We inspected Orchard House on 21 May 2018. Orchard House 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 service was registered to accommodate up to 50 older people, with age related conditions, including frailty, mobility issues and dementia. On the day of our inspection there were 43 people using the service.

The service was last inspected on 29 October 2015; no concerns were identified and the service was rated ‘Good’ overall.

There was a registered manager in post, who was present on the day of 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.

People received care and support from staff that were appropriately trained and competent to meet their individual needs. Staff received one-to-one supervision meetings with their line manager.

People’s needs were assessed and improved care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to guide staff on how keep people safe from harm and staff showed a good understanding of their responsibilities.

People were supported with patience, consideration and kindness and their privacy and dignity was respected. People were protected from potential discrimination as staff were aware of and responded effectively to their identified needs, choices and preferences. People’s individual communication needs were assessed and they were supported to communicate effectively with staff.

Thorough staff recruitment procedures were followed and appropriate pre-employment checks had been made.

Systems were in place to ensure medicines were managed safely in accordance with current regulations and guidance. People received medicines when they needed them and as prescribed.

The registered manager worked in cooperation with health and social care professionals to ensure people received appropriate healthcare and treatment in a timely manner. People were able to access health, social and medical care, as required.

The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). 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.

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments and views.

We carried out an unannounced inspection of the service on 29 October 2015.

Orchard House Care Home provides accommodation to older people in the Nottingham area. It is registered for a maximum of 37 people. There were 34 people receiving care and support at the home at the time of our visit.

There was a manager registered with the Care Quality Commission (CQC). 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 told us they felt safe at the home. They were supported by staff who understood how to report allegations of abuse. Risk assessments were in place to identify and reduce the risk to people’s safety. There were sufficient staff in place to keep people safe and medicines were stored and handled safely.

People were supported by staff who received a comprehensive induction and training programme. Staff told us they felt well trained and supported by the registered manager and they were knowledgeable about the people they cared for.

People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

People were treated with kindness and compassion and spoke highly of the staff. Staff interacted with people in a friendly and caring way. People’s privacy and dignity was protected and they felt able to contribute to decisions made about their care. Arrangements were in place for people to receive support from an independent advocate if they needed one.

People’s care records were written in a person centred way that focused on people’s wishes and respected their views. Staff responded to people’s needs promptly. They encouraged people to participate in activities that were available in the home which reflected their needs. A complaints process was in place and staff knew how to respond to complaints.

People, relatives, staff, and representatives of the local community all complimented the registered manager. People felt empowered to contribute to the development of the service. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of all of the people at the service. They had a robust auditing process in place that identified the risks to people and the service as a whole and they were dealt with quickly and effectively.

We spoke with several people who lived at the home, although due to their needs it was not possible to have extended conversations. One person said, "They are marvellous here" and another said "I am well looked after." We spoke with two relatives of people who were visiting the home. They described the care provided as, "Exceptional," and further stated, "The love and relentless positivity that the staff show to the people here is incredible."

Many of the people who used the service had significant communication needs. The manager and all the staff with whom we spoke demonstrated a considerable degree of enthusiasm for their jobs of supporting them to live better, happier, safer and more fulfilling lives.

We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which enabled them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment, induction and training systems were robust. The accommodation was appropriately designed and suitable to meet the needs of the people living there and there was an ongoing plan in place for necessary replacements and renovations.

When we inspected Orchard House on 21 February 2013, we spoke with six people who used the service and some people who were visiting their relative in the home. We found people were very happy with the care and support provided in this home. They told us they felt safe and were well looked after by the staff. One person said, “I've been here years, they look after us well, it's alright here."

We observed that people were offered care and support at a level which encouraged independence and ensured their individual needs were met. There was a relaxed atmosphere in the home and we noted staff interacted confidently with people and were friendly and courteous in their approach to them. Everyone we spoke with commented positively about the quality of care and the conduct of the staff. One person said, "They're absolutely marvellous."

We noted people were encouraged to express their views and were involved in planning their care and making choices and decisions about their care. Within people's care files we saw care documentation had been signed by them, or their representative, to confirm they had been consulted and agreed with their particular care needs and how they should be met.

There were systems in place to promote quality and safety in this home. The responses from the July 2012 satisfaction survey included many comments which reflected that most people were very satisfied with this service. Improvements had been made in response to some people's comments.

People who use the service told us they were happy with the way their medicines were handled and they received their medicines regularly.

People told us that they were treated with dignity by staff, had their privacy respected and were given adequate choices. They said that staff knew their needs and provided a service that reflected these. They also felt safe living at Orchard House.