Rose Orchard 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.

Rose Orchard accommodates five people in one adapted building. There were five people living in the home on the day of inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place 19 July 2018 and was unannounced. We gave the provider 48 hours’ notice of the inspection visit because we needed to be sure someone was available.

Rose Orchard has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People continued to be kept safe from staff who had the understanding in how to protect them from harm. Staff had identified potential risks to people and had put plans in place to support the person to reduce the risk without taking away people’s right to make decisions about their care. There were enough staff with the right skill mix to support people’s care needs. People were supported with their medicines in a safe way. Staff understood the importance of reducing the risk of infection to keep people safe.

People continued to have their care and support needs effectively met. Assessments and reviews of care were done regularly and alongside external healthcare professionals. People were supported to with their nutrition and hydration in a way which kept them well and healthy by staff who were competent to do so. 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 support this practice.

Staff treated people in a kind and considerate manner. People were treated with respect and their dignity and privacy was maintained. Staff helped people to make choices about their care and the views and decisions they had made about their care were listened and acted upon.

People received personalised care which met their needs in a timely way. People were supported to continue with their hobbies and interests which was in line with their preferences. The provider had a complaints process that was shared with those who used the service. The provider had not received any complaints about the service provision.

People and their relatives were happy with the way the service was run. The registered manager worked alongside their staff team to ensure they were working within the providers values. The culture of the service was an open and transparent. People and relatives were listened to and had the opportunity to raise their suggestions and ideas about how the service was run. Staff worked well as a team and were supported by the provider to carry out their roles and responsibilities effectively, through training and regular contact with the registered manager. Staff felt involved in the service and said they felt able to share their ideas about the way in which the service was run. We found checks the registered manager and the provider completed focused upon the experiences of people to make sure there was a focus on continuous development.

This inspection took place on 28 January 2016 and was unannounced.

The provider of Rose Orchard is registered to provide accommodation with personal and nursing care for up to five people with learning disabilities. At the time of this inspection three people lived at the home.

The registered manager was in post and they were present at our 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 were supported by staff who knew how to recognise and report any concerns so people were kept safe from harm. There were sufficient staff on duty to respond to people’s individual needs at the times they needed support. People were helped to take their medicines by staff who knew how to manage these in line with safe principles of practice.

Staff respected people’s rights to make their own decisions and choices about their care and treatment. People’s permission was sought by staff before they helped them with anything. Staff made sure people understood what was being said to them by using a range of communication methods. These included gestures, short phrases or words. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and were authorised to do this.

Staff met people’s care and support needs in the least restrictive way. Where it was felt people received care and support to keep them safe and well which may be restricting their liberty the registered manager had made applications to the local authority. These actions made sure people’s liberty was not being unlawfully restricted.

Staff had been supported to assist people in the right way which included helping people to eat and drink enough to stay healthy and well. People had been assessed for any risks associated with eating and drinking and care plans had been created for those people who were identified as being at risk.

People were supported to access health and social care services to maintain and promote their health and well-being.

People were treated with kindness, compassion and respect. There were many examples of staff showing they cared for people and appropriately used the warmth of touch. Staff promoted what people could do and supported people with dignity when they needed assistance. People’s right to private space and time to be alone and with their relatives was accepted and respected.

People indicated to us with verbally with a mixture of words, facial expressions and body language they were happy with the support they received from staff. People received care and support to meet their diverse needs including their complex health conditions. Staff offered people the opportunity to pursue their interests and try different things for fun.

There were good arrangements in place for receiving and resolving complaints which took into account people’s individual needs.

The views of people who lived at the home and their relatives were sought to develop the service and quality checks had also been done to make improvements. The registered manager had strong values about encouraging inclusive opportunities for all and people benefitted from staff being involved in good practice initiatives.

We inspected Rose Orchard and spoke with some of the people who lived at the home and with some of the staff on duty. We spent some time in communal areas and observed the interaction between staff and people who used the service.

We looked at care records for two people and other supporting documents for the service. Staff told us they: “Always ask people if they are happy with me giving care before I give it”.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs. People told us they were: “Happy” with the staff who worked at the home.

We saw that people appeared comfortable with the staff that supported them. We saw that staff were kind and caring in their approach to people who lived in the home. Recruitment procedures were in place to make sure that suitable staff were employed to care for people.

There was a complaints procedure in place at the home. The registered manager told us this procedure would be followed in the event people had any comments or complaints.

Rose Orchard is a nursing home for five people with severe learning disabilities. We spoke with two people who lived at Rose Orchard. The two people we spoke with had limited verbal communication. Both people said they were happy at Rose Orchard and said that they felt safe.

While we were at Rose Orchard we conducted a Short Observational Framework for Inspection (SOFI). SOFI is designed to be used when we visit a service were people cannot reliably give their verbal opinions on the services they received. SOFI is used to observe peoples experience of care first hand by observing staff interaction, staff engagement and their mood. The SOFI highlighted to us that care staff were kind and caring, engaging positively with all of the people that we were observing during the period of time.