. Staff had a good understanding with regard to safeguarding, whistleblowing (telling people), restraint and supporting people to manage their own money

The provider had a robust recruitment process in place which meant that only suitable people who had appropriate checks carried out on them worked for the service.

There were sufficient staff available to meet people's needs; staffing was arranged flexibly in order that people could be supported in activities of their choice.

The provider had systems in place to audit and monitor the quality of service

We were told that people were able to make decisions and choices regarding their care. The home had updated their care documentation to reflect mental capacity issues. This was in the process of being updated onto the new format. We saw that where people were able they were signing their agreement to their care records.

Staff had received training in safeguarding adults and the home had ensured that certificates were in place to evidence this training. Non violent crisis intervention training had also been updated and the home had applied for a Best Interest Meeting for an individual.

We looked at medicines and found that these were administered safely. There were some minor issues with recording which were discussed with the manager during our visit. People told us they received their medicines safely.

Staff training had been provided and staff were now receiving regular supervision. The training matrix would still benefit from some updating but the certificates we saw evidenced that regular updated training was being provided to staff.

People were supported to make decisions and choices in most areas of daily living. People said “Staff knock on the door and I can choose when I get up and go to bed”.

We found that there was insufficient evidence to demonstrate that people were able to consent to their care and treatment. People had not signed their agreement to their care records and Mental Capacity assessments and Best Interest Decisions had not been made. One person said “I have not seen my care records.”

People said they were well cared for although some people expressed concerns about the behaviour of some people and how this impacted on others living at the home. One person said “The staff are kind, it’s other people living here, they shout and I don’t like it.”

Although the home had policies and procedures which helped to protect people we found that they had insufficient systems in place to manage challenging behaviour and there were insufficient records to demonstrate that staff had received proper training in the use of restraint. One person told us “Staff do protect me.”

People received their medicines safely but records in this area need to be improved.

Not all staff had received sufficient training to enable them to meet the needs of people living at The Orchard. One person said “I can’t talk to them (the staff) about things which upset me as they can’t do anything about it.”

We were unable to talk with people living at The Orchard about what it was like to live there. This was either because people were unable to say how they felt, or we were unable to understand what their gestures and hand signals meant.

However we observed how people were responding in the presence of the support workers and how those workers spoke to, and generally interacted with the people living there.

We observed a very friendly and relaxed environment. People were moving around the house as they wanted and support workers were responding positively and knowingly to people’s gestures and behaviours. We observed the support workers using distraction as a way of calming and supporting people, who were becoming upset or frustrated. Our observations helped to show that people trusted the support workers and felt safe and comfortable in their presence.