This inspection was carried out on 05 and 10 April 2017 and the first day was unannounced.

Orchard Residential is registered to provide accommodation and personal care for up to 26 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 23 people using the service at the time of this inspection.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. 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.

The last inspection of the service was carried out on 15 September 2015 and we found that the service was not meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations. The registered provider sent us an action plan following the last inspection detailing how and when they intended to make the improvements in relation to good governance. During this inspection we found that the required improvements had been made.

Checks on the quality and safety of the service had improved making them more effective. Checks were carried out as required on things such as care records, infection control, medication and the environment. Action plans were put in place to address improvements identified and they detailed who was responsible for following up on the action and the timescales for completion.

People received their medication on time by staff who had received the appropriate training and competency checks. Medication was stored safely and records of medication were appropriately completed. Protocols for the use of PRN medication, medicines to be taken ‘when required’, were in place and staff followed instructions given by GPs for its use.

Staff had undertaken safeguarding training and they were confident about recognising and reporting actual abuse or suspected abuse. The registered manager and other senior staff were aware of their responsibilities to report abuse to relevant agencies.

There were sufficient numbers of suitably skilled and qualified staff to keep people safe. All staff had completed training in emergency procedures and they were aware of their responsibilities for keeping people safe.

The procedure for recruiting staff was safe and thorough. Applicants were required to provide information about their previous employment history, skills and experience. A series of pre-employment checks including a check with the Disclosure and Barring service (DBS) were obtained before employment was confirmed.

The registered manager and staff had good knowledge and understanding of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. The registered manager worked alongside family members and relevant health and social care professionals to ensure decisions were made in people’s best interests when this was required.

People’s nutritional and hydration needs were assessed and planned for and staff had a good understanding of them. People received the support and assistance they needed to eat and drink, and those who needed it had their food and fluid intake monitored to help minimise the risk of malnutrition and dehydration. Menus did not reflect healthy food options which people were offered and they lacked some variety. However following the inspection we were assured that menus were being revised.

Care plans identified people’s needs and any associated risks, and they instructed staff on how to meet them. Care plans were kept under review so that they remained relevant and up to date. Communication amongst the staff helped to ensure that people received consistent and effective care and support.

Staff received an appropriate level of supervision and training for t

This was an unannounced inspection, carried out on 15 September 2015.

Orchard Residential is a care home for up to 26 people who require personal care. It is a converted building located in a residential area of Huyton near Liverpool, with access to public transport and local shops. Garden areas and a car park are available directly outside.

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 2008 and associated Regulations about how the service is run.

The last inspection of Orchard Residential was carried out in May 2013 and we found that the service was meeting all of the regulations we assessed.

At this inspection we found there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were required to ensure people’s safety. People’s safety was put at risk because pull cords for activating call bells were tied up out of reach in toilets and bathrooms. Following a discussion with the manager during our inspection, a check was carried out on all call bells across the service to ensure they were fully accessible to people.

Some parts of the service and equipment used to help people with their mobility were unclean, increasing the risk of the spread of infection. Following a discussion with the manager during our inspection, a deep clean of areas which were unclean was carried out at the time of our inspection.

Staff told us that they felt well supported in their role on a day to day basis; however they had not been formally supervised in line with the registered provider’s staff supervision policy which stated all employees should receive formal supervision at three monthly intervals. Over half of the staff team had not received a formal one to one supervision for more than a year. This meant that staff were not given the opportunity to discuss formally their personal objectives, performance, training and development needs.

People were not always treated in a way which was dignified and person centred. Staff referred to people in groups rather than as individuals. Staff assumed it was appropriate to serve people their meals and drinks using plastic tableware without taking account of their individual needs. We discussed this with the registered manager during the inspection and she confirmed that she would address this.

Although the registered provider had systems in place for checking the quality of the service they were not always effective as they failed to identify a safe environment for people who used the service. The registered provider failed to address concerns about people’s safety despite previously being made aware of them.

There were safe systems in place for the management of people’s medicines. They were stored in an area which was secure, clean and well organised and they were handled by staff who had undertaken medication training. People received their medication on time and appropriate records were completed for the administration, receipt and destruction of medicines at the service.

Staff had access to information and guidance about safeguarding procedures and they were confident about recognising abuse or potential abuse and reporting any concerns they had. People who used the service told us they felt safe and that they had a lot of trust in the staff.

Processes for recruiting staff at the service were thorough and safe. Applicants were subject to a range of checks prior to starting work at the service; including a check with the Disclosure and Barring Scheme (DBS). These checks helped the registered provider to determine if the applicant was suitability qualified, skilled and experienced for the job and of good character.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and DoLS to ensure that people who could not make decisions for themselves were protected. Appropriate safeguards were put in place for people who did not have the ability to make decisions about aspects of their care and support.

People were provided with a choice of food and drink. People who needed it had their food and fluid intake closely monitored and they received assistance to eat and drink. Appropriate referrals were made to dieticians and nutritionists and staff acted upon their advice and guidance to ensure people received the support they needed to maintain a healthy diet.

People’s needs were assessed, planned for and regularly reviewed with their involvement. Relevant others such as family members and other health and social care professionals were consulted required. People received the right care and support by staff who knew them well.

People who used the service and relevant others were provided with information about how to complain and they told us they would not be worried about complaining if they needed to. People were confident that their complaints would be listened to and acted upon. A record of complaints was maintained and this showed people’s complaints had been acknowledged and dealt with in a timely way.

We spoke with four people who used the service and also spoke to their relatives. People told us they had made decisions about their care and treatment and they told us they had received the right care and support.

Each person had a care plan with up to date information about the care and support they

needed and they told us that they were happy with the care they received. They also told us that they felt safe living at the home and they knew who to tell if they were unhappy with anything. Their comments included:

“There is nothing to find fault with any of them".

"Staff are always available to help".

"The staff are excellent".

"They get everything right”.

We found the home to be clean and regular checks had been carried out to ensure the

required standards of cleanliness and infection control. We also found that the relevant checks were made on staff working in the home.

We used a number of different methods to help us understand the experiences of people living at Orchard Residential. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke individually with four of the people living there and with four visitors. We also spent time observing the support provided by staff.

We looked at the results of a resident and relative’s questionnaire for 2012.

People using the service told us the care they had received at Orchard Residential had been, “Very good” and they had been, “Well looked after”.

People told us that staff had always been polite and respectful towards them. They said staff had always knocked on their bedroom door before entering. One person commented that, “The staff are all very pleasant”.

People told us they had no concerns about the way they had been treated at the home. They said they would tell somebody if they were unhappy about their treatment.

People said staff were available when they needed them and there had always been enough staff on duty to help them. One person commented, “Yes the staff are always there to help me when I need them”.

We spoke with four people who lived in the service they told us that the care workers respected their wishes and feelings and treated them with dignity. They said that their requests and preferences were listened to and acted upon.

Some comments made were;

"I'm happy here. The staff are lovely”,

"The girls are lovely here can't find a fault. I am happy to stay here. It's not home but it’s as good as.".

"I'm well looked after. It's a nice place.",

"The staff are lovely. The home is kept clean and the food is good."

During our visit we saw that care workers were attentive to people who lived in the service.

Relatives spoken with told us that they found the care workers were friendly and helpful. They told us that the environment was clean and looked nice. They were contacted if issues occurred with their relatives such as a doctor’s appointment.

Comments included,

"Its very nice my mother is really happy, she has got so much better since she got here",

“I am so happy that he lives there",

"Can not fault it, they look after her so well",

"My mother is loved, what more can I ask?".