This inspection took place on 4 and 6 December 2018.At our last inspection of the service in November 2017 we rated the service ‘Requires Improvement’ overall. This was because staff were insufficiently prepared to respond to a fire emergency, they did not receive supervision or appraisal and quality assurance processes were not robust. We rated the service ‘Requires Improvement’ in the domains of ‘Safe’, ‘Effective’ and ‘Well-led’.

At this inspection we found the service had improved in relation to each key question and as a result the service’s overall rating has risen to ‘Good’.

Orford House Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Orford House Residential Home accommodates up to 29 people in one adapted building. The service specialises in supporting older people some of whom maybe living with dementia. At the time of our inspection there were 22 people using the service.

The service did not have a registered manager in post. 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 manager of the service had submitted an application to register with CQC shortly before our inspection.

People’s safety was enhanced by the preparedness of staff to respond to emergencies. Staff received on-going training to ensure they were clear about their roles and responsibilities in safeguarding people from improper treatment and the provider took prompt and decisive action where safeguarding concerns arose. Risk assessments were in place to reduce people’s risks of experiencing avoidable harm. The provider ensured that staff were safe and suitable to deliver care and support. The environment of the care home was clean.

People’s assessed needs were met by trained, supervised and appraised staff. People’s mental capacity was assessed and supported. People ate well and staff supported them to access healthcare services whenever required. People, their relatives and healthcare professionals were actively involved in successful transitioning into the service.

People and relatives told us the staff were caring and kind. Staff respected people’s privacy and dignity and promoted their independence. People and staff shared positive relationships and visitors were made to feel welcome at the service.

Staff were responsive to people’s changing needs. People’s needs were detailed in their care plans which people participated in developing. People engaged in a range of activities made available at the service. The provider managed complaints appropriately. Staff ensured that people were cared for compassionately at the end of their lives and in line with their preferences.

The service had improved the robustness of its quality assurance processes so that action was taken where shortfalls were identified. Staff felt supported by the manager and encouraged to share their views regarding improvements to the service. The provider sought and responded to feedback from people and relatives and made information available to them. People benefitted from the provider’s partnership working with external organisations.

Orford House Residential Care Home 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. Orford House Residential Care Home provides personal care to people. The service does not deliver nursing care.

At our last inspection in August 2015 the service received an overall rating of Good.

Orford House Residential Care Home accommodates up to 29 older people in one adapted building. 24 people were living in the service at the time of our inspection. People had individual bedrooms, three of which had en suite facilities.

The service had a registered manager in post. 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 were not protected by the readiness of staff to respond as planned in the event of an emergency. The service had not complied with its policy to undertake building evacuation drills and staff were not clear what the provider’s evacuation plan was.

There were sufficient numbers of staff available to support people effectively. Robust procedures were in place to ensure that only safe and suitable staff were recruited. However, further routine checks were not systematically carried out once staff were in post.

Staff were not always supported to reflect on their practice or plan their professional development because they did not always receive regular one to one supervision or annual appraisals. The registered manager and the provider carried out detailed audits of the service. However, where shortfalls were identified such as the absence of evacuation drills, DBS updates and staff supervisions action plans were not followed through and the shortfalls persisted.

People were supported with risk assessments and risk management plans to reduce their likelihood of experiencing avoidable harm. Staff were trained to administer people’s medicines and did so safely. The environment of the care home was visually clean and staff followed appropriate infection prevention practices.

People had detailed needs assessments and plans were in place to meet those needs. Staff received on-going training to deliver care and support effectively and appropriately referred people to healthcare services when required. People received the support they required to eat and drink well. The service was approaching the end of extensive refurbishments, redecoration and improvements at the time of the inspection. This had been well received by people, their relatives and staff. People were treated in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Kindness and compassion were in evidence at the service. People and their relatives were pleased with the positive relationships they shared with staff. People’s cultures were recognised and they were supported with cultural expression when they chose. Staff promoted people’s privacy, dignity and independence.

People received care and support that met their needs and preferences. People participated in activities at home and in the community. Staff supported people to continue to follow their interests and hobbies. The registered manager addressed complaints promptly and in line with the provider’s policy. Complaints were reviewed for collective learning and improvement. People were treated with dignity and compassion during their end of life care.

People, relatives and staff spoke favourable about the registered manager. The responsibilities of the registered manager had increased to include the management of another of the provider’s services. This meant they were able to spend les

This inspection took place on 25 August 2015 and was unannounced. The last Care Quality Commission (CQC) inspection of the home was carried out on 7 July 2014, where we found the service was meeting all the regulations we looked at.

Orford House is a care home that can accommodate and provide personal care for up to 29 older people. At the time of our visit, there were 25 people using the service, of whom approximately half were living with dementia.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Although people told us they were happy with the standard of care provided at the home and always spoke positively about the staff who worked there; we found not enough staff were suitably deployed in the main dining room during lunch, and when staff were visible, they did not spend enough time interacting and socializing with people. This meant people’s needs may not always be fully met during lunch and nor was their mealtime experience as pleasant as it could have been.

People told us staff looked after them in a way which was kind and caring. Our discussions with people using the service and their relatives supported this. People’s rights to privacy and dignity were also respected. When people were nearing the end of their life they received compassionate and supportive care.

People were safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. The service also managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies.

We saw people could move freely around the home. The provider ensured regular maintenance and service checks were carried out at the home to ensure the environment was safe. The building was well maintained and safe.

Staff were suitably trained, well supported and knowledgeable about the individual needs and preferences of people they cared for. The registered manager ensured staffs’ knowledge and skills were kept up to date.

People were supported to maintain social relationships with people who were important to them, such as their relatives. There were no restrictions on visiting times and we saw staff made peoples’ guests feel welcome.

Staff encouraged people to participate in meaningful social, leisure and recreational activities that interested them. We saw staff actively encouraged and supported people to be as independent as they could and wanted to be.

People were supported to keep healthy and well. Staff ensured people were able to access community based health and social care services quickly when they needed them. Staff also worked closely with other health and social care professionals to ensure people received the care and support they needed. There was a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well. People received their medicines as prescribed and staff knew how to manage medicines safely.

Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wanted this to be provided. Where people's needs changed, the service responded by reviewing the care and support people received, which included their care plan.

Managers understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The service had a clear management structure in place. We saw the registered manager led by example and was able to demonstrate a good understanding of their role and responsibilities.

The views and ideas of people using the service, their relatives, professional representatives and staff were routinely sought by the provider and used to improve the service they provided. People and their relatives felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

There were effective systems in place to monitor the safety and quality of the service provided at the home. The registered manager took action if any shortfalls or issues with this were identified through routine checks and audits. Where improvements were needed, action was taken.

Below is a summary of what we found. The summary is based on our observations during the inspection and we used our SOFI tool to observe care and interactions between staff and people who used the service. We spoke with three people who used the service, two sets of relatives, members of staff and the manager. We looked at three sets of information about people who used the service and care home records. There were 27 people living at the home on the day of our inspection.

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

We considered our inspection findings to answer five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

Care plans detailed that people’s needs were identified and met. These plans were regularly reviewed and updated so that they were meeting people’s current needs. Any risks were assessed and reviewed regularly to ensure people’s safety was promoted whilst ensuring their independence.

People living at the home told us they felt safe, one person commented “They’re so quick at answering the call bell especially at night” and a relative told us “I’ve never seen anything untoward”. Staff had all completed training in keeping vulnerable adults safe and this training was refreshed regularly so staff were aware of the types of abuse and what to do should they suspect abuse. The home had all the appropriate policies and procedures in place.

The Care Quality Commission monitors the operation of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We saw staff had received training and that the home knew how to make a referral to the local authority if a DoLS assessment was required. This could help to ensure that people’s human rights were properly recognised, respected and promoted.

Is the service caring?

People we spoke with were positive about the care provided at Orford House. Comments included, “The staff are lovely, they’re caring” and another person told us “I think they’re wonderful”. We saw people who used the service were supported by kind, attentive and compassionate staff. Staff treated the people who used the service with respect and dignity.

Is the service responsive?

We found staff continually monitored people’s condition and where necessary sought advice and assistance from other community based health and social care professionals. In one example, a referral had been made to a physiotherapist as a person’s walking frame was not suitable for them.

The service had a complaints policy and procedure. People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. The home sent out an annual survey for people who used the service and their relatives to comment on the care provided by the home.

There was choice of activities available for people who used the service. These ranged from bingo and quizzes, to aromatherapy and massage, to days out by the seaside.

Is the service effective?

People received effective support from staff that were trained and supported by the manager. Staff told us and we saw evidence that they had received specific training to meet the support needs of people who used the service. There were sufficient numbers of suitably qualified and experienced staff on duty to safeguard the welfare of people who used the service.

People’s specific needs were taken into account and there was guidance and instructions for staff on how these should be met. People’s care plans were reviewed regularly and any necessary changes made. In this way people were receiving care that was appropriate to their needs.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

Is the service well-led?

The service had a registered manager who knew the service well.

The service had quality assurance systems in place. We saw records that showed us any issues identified were addressed promptly. As a result the quality of the service was continuingly improving. An annual survey was completed by people who used the service or their relatives.

Regular audits of the care plans, medication and infection control were carried out to help ensure that people received good quality care at all times. There were systems in place to make sure staff learnt from incidents and accidents and other untoward events.

We reviewed records and spoke with staff. We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We were previously concerned that high levels of asbestos had been found in the home and the recommendation that it should be removed immediately had not been followed. However, during this inspection we found the asbestos containing material had been removed by experts under controlled circumstances.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us they were treated with dignity and respect. One person told us, “they always ask me if they want to do anything.”

We reviewed six people’s care files and found that people’s needs were assessed. We saw that a variety of activities were available to people who use the service. One person told us, “I join in the activities as much as I can and when they have a picnic I always go." Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were satisfied with the way their care was delivered. People using the service told us, “I am very happy here.” “The staff are lovely.” A relative said of the service, “Staff are nice but there could be more interaction between the staff and residents.”

We found that people were cared for in a clean and hygienic environment. However, we were concerned that people who use the service, staff and visitors were not protected against the risks of unsafe premises. Asbestos containing material had been discovered in the building in 2012, but the provider had not taken the necessary steps to make the building safe.

There were effective recruitment and selection processes in place and appropriate checks were carried out before staff began to work with people using the service.

People told us staff were nice and treated them with respect. One person said ‘The staff are good to me and they look after me well’. We also spoke with two relatives and they told us the staff were very good and very caring. They did not raise any concern about the care being provided in the home. All the people we met appeared to be happy and looked well cared for. People were happy with the support and care that they were receiving. Relatives that we spoke with told us that they were always kept fully informed about what was happening and asked about their opinions.

Comments from people using the service were generally positive, indicating that staff are kind and helpful in meeting their care needs. People were observed to be treated with respect by staff and to have their privacy and dignity respected.