The inspection was unannounced, and the inspection visit was carried out on 7 March 2017. The home was previously inspected in August 2015, where two breaches of legal requirements were identified; the home was not always keeping people safe, and concerns were identified in relation to governance. At that inspection the home was rated “Requires Improvement.”

Orchid House is a 4 bed care home, providing care to adults with learning disabilities. At the time of the inspecdtion three people were living at the home. Orchid House is located in the St Annes area of Rotherham. It is in a quiet residential area, but within walking distance of the town centre.

At the time of the inspection the service had 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. However, we identified that the home’s registered manager was not involved in the running of the home. The provider told us they will identify a more appropriate person who will apply to register.

Staff routinely promoted choice and independence, and spoke to people with respect, upholding their dignity. Staff we spoke with had a good knowledge of people’s needs and preferences, and care plans were highly personalised which indicated that staff understood people’s needs well. Care was formally reviewed regularly to ensure it met people’s needs, and where changes were required these were implemented.

Staff were trained in relation to how to keep people safe from the risks of harm or abuse, and there was information available in the home for people using the service and staff about what action to take if abuse was suspected.

Medicines were safely managed, and staff we spoke with had a good knowledge of the medication system in use at the home.

There were appropriate arrangements in place for people to consent to their care and treatment, and staff had received training regarding consent and mental capacity.

People told us that the food available was good, and reflected their preferences. People using the service were encouraged to be involved in meal planning and preparation.

There was a complaints system in place. We asked people using the service whether they would feel confident to complain if they wished to, and they told us they would.

There was a system in place for monitoring the quality of service people received, and making ongoing improvements as part of the monitoring system

At this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people using the service, three relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. One person we spoke with said, “I feel safe, I would speak to staff if I was worried about anything.”

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The manager had attended training to ensure he understood his responsibilities to keep people safe during their stay at the home. Safeguarding policies and procedures were in place if required.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People said that they had been involved in writing their care plans and they reflected their current needs. One person said, “Staff supports me to eat well and keep healthy.”

Is the service caring?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. For example, staff ensured people were able to go on holidays of their choice. People we spoke with told us about a recent holiday to Egypt where they had been swimming with dolphins.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home has its own adapted minibus, which helps to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. Two people we spoke with said they were happy living at Orchid House and they would tell staff if they had any concerns.

We looked at how complaints had been dealt with, and found that the responses had been dealt with in a timely manner. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The provider/owner has been registered with the commission for over 10 years and most of the people who used the service had also lived at the home for a number of years. Two people who we spoke with told us they liked living at Orchid House and would not want to live anywhere else.

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We carried out this inspection because when we visited the home in August 2013 we found the provider was not compliant with cleanliness and infection control requirements. We therefore issued a compliance action which told the provider they must take steps to achieve compliance.

We also found the provider was not compliant because accurate and appropriate records were not maintained. We issued a compliance action. The provider wrote to us and told us the action they would take achieve compliance.

At this inspection we found the provider had made significant improvements to ensure systems were in place to reduce the risk and spread of infection. People we spoke with told us they liked the new kitchen facility. They also liked the new flooring downstairs.

People received care and treatment from suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work.

We saw that the care records for people were held securely within the building and were accessible and easily located.

We spoke with three people who used the service and three relatives to gain their views. People told us they felt supported by staff that helped them maintain their independence. One person said, “I like to be independent, the staff are great. We go lots of places and I also enjoy my jobs, gardening and at the animal sanctuary.” One relative said, "The staff are excellent they keep me informed about the care of my relative."

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff had a good knowledge of the needs of people who used the service.

People were not protected from the risk of infection because appropriate guidance had not been followed.

We found that the premises had been adequately maintained.

People received the care and treatment from suitably qualified, skilled and experienced staff. Appropriate employment checks had been undertaken before staff began work. However, records did always reflect information about previous work history or a photograph of the employee.

Some records were not fit for purpose or absent

People we spoke with told us they liked living at the home and staff were friendly and provided the support they needed. On person said “I like it here I can go and do the things I want to. I like meeting friends”. People said we can go on holiday and we have chosen to go to Egypt this year. One person said “Staff goes with us on holiday to make sure we are safe”.

People told us that they were involved in making decisions about the running of the home, and would feel confident to tell the staff if they were unhappy about anything.

People told us that staff looked after them very well and they had been involved in the planning of their care. They said they were able to do most things for themselves, but sometimes needed staff to prompt them with their personal care. One person told us that staff respected the time they wanted to be on their own and they were always treated as an individual.

People told us that they were involved in making decisions about the running of the home, and would feel confident to tell the staff if they were unhappy about anything.

The inspection took place on 17 and 18 August 2015 and was unannounced on the first day. At the last inspection in May 2014 the service was judged compliant with the regulations we looked at.

Orchid House is a care home providing accommodation for up to four younger adults. It is situated close to Rotherham town centre and has limited restricted parking. It provides accommodation on both the ground and first floor and has small gardens to the front and rear of the building.

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.

People we spoke with told us they felt safe while staying at the home. We spoke with three people who used the service and they said that staff helped to ensure they were safe. One person said, “I like to know staff are there to help me with my money.” Another said they liked staff to be with them when they were out in the community. This gave them reassurance.

There were enough staff to ensure people could take part in activities of their choice. There was a programme of training, supervision and appraisals to support staff to meet people’s needs. However, we identified that four staff required moving and handling training to ensure they could move people safely. We found several falls had occurred in the home which were recorded, however the provider told us that there was no equipment to safely assist people that had fallen. This meant people and staff were at risk of sustaining an injury by manually lifting people following falls in the home. This 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.

Procedures in relation to recruitment and retention of staff were robust and ensured only suitable people were employed in the service.

Care plans were person centred and most contained information needed to ensure staff could deliver care safely. However, we identified that one person’s care needs required a formal review to ensure staff could continue to meet their needs. The provider had identified this and was liaising with the other health agencies to arrange this review.

The provider was aware of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection the registered manager told us they had made one application to the local authority who were the supervisory body for dealing with DoLS.

People were encouraged to make decisions about meals, and were supported to go shopping and be involved in menu planning. We saw people were involved and consulted about all aspects of their care and support, where they were able, including suggestions for activities and holidays. Two people told us about their recent holiday to Egypt, while another person preferred to have holidays in England.

Medications procedures were in place including protocols for the use of ‘as and when required’ (PRN) medications. Staff had received training in medication management and medication was audited in line with the provider’s procedures. However, there were a number of records used to record medications in and out of the home which made it difficult to monitor. Some improvements were needed to ensure medications discharged to day centres and for overnight stays to relatives were clearly recorded. This 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.

People had access to a wide range of activities that were provided both in-house and in the community. One person told us they liked going to the drama group while others enjoyed ‘Gateway’ which is a social group held in the evenings.

We observed good interactions between staff and people who used the service. People were happy to discuss the day’s events and they showed us the small allotment in the back garden where they had grown their own vegetables and herbs.

People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it. People could also access ‘Speak up’ if they needed any assistance to raise concerns. ‘Speak up’ is an advocacy organisation which mainly aims to ensure that people with learning disabilities are valued and included within society. People’s views were gained using a survey and by attending regular meetings.

Quality monitoring systems needed improvements to ensure the service learnt from events that occurred in the home. This 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.