About the service: Orchard House is a residential care home providing personal care to a maximum of seven people with mental health needs at the time of the inspection.

People’s experience of using this service:

¿ People’s safety had been promoted and their risks has been recorded.

¿ Staff were safely recruited and received the training and support they needed to undertake their role.

¿ People and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

¿ There was a wide range of opportunities for people to engage in activities and follow hobbies and interests.

¿ People were very positive about the staff and told us that their privacy and dignity was promoted.

¿ The service had good community links such as local churches and schools.

¿ Preferences and choices were considered and reflected within records

¿ The service checks and maintenance had ensured the service and equipment was safe for people living at Orchard House.

¿ Systems of governance and oversight were robust and had identified any issues which required improvement.

We found the service met the characteristics of a “Good” overall rating

More information is available in the full report.

Rating at last inspection:

Requires Improvement (Published March 2016).

Why we inspected:

This was a planned inspection based on previous rating. Since the last inspection the home became dormant and no longer offers the service type of Learning Disabilities.

Follow up:

We will continue to monitor the service closely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Our inspection was unannounced and took place on 25 January 2016.

At our last comprehensive inspection on 26 and 27 August 2015 we found multiple breaches of the regulations. We found that the provider did not have effective arrangements in place to monitor the quality of the service, did not ensure that sufficient numbers of suitably qualified staff were employed at all times, did not ensure that care was provided in a way that ensured people’s privacy and dignity was respected at all times, people had not received person centred care, people were not protected from receiving unsafe care and treatment, people were not protected against the risk of harm, robust recruitment practice were not in place, the provider had not informed us of notifiable occurrences and effective governance systems were not in place. As a result of our inspection we placed the home into special measures and kept the home under review. At this inspection we found that improvements had been made and the regulations were met. However some improvements were needed to ensure robust recruitment procedures were followed through in practice.

The provider is registered to accommodate and deliver personal care to a maximum of six adults who lived with a learning disability. At the time of our inspection two people lived at the home.

The manager completed the registration process with us shortly after this inspection took 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 were safe because the manager and staff understood how to protect people they supported from abuse, and knew what procedures to follow to report any concerns.

Most staff had a good understanding of risks associated with people’s care needs and knew how to support them. There were enough staff to support people safely and provide people with support in the home and whilst outside of the home. Recruitment procedures were in place but had not been robustly followed to ensure people were protected from unsuitable staff being employed.

Medicines were stored and administered safely, and people received their medicines as prescribed. People were supported to attend health care appointments when they needed to and received healthcare that supported them to maintain their wellbeing.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and supported people in line with these principles.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed eating. People were supported to pursue their hobbies and interests both within and outside of the home.

Staff had received adequate training and plans were in place for further training so that staff had the skills and knowledge they needed to provide safe and appropriate support to people.

Complaints systems were available for people to use if needed. The provider had made many improvements to the service and quality monitoring systems were in place. Although some further improvements were needed to ensure these were fully effective.

We carried out this unannounced inspection on 30 September 2015 to look only at the arrangements in place for the proper and safe management of medicines. We found that a new manager had been appointed on 21 September 2015 and arrangements were in place to manage people’s medicines safely.

Orchard House is registered to provide accommodation for six people with Learning Disabilities. There were three people living there when we inspected.

We last inspected this service on 26 and 27 August 2015. We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had not ensured that procedures were in place to protect people from the risk of abuse. This was a breach of Regulation 13. We found that care and treatment was not provided in a safe way. This was a breach of Regulation 12. Robust recruitment arrangements were not provided. This was a breach of Regulation 19. Arrangements in place did not ensure that sufficient numbers of staff were deployed to ensure people’s needs were met. This was a breach of Regulation 18. Arrangements in place did not ensure that people’s dignity was promoted. This was a breach of Regulation 10. The provider had not ensured that people were provided with person-centred care. This was a breach of Regulation 9. The arrangements for complaints did not ensure that the provider acted on complaints. This was a breach of Regulation 16. Arrangements in place did not ensure that the systems were established for good governance. This was a breach of Regulation 17. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Orchard House on our website at www.cqc.org.uk.

The provider sent us an action plan on 09 December 2015 detailing what action they had and will be taking to ensure that they meet the breaches of the regulations and keep people safe.

We did not review the rating of the service at this focused inspection. Services in special measure are kept under review and we will carry out a full inspection of this service within six months of the previous comprehensive inspection. This service will be inspected again before the end of February 2016 and we will review the rating.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

We carried out this inspection because we had concerns shared with us about the provider. The provider has two other locations registered with CQC. They had recently been inspected and a number of concerns were identified. We brought forward our planned inspection of this service.

Orchard House is registered to provide accommodation for six people with Learning Disabilities. There were three people living there when we inspected. The service was registered in June 2013. This is our first Inspection of this service.

A registered manager is required to manage this service. 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. A registered manager was not in post.

People were not protected from the risk of abuse because the provider did not have had systems in place to minimise the risk of abuse. Staff were not trained to identify the possibility of abuse occurring. Risks associated with people’s care was not always identified and planned for and this put people at risk of harm.

Arrangements in place did not ensure that there were sufficient numbers of staff available to meet people’s identified needs. Recruitment procedures had not always been followed to ensure staff were suitably recruited and received the necessary training to meet the care and support needs of people.

People had been supported to attend some health care appointments. However, arrangements in place did not ensure that people’s health care needs were well managed and monitored.

People were comfortable and relaxed around staff. Staff did not always ensure that they protected people’s privacy and dignity. Staff did not always ensure that they sought people's consent before providing care. 

People were supported to access some community based activities which they enjoyed.

There were no systems in place to seek people’s views about their care and to listen to people’s concerns and complaints.

Systems in place to assess and monitor the quality of the service provided were not effective. We found multiple breaches of the regulations. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. You can see what action we told the provider to take at the back of the full version of this report.