Orchard House is a large detached stone built property which provides accommodation for up to six people with autism. At the time of our inspection there were five people living in the home.

Following our last inspection in January 2015 the home was rated ‘Good’. At this inspection we found the service remained Good overall and was Outstanding in responsive.

People received high quality person-centred care from staff who understood their needs. Detailed information was gathered about each person before they began living in Orchard House. This resulted in comprehensive care documents which accurately reflected each person’s history and needs. Regular reviews were carried out to ensure people’s care provision was up to date and reflected each person’s individual preferences.

Everyone we spoke to was extremely complimentary about the service. Relatives we spoke with were very positive about the ability of the staff to care for people and felt confident their family members were receiving the best care.

Staff demonstrated to us they had an excellent understanding of the care people needed and in particular the need to have very detailed planning in place to support people with autism undertake transitions. We found the care provided by the service strongly followed the best practice guidelines published by the National Institute for Health and Care Excellence in 2016 on autism spectrum disorder in adults.

Choice was a key factor in the service. We found people were afforded a range of choices and were supported by staff who ensured people’s individual choices were highly respected. This enabled people to have fulfilling lifestyles.

The manager told us they believed in taking positive risks with people to increase their confidence. We found risks assessments in the service were well-documented and were highly personalised. Staff understood these risks and demonstrated the actions they took to mitigate risks to people in order for them to gain further confidence.

Staff understood the needs of people with autism and the challenges people faced when making a transition to a new place or a new home. We found when there was a transition to be made people’s needs were considered in great detail.

The registered manager told us no one had made a complaint. We spoke with relatives who told us they had no qualms about the service and confirmed they had not made any complaints.

We found staff recruitment was robust. Staff were supported through a programme of induction, training and appraisal.

Staff had been trained in safeguarding and were confident if they raised a concern with their manager they would respond appropriately.

We reviewed people’s medicines and found there were safe systems in place for their storage and administration. Guidance was available to staff to support them to give people medicines which were required on an as and when basis.

Relatives and professionals alike told us they thought people who used the service were well cared for. We found staff respected people’s privacy and dignity.

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.

The service had systems and processes in place to monitor quality. Audits were regularly carried out. Staff told us they felt supported by the manager.

There was clear partnership working between the service and other agencies including health and social care professionals and psychological services.

Further information is in the detailed findings below.

We used a number of different methods, for example observing how people were supported to make decisions about their care, to help us understand the experiences of people using the service. This was because some people were unable to give us their comments directly about the care they received.

During our visit we found people were asked for their consent before they received any care or treatment and the provider acted in accordance with their wishes.

We found care and treatment was planned and delivered in a way which ensured peoples’ safety and welfare. We spoke with people about how they felt about the home. They said things like “Orchard House is good” and “Staff are good.”

The provider had made suitable arrangements to protect vulnerable people and responded appropriately to any allegation of abuse.

We found people were cared for by staff who were supported by the provider to deliver care and treatment safely and to an appropriate standard.

We found people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We contacted some relatives of people who lived at the home. They said things like, “Wonderful home”, “Staff are like friends really special,” “Fantastic care,” “My (relative) is dressed lovely and goes everywhere” and “I can sleep at night without worrying about (my relative).”

During our visit we found people’s privacy, dignity and independence were respected. We spoke with several people who used the service. They said staff respected their choices, privacy and dignity. One person told us, “I have just written a letter to the manager about what I want. I’m sure he will be happy with that.”

We found care and treatment at the home was planned and delivered in a way which ensured people’s safety and welfare. One person said, “I’m happy with the service I get, I have my things.”

We looked at the way medication was handled at the home. We found people were protected against the risks of unsafe use or management of medicines because the provider had appropriate arrangements in place.

We found staff received appropriate professional development. People told us they were happy with the support they received from staff. One person said, “I like the staff they are OK.”

People who used the service, their representatives and staff were asked for their views about the care and treatment offered. We saw their responses were acknowledged and acted on. When we spoke to people they said “everything’s fine in my life” and, “I like it here, I don’t want to be anywhere else.”

We inspected this service on 7 and 8 January 2015 and our visit was unannounced. This meant the staff and provider did not know we would be visiting.

Orchard House provides care and accommodation for up to seven people. The home is a large detached house set in its own gardens in a residential area, near to public transport routes and local shops. The home specialises in the care of people who have autism and learning disabilities. On the day of our inspection there were a total of six people using the service.

The home 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.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a very friendly and respectful manner.

We spoke with two care staff who told us they felt supported and that the registered manager and deputy were very approachable. One staff member told us, “We work together as a team with the manager taking part in the routine of the day and helping to care for everyone.” Throughout the day we saw that people and staff appeared very comfortable and relaxed with the registered manager, deputy and staff on duty.

People had their physical and mental health needs monitored. There were regular reviews of people’s health and the home responded to people’s changing needs. People were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

We saw people’s care plans were very person centred and written in a way to describe their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for service users to understand by using of lots of pictures and symbols. We saw lots of evidence to demonstrate that people were involved in all aspects of their care plans.

The care staff we spoke with said they received appropriate training, good support and regular supervision. We saw records to support this.

People were protected from the risk of abuse. The care staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They had undertaken training and were able to describe the different ways that people might experience abuse. Staff were able to describe what actions they would take if they witnessed or suspected abuse was taking place.

One person told us, “I’m safe and I know who to talk to if I wasn’t thank you.”

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. We also viewed records that showed us there were safe recruitment processes in place.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

For example, there was a policy and procedure in place for people to follow in the event of a fire. Staff outlined to us what they needed to do in the event of a fire or medical emergency.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and were able to describe the circumstances when an application should be made. The registered manager told us that some people had DoLS authorisations in place and they had worked with the local authority to ensure that they were appropriate and had been considered in peoples’ best interests.

Throughout the day we saw staff interacting with people in a very caring and professional way. The registered manager and staff that we spoke with showed genuine concern for peoples’ wellbeing and it was evident that all staff knew people at the home very well. This included their personal preferences, likes and dislikes and had used this knowledge to form very strong therapeutic relationships. We saw all of these details were recorded in people’s care plans. We found that staff worked in a variety of ways to ensure people received care and support that suited their needs. For example, we saw that staff gave explanations in a way that people could understand. Throughout our visit we observed staff and people who used the service engaged in general conversation and enjoy humorous interactions.

People were given opportunities to make decisions and choices during the day, for example, what activities to take part in , or where to sit in the lounge. We saw carers encouraged people to give their views and supported people to make choices and decisions. People were asked about things like activities they would like to do and meal preferences. We also saw people asserted their views and preferences and were empowered and encouraged to be in control of their lives and activities were personalised for each person

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

People received a balanced diet. We saw people could choose what they wanted to eat each day and this was supported by the staff. The cook was very knowledgeable about peoples’ diets and their preferences were always available. There was fresh fruit and snacks available so people could help themselves throughout the day.

We saw the provider had policies and procedures for dealing with medicines and these were followed by staff. Medicines were securely stored and there were checks and safeguards in place to make sure people received the correct treatment.

There was a complaints policy at the home which provided people who used the service and their representatives with clear information about how to raise any concerns and how they would be managed. We saw pictures had been used to help people understand the information. The staff we spoke with told us they knew how important it was to act upon people’s concerns and complaints and would report any issues raised to the registered manager or provider.

We discussed the quality assurance systems in place with the registered manager. We were told audits of accidents and incidents were carried out and these were investigated by the registered manager to ensure risks were identified and improvements made. We saw records that showed us this took place. We also saw the views of the people using the service were regularly sought and used to make changes. We found that the provider had very comprehensive systems in place for monitoring the quality of the service. This included monthly audits of all aspects of the service, such as infection control, medication, learning and development for staff which were used to critically review the home. We found that the manager produced action plans, which clearly showed when action had been taken.