The inspection took place on 16 and 17 May 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The service was last inspected by CQC in August 2014, at which time it was compliant with the regulations and rated Good. At this inspection the service remained Good.

Orchard Home Care Services provides personal care to people who live in their own homes in Chester-le-Street and surrounding areas, including Consett and Durham. There were 250 people using the service at the time of our inspection.

The service had a registered manager in place. 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 using the service felt safe. The provider operated an out-of-hours phone line in case of unforeseen circumstances. Staff had received training in safeguarding and displayed a good understanding of what signs could indicate someone who used the service was at risk of harm.

Risks were assessed and managed through pre-assessment and ongoing review, with the involvement of people and their relatives.

We saw there were sufficient numbers of staff on duty to meet the needs of people who used the service. Pre-employment checks, including Disclosure and Barring Service checks, were in place.

We observed no errors in the documentation pertaining to medicines administration. Staff displayed a good knowledge in this regard and regular auditing was in place.

Training was a blend of face-to-face and distance learning, and included safeguarding awareness, moving and handling, infection control, health and safety, first aid and dementia awareness. The registered manager kept a record of when staff were due to refresh training courses.

Staff at all levels liaised well with external healthcare professionals, from who we received positive feedback about the service.

Staff were supported through regular supervision and appraisal, as well as ad hoc support from care co-ordinators regarding whom we received consistently positive feedback.

People who used the service, relatives and healthcare professionals told us staff were compassionate, caring, and treated people with dignity and respect. People confirmed staff were encouraging in helping them retain their independence.

People who used the service and staff confirmed they generally received good levels of continuity of carers. They confirmed they were introduced to staff.

We saw people were encouraged and supported to contribute to their own care planning and review, with family members also involved. People were 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.

We saw that personal sensitive information was stored securely.

People who used the service and healthcare professionals told us staff were accommodating to people’s changing needs and preferences.

People who used the service knew how to complain should the need arise and we saw this information was provided to all people who began using the service.

The registered manager and care co-ordinators were described in positive terms by people who used the service and other staff. We found the leadership of the service was strong.

We found auditing and quality assurance systems were in place.

The culture of the service was in line with the goals of the statement of purpose and the customer service guide, focussed on ensuring people could maintain their independence whilst receiving dignified support from staff.

The inspection was carried out by a pharmacist inspector. We set out to answer four key questions; Is the service safe? Is the service effective? Is the service caring? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and people who use the service, looking at supplies of medicines and looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with use and management of medicines. People who used the service received appropriate assistance with their medicines to enable them to receive their treatment safely in accordance with their plans of care.

Is the service effective?

We found that care plans for managing medicines were much improved and reflected the current needs of people so that they received appropriate care.

Is the service caring?

We saw that people were treated in a caring way and with respect.

Is the service well led?

We saw that audits, or checks of medicines records, were done regularly to assess the way medicines were managed. Care workers were also assessed regularly to make sure they followed safe procedures.

We spoke with two people who use the service and one relative about the way that medicines were managed. People were complimentary about the care workers and said:

“The girls are really good, cannot complain, they are nice and jolly”.

“I take my own tablets and the girls make certain I have my Careline with me”.

“Fine, visits regularly. They prepare the medicines for me”.

However, there were concerns raised about the time of some visits. One person said “sometimes they are a bit early or a bit late and that can affect my medicines. I have to have food within a certain time and sometimes I have to wait’. Another person also commented that recently the teatime visit to prepare tea and assist with medicines was too early and the care worker had to be told to return later.

Overall, we found that medicines were not managed in a safe way because records did not clearly indicate the medication that care workers assisted people with, or the support that people needed.

We spoke with five people as part of our inspection. Everyone without exception told us staff treated them with respect. One person said “I couldn’t fault her (the carer)," another said “she does a lot for me, I’ve got no complaints.”

People told us they generally had the same staff coming to their home. One person said “I get on very well with her, she supports me well.” We also saw some completed client surveys, of the 20 we looked at, 14 people said they usually had the same team of staff. However, one relative we spoke with said “(relative) knows when someone is coming, but not who it is."

People told us they felt able to say if they were unhappy. One person said "I would ring the office if I had a problem." Other comments included "I have their contact details" and "if I have any problems I would speak to (staff member)."

Staff were knowledgeable about people and were able to explain, with examples, about how they would promote people’s independence and choice. We spoke with five members of staff and asked them how they made sure people they supported were treated with dignity and respect. One member said “I always make sure people are covered and ask how they want things done,” another said “if a person has visitors I always ask if they want me to leave the room so they can have privacy.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

We undertook an announced inspection to Orchard Homecare Services on 12 and 18 August 2014 We told the provider two days before our visit that we would be coming. Orchard Home Care Services Limited provides personal care services to people in their own homes. At the time of our inspection 260 people were receiving a personal care service. Some people were funding their own care through direct payments. Other people had their care purchased by Durham County Council.

At our last inspection in 5 June 2013 the service was meeting the regulations inspected.

The service had a Registered manager at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People using were safe because there were appropriate numbers of staff with suitable skills and experience to ensure the risk of harm to people was minimised. We saw that where last minute changes to care were required the service had a system in place that allowed them to be flexible to ensure people’s needs were met.

Staff received training relevant to their job role and where additional specialist training was required the service sought the support from relevant health professionals such as district nurses. Staff had the skills, knowledge and experience required to support people with their care and support needs.

Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Care plans were kept in people’s own homes so staff always had access to the correct and up to date information. People using the service spoke positively about the people who cared for them although we did receive some comments that we brought to the attention of the provider to address.

Staff supported people to make healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The registered manager was professional and had a good detailed understanding of the service and the people who used it. Staff, people who used the service and relatives told us they felt able to speak with the registered manager when they were concerned and shared examples of when things had gone wrong which needed to be put right. People took part in annual surveys which meant they were able to express their opinion on the quality of care provided. To ensure people received good care the registered manager and senior care staff undertook spot checks to review the quality of the service provided.