This unannounced inspection took place on 12 September 2017. 50 Cherry Orchard provides accommodation and personal care for up to five people who have learning disabilities. At the time of our inspection there were four people living in the home.

At the last inspection on 17 February 2015, the service had been rated ‘good’. At this inspection we found the service remained ‘good’.

The service ensured people living in the home were safe. Risks to people had been identified, assessed and were managed safely. Staff were aware of their responsibilities and knew how to identify and report abuse. Medicines were administered safely. The registered provider followed safe and robust recruitment procedures. There were sufficient numbers of staff to support people safely.

People received effective care. Staff were supported to undertake training needed for their professional development, including nationally recognised qualifications. Staff received regular supervisions and appraisals which enabled them to develop their understanding of good practice and to fulfil their roles effectively. Where some people were unable to make certain decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. People were supported to have their health needs met by health and social care professionals including their GP and dietitian. People were offered a healthy balanced diet and when people required support to eat and drink, this was provided in line with relevant professionals’ guidance.

The service continued to provide support in a caring way. Staff protected people's privacy and dignity and treated them with respect. People's requests for support or assistance were responded to promptly and kindly. People had developed positive relationships with staff and were treated in a caring and respectful manner. People were supported to be as independent as they possibly could be.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. Any changes in people's needs were addressed immediately. People had access to a variety of activities that met their individual needs. People’s relatives were aware of how to make a complaint. When concerns had been raised, they had been dealt with effectively to the complainants’ satisfaction.

The service was led by the registered manager who promoted a service that put people at the forefront of all the service did. Staff were valued and supported by the registered manager and provider. They were given appropriate responsibility which was continuously monitored and checked by the registered manager. A system to monitor, maintain and improve the quality of the service was in place.

Further information is in the detailed findings below:

The inspection took place on the 17 February 2015. This inspection was unannounced. During our last inspection we found the provider satisfied the legal requirements in the areas that we looked at.

The home had two managers who job shared the position, one of whom was the registered manager. 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.

50 Cherry Orchard provides accommodation and personal care for up to five people who have learning disabilities. At the time of our inspection there were four people living in the home. The main aims of the service are to treat everyone as individuals and involve them in choices about their daily living which promote their independence. Relatives we spoke with were positive about the care and support their family member received.

CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require providers to submit applications to a ‘Supervisory Body’, the appropriate local authority, for authority to do so. Whilst all necessary DoLS applications had been, or were in the process of being submitted by the provider the requirements of the Mental Capacity Act were not always followed by the provider when reaching a best interest decision on behalf a person who lacked capacity.

This is a breach of Regulation 18 of the Health and Social care act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the end of this report.

Because of people’s complex needs they were unable to tell us verbally about their experiences of living at 50 Cherry Orchard. From our observations staff members’ approach to people who use the service was warm and caring. We saw that positive praise and choices were offered and that communication was calm and respectful. People were encouraged to make their rooms at the home their own personal space.

People were involved in deciding what food and drink they would like. Staff showed us a folder of pictures of food they used to support people with choosing and planning the weekly menu. If they wanted to people could be involved in the preparation of food at mealtimes.

Each person had a care plan that outlined their needs and the support required to meet those needs. People were supported in a range of interests, both as activities together or on an individual basis, which suited their needs. They were encouraged to take part in activities outside of the home to enable them to access their local community.

There were enough qualified, skilled and experienced staff to meet people’s needs. All necessary checks had been completed before new staff members had started work at the home and they had completed an induction programme when they started work. Staff members received training in areas that improved their capability in providing care and support to people who lived at the home and had regular supervision and appraisal meetings with the manager at which their performance and development were discussed

The provider had systems in place to ensure that medicines were administered and disposed of safely. All medicines were stored securely.

There was a management structure in the home that provided people 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.

People who lived in the home were receiving appropriate care and support to meet their needs. Due to their complex needs people were unable to comment directly on the service but we observed that they appeared relaxed and well cared for.

Staff we spoke with were well informed about the communication needs of people and we observed staff interacting in a positive and professional manner.

The home provided a nutritious and varied menu and supported people to make choices over their food.

We found that the home provided the appropriate staffing levels to meet people needs. Staff were well supported and received regular supervision from the manager.

The home had systems in place to audit and monitor the quality of service and to manage potential risks.

We found that people who lived in the home were receiving care and support that met their identified and assessed needs. There were detailed person centred care and support plans in place which were being reviewed and updated when required.

We found that the home was well maintained and a clean and hygienic environment was promoted and maintained.

The home had safe and effective recruitment procedures in place that ensured all staff were subject to the correct checks before they were allowed to commence their employment.

The service had effective systems in place to monitor and manage the quality of service and potential risks to people using the service.

The people living at 50 Cherry Orchard were not able to tell us what they thought about the care they received. However we observed that they were clean and appropriately dressed, and they appeared to be content and very comfortable in the company of staff that they knew. We spoke on the telephone to relatives of people living at the home. Feedback was entirely positive. One relative told us, “I couldn’t be happier with the care X receives. All the staff are well suited and capable”.