This inspection took place on 22 and 29 August 2018. The first date was unannounced and the second date announced to ensure the registered manager was available to speak with us.

Orchard Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is situated in South Cave, a village in the East Riding of Yorkshire. It is purpose built over two floors, with two lounges, a dining area and other small seating areas. The service has a garden and a car park.

At our last inspection we rated the service good. At this inspection we found that improvements were needed in safe, effective, responsive and well-led and have rated the service as requires improvement.

The service had a registered manager who had been in post since January 2018. 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.

Areas of the environment were not regularly maintained and required attention. Possible risks within the environment were not assessed to ensure the safety of people.

Care plans were inconsistent and lacked detail. Risk assessments did not include guidance to enable staff to support people’s needs in line with their preferences.

Staff had received training in dementia care. However, observations showed a lack of positive interactions between staff and people living at the service. Activities were varied and we saw that staff welcomed visitors to the service. People were supported to practice their religious beliefs if they wished.

Complaints were not dealt with in line with company policies and procedures. Actions identified from complaints were not always completed.

Best interest meetings were not recorded or detailed in peoples care plans.

Quality assurance systems had not been effective in ensuring that standards in relation to record keeping had been consistently maintained. Audits had failed to identify some of the issues raised during this inspection.

Systems were in place to ensure people were safeguarded from abuse. Staff showed understanding of how to protect people from avoidable harm or abuse and were confident in raising concerns if they needed to.

We observed staffing levels were sufficient to meet people’s needs.

People who used the service told us that staff were caring. We observed staff supporting people in a way that promoted their dignity and independence.

This inspection was carried out on the 12 and 13 July 2017 and was unannounced.

Orchard Court is a care home which provides accommodation for up to 43 people. The service supports older people, some of whom may be living with dementia.

The service is located in South Cave, a village in the East Riding of Yorkshire. Accommodation is provided across two floors. The service also has two lounges, a dining room and bathrooms on each floor. There is a safe garden and car parking available for visitors. At the time of our inspection there were 43 people living at Orchard Court.

There was a manager in post who had registered with the Care Quality Commission in April 2017. 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. The registered manager will be referred to as 'manager' throughout the report. The manager was on holiday during this inspection. A manager from another of the provider’s services supported us on the first day of this inspection. On the second day we were supported by the deputy manager and a regional manager for the provider.

At the last inspection in November 2016 the provider was rated as required improvement. This was because they were in breach of three Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance. We asked the provider to submit an action plan regarding the breaches identified and during this inspection we saw these actions were met. The service was no longer in breach of these regulations.

Systems and processes were in place that helped keep people safe from harm and abuse. Staff had completed safeguarding training and knew the signs of abuse to look out for and how to raise any concerns.

People told us they felt safe. The provider followed safe recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way. Medicine management practices were managed appropriately to ensure medicines were given safely and as prescribed by people's GPs.

The provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

People and their representatives told us they were involved in their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People's dignity and privacy was protected. Staff understood people's individual needs in relation to their care. Care plans were in the process of being improved and the new plans were centred on the person and reflected individual's preferences.

People who were able told us they were happy with the variety and choice of meals available to them.

People told us they were happy with the activities organised at Orchard Court. Activities were arranged for individuals and for groups.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the manager was approachable.

The provider had implemented a range of audits which were completed regularly to maintain people's safety and welfare.

The inspection of Orchard Court took place on 29, 30 June and 5 July 2016 and was unannounced. At the last inspection on 5 August 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The 2010 regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and it is these regulations that we have used to inspect the service.

Orchard Court is a care home registered to provide accommodation and personal care for up to 42 older people, including those living with dementia. It is situated in South Cave, a village in the East Riding of Yorkshire and is purpose built over two floors, with two lounges, a dining area and other small seating areas. The service does not provide nursing care. All bedrooms are single occupancy and fifteen of them have an en-suite toilet, with six of those also having shower facilities. The service has a garden and car parking for eight cars. At the time of our inspection there were 37 people living there permanently and one person staying there on respite.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last two years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The registered provider had systems in place to identify, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. However, there was a minority of staff whose actions were not always appropriate and which were perceived by people that used the service as 'bullying', which meant not all staff fully understood their responsibilities with regard to their behaviour. Risks were managed and reduced on an individual and group basis so that people avoided injury of harm whenever possible.

There was up-to-date electrical safety certificate and people were at risk of being locked in their bedrooms and unable to exit independently in an emergency. The registered manager arranged for an electrical safety check to be carried out soon after the inspection, but evidence of this was still unavailable three weeks later and was only sent to us when we requested it a second time.

We contacted the registered provider after the inspection, using our formal systems for requesting further information, and on 10 August 2016 we received a copy of an electrical installations inspection that had been carried out on 9 July 2016. We also received information that sneck locks had been removed from all bedroom doors and personal emergency evacuation plans had been produced for those people that required them.

Other utilities and the premises in general were safely maintained and there was evidence of this in the form of maintenance certificates, contracts and records.

Staff understood the principles of the Mental Capacity Act 2005 and the management followed these in relation to making applications for Deprivation of Liberty authorisations. On the day of the site visit we found that people were at risk of having their liberty deprived if their bedroom doors were locked when people were in them; this was rectified following this inspection. People were at risk of financial abuse because of inadequate management of their money held in safe keeping.

We saw that the service was not always well-led. People did not always have the benefit of a positive and empowering culture and although the management style of the service was

Our inspector visited the service and the information they collected helped answer our five questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were quite happy at Orchard Court. The said, "I have been here four years now and I find it very satisfactory," "We are well looked after" and "The manager is excellent and the staff are very helpful." We found that people were safely cared for by staff that were competent or appropriately supervised to do so.

People that used the service were protected from the risks of harm and the service was safe because there were systems in place to prevent abuse happening or to report and deal with it if it happened. The senior staff understood their responsibilities.

We found that the management of medicines was safe, because staff handling them had been trained to do so, safe systems were being properly followed and people received the correct medication at the time they needed it.

What we observed during our visit was a staff group that were efficient, kind, caring and considerate towards people that required their support. We found that peoples' needs were being appropriately met by capable and competent staff and therefore the service was safe.

Is the service effective?

People were effectively cared for because staff followed well developed and reviewed care plans which meant people effectively received the support they required.

Is the service caring?

Staff were caring and understanding and treated people respectfully. People said, "The staff are lovely," "We are well looked after" and "We get on well with the staff." We saw that staff were attentive to people at lunch time and helped them with their comfort.

Is the service responsive?

Staff were responsive to peoples' needs, but encouraged people to maintain their independence. Staff supported people when they required it.

Is the service well led?

The manager had begun to develop new ways of working and had produced new care plans for staff to follow. There was still 'some way to go' in respect of achieving high standards within the service but the manager knew what the shortfalls were and what still needed to be achieved. These were being worked towards.

There was a system of quality monitoring and assuring the care and support people required, which included surveys and audits and which had yet to develop to include other areas of the service so that all aspects were assessed.

In our previous inspection we found the premises were of suitable design but we had concerns regarding the maintenance of the premises that could impact on the health, safety and wellbeing of the people that lived there, the staff and visitors.

In response the provider had sent us an improvement plan telling us how they would ensure the above standard was met. We visited Orchard Court and spoke with three staff and people who used the service about the improvements made. We reviewed their improvement plan and inspected the premises to check the improvements had been made. We also checked the overall safety, suitability and maintenance of the building and looked at other relevant documentation.

At this visit we saw the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

This inspection was over two days; we returned on the second day to gather further evidence about the safety of the premises.

Due to having a variety of needs and communication difficulties, some people who used the service were not able to tell us directly about their care and treatment. We used a number of different methods to help us understand the experiences of people who used the service. During the day we sat with the people who used the service and observed their daily activities including the lunchtime meal. We also observed their interactions with staff. We spoke with some people who used the service, members of staff and a visiting health professional.

We saw care needs were discussed with people and/or their relatives and before people received care their consent was asked for. One person said “We can choose when we get up. The staff know when I like my bath”, and another person told us “They know what I like – they ask me”.

The visiting health professional told us they thought the cleanliness of the home was fine. There were effective recruitment procedures in place which ensured staff were employed with the appropriate qualifications, skills and experience necessary. The provider had systems in place to assess and monitor the quality of service that people received.

During our visit we noted a number of areas of concern regarding the safety and maintenance of the premises that could have caused harmed to staff and people that lived at the home.