We inspected the service on 30 June 2017 and the inspection was unannounced. Orchard House is a care home providing accommodation for up to 30 older people who require assistance due to their age or people living with dementia or physical disabilities. There were 22 people using the service at the time of our inspection

There was a registered manager in post. It is a requirement that the service has a registered manager. 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.

At our previous inspection on 8 & 9 February 2016 we found that the service was not meeting three of our regulations and improvements were required. The provider sent us an action plan and at this inspection we found that the actions had been implemented and improvements had been made.

People told us they felt safe. Staff understood their responsibilities to keep people safe from abuse and from avoidable harm. Risk was assessed and management plans were put in place and followed to that risk could be reduced.

Arrangements for managing people's medicines were safe and in line with current guidance. One person had not received their medicines because there was no stock available. The registered manager took action to address this during our inspection. Medicine administration was accurately recorded and medicines were stored in the correct way.

People received care and support from staff that had the knowledge and skills they required to meet people's needs and were supported to do so. Staff were able to communicate with people effectively and they knew about people's individual needs.

Staff sought people's consent before carrying out care and support. Capacity to make decisions was assessed and staff followed the principles of the Mental Capacity Act and only deprived people of their liberty if this was in their best interests and was lawful.

People were supported to have enough to eat and drink and enjoyed the meals provided. Staff knew people's eating and drinking needs and recognised risk and took action where this was required. People had access to the healthcare they required and staff were able to recognise deteriorating health and knew what action to take,

People and staff had positive relationships and staff were caring and respectful. Staff knew about the things that mattered to people and gave people choice in their day to day lives. People had their privacy and dignity protected.

Care and support was delivered in the way people preferred and met their needs. People's relatives and visitors were made to feel welcome at the service. Staff knew about people's cultural and religious needs and supported people to follow them. There were a range of activities available but opportunities for people to follow their chosen hobbies and interest could be developed further.

People knew how to make a complaint and felt sure they would be listened to and action would be taken. People had confidence in the registered manager and felt they were open, approachable and accessible. There were effective systems in place to monitor the quality of service provision. People were asked for their feedback and this was used to make changes and improve the service.

This inspection took place on 8 and 9 February 2016. The first day of our inspection was unannounced. We told the provider that we would be returning for a second day.

Orchard House is a single storey purpose built care home located in Market Bosworth. The home provides accommodation for up to 30 older people who require assistance due to their age or people living with dementia or physical disabilities. There were 27 people using the service on the two days of our inspection.

There was a registered manager who was responsible for the service but at the time of our inspection they had not been away from the service for 10 months. 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. An acting manager was overseeing the day to day running of the service was in the process of submitting their application to become the registered manager.

At our last inspection of the service in November 2014 the service were in breach of one regulation, people were not always treated with consideration and respect. The provider sent us an action plan that detailed how they were going to improve this and we found that the provider had taken action to address this.

People felt safe at the service and staff had a good understanding of how to identify and report any concerns. Staff had not always taken appropriate action when people had sustained injuries and systems were not in place to ensure that staff responded immediately to any allegations or evidence of abuse. Where people had sustained injuries there was no investigation into how these had occurred.

Environmental risk assessments had been carried out but appropriate action to reduce identified risks had not always been carried out. This put people at the service at risk. Risks relating to people's care and support had not always been appropriately assessed.

There were some processes in place to ensure that people medicines were managed safely however some improvements were needed to ensure that people consistently received their medicines correctly and when they needed them.

People's capacity in relation to their care had been considered but information was not decision specific and therefore did not fully meet the requirements of the Mental Capacity Act (MCA) 2005 legislation.

People were provided with a balanced diet and varied diet. People were provided with appropriate assistance to eat their meals.

People had access to appropriate healthcare services. However, advice relating to people's healthcare was not always acted upon without delay and shared with staff members effectively.

People told us that staff treated them with dignity and respect. Staff had a good understanding of people's likes, dislikes and preferences. Staff’s detailed knowledge of people’s preferences sometimes led to people not being provided with choices throughout the day.

People were involved in making day to day decisions about their care and support. People did not always receive person centred care that was responsive to their needs. Activity sessions were available but they did not reflect people’s individual hobbies and interests.

People and their relatives told us that they felt able to raise any complaints. There were missed opportunities for the service to benefit from information within complaints that had been received.

Staff spoke highly of the manager. People and relatives told us that they were able to speak with the manager if they needed to.

Environmental audits had been carried out but these had failed to identify the environmental issues that we found. The provider had failed to ensure that actions put in place to improve their service had been carried out. The service had failed to act on the f

The inspection took place on 26 November 2014. It was an unannounced inspection. When we last inspected the service on 1 August 2013, the service met the standards we inspected.

Orchard House is a single story residential care home that provides accommodation and personal care for up to 30 older people. At the time of our inspection 30 people used the service.

The service has a 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 and associated Regulations about how the service is run.

The service had effective arrangements for protecting people from abuse. Staff knew how to recognise and respond to signs of abuse. People’s plans of care included risk assessments that helped staff to support people in a way that minimised the risk of people suffering injury. However staff did not respond to signs that a person was at risk of falling whilst walking until we intervened. There were enough staff to meet the needs of people using the service. Arrangements for the management of medicines were safe.

Standards of cleaning and monitoring of cleaning standards required improvement.

Staff received relevant training and support to be able to understand and meet the needs of people using the service.

The registered manager and senior care workers had awareness of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). That legislation had been correctly used at the service.

Staff supported people with their health needs by involving the relevant health professionals. . People had a choice of food and their nutritional needs were met.

The décor of the home showed signs of age. The registered manager was exploring ways to improve the décor of the home to make it more friendly for people with dementia. We have made a recommendation about providing an improved environment for people living with dementia.

Most staff demonstrated care and compassion when they supported people. However, we saw instances of staff not treating people with dignity and respect in the way they spoke with people. People’s rights to privacy were not always respected because the provider had not made it easy for relatives to be able to spend private time with people using the service. People were not always involved or consulted about decisions that affected them, for example about relatives visiting at meal times.

People’s documented plans of care focused on people as individuals and contained useful information about them. However, that information had not always been used to develop meaningful and stimulating activities that helped people maintain their interests and hobbies. The registered manager had begun to address this issue.

The provider had a complaints procedure. People we spoke with knew how to make a complaint. The complaints procedure was not available in an easy to read and understand format for people with reduced communication skills.

The provider sought people’s views about the service. Staff felt able to make suggestions about developing the service.

The provider had arrangements for monitoring and assessing the quality of the service. Those arrangements had not always ensured that all areas requiring improvement were identified. The registered manager had ideas for improving the service.

We found that people were not always treated with consideration and respect. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with five people, one visiting health professional and six members of staff. We also reviewed six care records and eight staff files.

We observed good interactions between staff and the people who used the service. We saw that staff were respectful and caring. They offered choices and patiently waited for agreement before proceeding with any care.

We spoke with four members of staff and asked them to explain their understanding of the types of abuse and what action they would take if they suspected or recognised abuse. All the staff we spoke with were able to identify all types of abuse. They all explained with confidence who they would report to, both within the service and to external agencies.

We saw that the staff had attended a variety of training in June and July 2013, such as moving and handling, infection control practices, food safety. Health and safety, challenging behaviour and dementia care.

We spoke with seven people who used the service, two visitors to the service and six members of staff. We also reviewed six care records and five staff files.

The care records we saw contained a section for the person who used the service or their representative to sign as evidence they had been involved in the care planning, understood the care planned and agreed to the delivery of the care. We found there were inconsistencies in the signing of the records. We saw some plans were signed where as others contained no signature.

One visitor told us:” I have seen some activities undertaken but they are not always appropriate for the people. I feel they should be more imaginative”.

We spoke with seven people who used the service and asked them their views in relation to the care they received. All the people spoke highly of the quality of care and support given. One person told us “I am happy and well looked after”.

All the staff we spoke with were unable to identify all types of abuse. They were however able to tell us they would report it to a more senior member of staff but were unclear what the process was after they had informed them.

During our visit we were unable to determine from the training records and the certificates held within the staff files whether staff received appropriate professional development.

We asked people if they were able to comment or complain about the service they received. Their responses indicated they were aware of the process. The majority of people told us they had never felt to the need to complain. However one person we spoke with told us:” I have complained and they listened to me and they made changes to make it better

We spoke to five people who use the service, five members of staff, two relatives of people who use the service and we saw six care plans and three staff files.

People told us they were happy and well cared for. One person told us ”I am cared for and looked after and always feel involved in my care”. The staff we spoke with were knowledgeable about people’s individual needs and how best to communicate with them.

People were protected from unsafe or unsuitable equipment because the provider demonstrated that equipment was regularly checked and faulty equipment was reported and dealt with in an appropriate manner.

People told us they knew what to do if they were unhappy. One person told us “I do complain when things are wrong” and another person told us “I would soon tell the manager what I wanted”. A relative of a person using the service told us they had raised a concern and it had been dealt with and changes made.

We spoke to three people who used the service and four relatives of people who used the service.

When we asked one person about their experience of living at the home they told us, “I like it here. It can be difficult sometimes because some people are not as able as others.” Another person who used the service told us that she thought that a lot of the activities were not suitable to some residents due to their lack of understanding about what that activity involved.

One of the three people we spoke to told us that they had seen their care plan and had been involved in reviews of the plan. They told us that they had attended residents meetings at which they had contributed ideas and suggestions about the home. They added that they were happy with the quality of care they had experienced and that there were always enough carers on duty.

Another person who used the service told us that “We’re very fortunate. We are treated very well. The staff are excellent.”

A third person told us that there was, “A good level of care. I am able to talk to the girls. They are very good to me”.

Relatives we spoke to were complimentary about the home. One relative, referring to the care their mother had received, said, “They’re ever so good to her. I can’t fault the home. The food is good.” That person told us that they had been involved in their relative’s care plan.

Another relative told us that when their sister had been admitted to the home their mobility was not very good and that carers had “taught” her to walk. That person added that, “My sister was always smartly cleaned and dressed.”

A third relative we spoke to told us they had been involved in reviews of their relative’s care plans. That person said that their relative “Wouldn’t be as good as they were if he hadn’t been at the home.”

A fourth relative we spoke to told us that, “The carers are nice, they talk to people.”

We spoke to three people who used the service and four relatives of people who used the service.