We visited Orchard End on the 28 June 2018, the inspection was announced. We gave the provider 24 hours’ notice of our visit, as the service is small and we wanted to be sure the registered manager, staff and the person who lived at the service were available to talk with us. The service is registered to provide accommodation for a maximum of six people with a learning disability. There was one person living at the home on the day of our inspection.

When we last visited the service we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was, at that inspection rated as inadequate.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well led to at least good. At this inspection we found the provider was no longer in breach of regulations, but still required further improvements and these needed to be sustained over a period of time.

There was a registered manager in post who was available throughout the inspection. 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 person living at the service was protected from harm as the provider had robust processes in place to ensure their safety. Staff supporting the person were aware of their responsibilities in relation to protecting them from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

The risks to the person’s safety were clearly identified with measures in place to reduce these risks. The environment and essential equipment were well maintained and met the needs of the person who lived there.

The person was supported by well-trained and competent staff in sufficient numbers to keep them safe. Their medicines were managed safely and the person was protected from the risk of infection through good hygiene practices, and staff knowledge of reducing the risks of cross infection.

The person’s needs were assessed using evidence based tools and their rights were protected under the Equality Act. Staff were supported with appropriate training for their roles. The person was supported to maintain a healthy diet, with staff showing good knowledge of their nutritional needs.

The person received support to manage their health needs through well-developed links with local health professionals.

Staff sought consent from the person before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The person was treated with kindness and care by staff who supported them with respect and dignity. Staff developed positive relationships with the person in their care.

The person was able to maintain relationships with people who were important to them and relatives felt their views and opinions about their loved one’s care were listened to.

The care the person received was person centred and met their individual needs. However, when treatments had been changed for one of their health conditions the information had not been up dated in their care plan.

The person was supported to take part in a range of social activities to prevent isolation. There was a

We inspected Orchard End on 26 October and 16 November 2017. The inspection was unannounced. The home is situated in Retford, in North Nottinghamshire and is operated by Creative Care (East Midlands) Limited. The service is registered to provide accommodation for a maximum of six people with a learning disability. There were three people living at the home on the day of our inspection visit. This was the first time we had inspected the service since they registered with us.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in post at the time of our inspection, the previous registered manager had left the service in July 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. There was a service manager in place during our inspection who had taken over responsibility for the day to day running of the service in late August 2017. However they were not registered with the CQC. The provider told us they would ensure a manager was registered with CQC. We will monitor this.

During this inspection we found that the service was not safe. People were not always protected from risks associated with their care and support. Where people needed support with behaviours that may put them or others at risk, there was not sufficiently detailed information for staff about how to support them safely. Systems to review and learn from accidents and incidents were not consistently effective and this meant we could not be assured that action was taken to protect people from harm. Action was not always taken to protect people from improper treatment or abuse. There were a number of safeguarding investigations underway at the time of our inspection visit following concerns being raised about possible abuse.

There were not always enough, adequately trained staff to provide care and support to people when they needed it. Staffing shortages meant people did not consistently receive the support they required. Temporary staff did not always have the necessary training to enable them to provide safe support. Safe recruitment practices were followed.

Medicines were not stored or managed safely. Staff did not always have the necessary training or competency to ensure safe medicines practices were followed and we were not assured that people received medicines when they needed them.

Where people lacked capacity to make choices and decisions, their rights under the Mental Capacity Act (2005) were not always respected. Some people had significant restrictions placed upon them, but a lack of formal capacity assessments meant we could not be assured these were in their best interests. Staff felt supported, but did not receive sufficient training to enable them carry out their duties effectively and meet people’s individual needs.

People were supported to attend health appointments. However, there was a risk that people may not receive appropriate support with specific health conditions as support plans did not contain enough information about people’s health needs and staff did not always have enough training. People were supported to have enough to eat and drink.

Some staff were kind and treated people with respect, however other staff were focused on tasks and had limited interaction with people who used the service. People were not supported to be as independent as possible. Staff did not consistently have an understanding of how people communicated and this had a negative impact on people who used the service. People’s right to privacy was not always respected.

People were at risk