About the service: The Orchard Trust - Sevenoaks is a care home and supported people with learning disabilities and/or autism.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. Ten people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and other large domestic homes of a similar size.

The service was divided into two homes/areas known as Larch and Rowan, each with its own communal rooms and facilties. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when accessing the community with people.

For more details, please see the full report which is at the CQC website at www.cqc.org.uk

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• Staff understood how to communicate with people effectively to ascertain and respect their wishes and preferences.

• People’s independence was respected and promoted. Staff prompted people during household tasks and activities, to enable them to do things for themselves and learn new skills.

• People's support focused on them having opportunities to be part of their community, meet others and maintain existing relationships.

We received positive feedback about the service and the care people received. The service met the characteristics of ‘Good’ in all areas.

• Risks to people had been assessed and plans were in place and followed by staff to keep people safe.

• Safe recruitment practices were followed to protect people from unsuitable staff.

• Staff were knowledgeable around safeguarding and understood provider policies and procedures in this regard. There were good links with local safeguarding bodies.

• Systems were in place to ensure people received appropriate support to take their medicines safely.

• Health and social care professionals guided staff to support people with their behaviour and epilepsy in accordance with national best practice guidelines.

• Staff received regular managerial supervision, felt supported in their role and received the training they needed to support people’s needs.

• All staff had a good understanding of the principles and application of the Mental Capacity Act. The Deprivation of Liberty Safeguards (DoLS) had been followed.

• Staff attitudes and behaviours were responsive, respectful and caring.

• People were supported through appropriate communication methods by staff that knew how to involve people in their own care.

• Interactions between staff and people demonstrated personalised, collaborative, action-oriented care planning and care delivery.

• There were processes in place to manage adverse incidents and complaints. There was evidence that learning from incidents and complaints was shared across the service.

• Effective quality monitoring systems were in place and regular audits and checks supported managers to identify concerns promptly to take action to improve the service.

• 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.

For more details, please see the full report which is at the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected The Orchard Trust – Sevenoaks on 9 November 2017. At the last inspection the service was rated Requires Improvement (this report was published on 19 January 2018). The provider had taken the required improvement actions and our rating of the service improved at this inspection.

Why we i

This inspection took place on 17, 18 and 20 October and 9 November 2017. It was unannounced and carried out by one inspector.

At the last inspection on 25 and 26 August 2016 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured staff received appropriate support or supervision to enable them to carry out their duties effectively. Systems to maintain accurate and contemporaneous records in respect of each person who used the service were not in place. The provider sent us an action plan telling us how they would meet these regulations by 18 November 2016. During this inspection, we found the provider’s improvement action plan had been completed and these requirements were met.

‘Sevenoaks’ is a care home which accommodates a maximum of 11 people in two connected units, with separate adapted facilities. People in care homes receive accommodation and nursing or personal care as single packages, under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection, 11 people with diverse and complex needs including learning disability, autism, sensory impairment and physical disability were living there.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the registered manager resigned their post before our inspection was completed. The provider’s head of support and operations told us they would register with CQC as manager of the service until a new manager could be appointed for the service.

During this inspection we identified breaches against two of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. Regulation 12 Safe Care and Treatment was not met. Improvements were needed to ensure people’s medicines were managed safely within the service. Temperatures in medicines storage areas were not monitored consistently, to ensure medicines were stored safely and staff did not always follow procedures in maintaining medicines records. The service was therefore again rated ‘Requires Improvement’.

The provider’s governance systems had not always been operated effectively and were not always sufficiently robust, to monitor and improve the safety of the service provided. Some managerial audits had not been carried out to monitor whether required standards were being met. Governance processes were not always robust enough to identify whether the systems in place were effective and to ensure external agencies had been informed of relevant incidents at the service.

You can see what action we told the provider to take at the back of the full version of the report. Following our visit, the provider sent us an initial action plan, on action already taken and actions they planned to undertake, to address the shortfalls we identified during our visit.

People benefitted from a service that worked closely with health and social care professionals to understand and meet people’s complex support needs. Staff understood how to protect people from harm and abuse. Risks to people's safety were identified and clear support plans were followed by staff. There were sufficient staff on duty and recruitment procedures were followed to protect people from the employment of unsuitable staff.

People were supported by staff who received on-going training and support to maintain or improve their skills and competency. 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. P

This was an unannounced inspection which took place over two days on the 25 and 26 August 2016. Orchards Trust – Sevenoaks provides accommodation and personal care for up to 11 people with a complex needs; such as a learning disability and a sensory or physical disability. Accommodation is divided into two distinct houses. People share some communal areas between the houses. The grounds around the houses are accessible and some areas are safe for people to use unsupervised. Additional facilities have been provided for activities and people have a range of play equipment such as swings they can use.

At the time of the inspection the registered manager had been promoted and had removed their registration from this location. 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. A new manager had been appointed and was going through the registration process with CQC.

People did not always have the support of enough staff to meet their needs and to ensure they could participate fully in their lifestyle choices. Staff had not received individual support meetings as scheduled and did not feel supported in their roles and responsibilities. People’s care records had not been kept up to date with their changing needs or reviewed as scheduled. During the inspection changes were made in response to our findings in medicines records, employment checks and submitting statutory notifications to CQC.

People’s care records were individualised and reflected their preferences and routines important to them. Staff had a good understanding of their needs and supported them with kindness, sensitivity and patience. When people were upset staff responded by offering reassurance or helping them to cope with their emotions by offering them a drink, music or space. Staff understood people’s preferred form of communication using sign language, music and objects to give them choices about they day to day lives. People’s personal space had been adapted to provide sensory environments which they could interact with. The gardens around their home also provided a stimulating space to spend time. People when able enjoyed going out to day centres, doing voluntary work or day trips. They used the provider’s swim gym and trampoline facilities.

People were supported by staff who had access to a range of training to maintain their skills and knowledge. They were able to complete training specific to people’s needs such as epilepsy and rebound therapy (trampolining). People’s rights were upheld. Staff had a good understanding of how to keep people safe and how to raise concerns. Accidents and incidents were closely monitored to make sure the appropriate action had been taken. A representative attended a Trust Our Voice Board which held managers to account and shared people’s experiences. People’s views were sought as part of the annual survey and during their reviews.

Quality assurance processes were in place which included feedback from people, relatives and staff. Visits by a representative of the provider had not been recorded and a new audit tool had been introduced to evidence any action being taken in response to their visits. Managers and representatives of the provider attended local networks ensuring they kept up to date with best practice and changes in legislation.

We found breaches 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.

We carried out an inspection on 11 September 2013 and published a report setting out our judgements. We asked the provider to send us a report of the changes they would make to comply with the standard they were not meeting.

We have followed up to make sure that the necessary changes have been made and found the provider is now meeting the standard included within this report. This report should be read in conjunction with the full inspection report.

We used a number of different methods to help us understand the experiences of people using the service. People using the service had complex needs which meant they were not able to tell us about their experiences in relation to cleanliness and infection control at the service.

When we visited the service on 20 December we found that the actions identified by the provider had been completed. Maintenance work was planned for one of the home's kitchens and some shower facilities which would make cleanliness in these areas easier to maintain. The provider was due to update their infection control policies in line with the current guidance.

On entering the home we found the atmosphere welcoming with good interaction between staff and people who used the service. We observed staff respecting people's wishes whilst understanding the care and support needed.

The people within the home had complex needs and we were unable to communicate directly with them. We spoke with family members and a visiting professional who said that they were "impressed with the knowledge of staff." We saw that people's rooms catered to their individual needs with some bedrooms being decorated with their personal belongings whilst others were minimal.

We looked at people's individual files which incorporated their care plans, risk assessments and health care needs. We found that they encompassed the safety and well-being of people who used the service.

Relatives and staff told us that they knew how to raise a concern or complaint and felt confident in doing.

The home had recruitment procedures in place which ensured that people employed had the necessary qualifications, skills and experience to support people who used the service.

We reviewed the quality of the service and noted that this was not conducted systematically with the last survey being completed in 2011.

We looked at the cleanliness and infection control procedures and found that the provider did not have adequate systems in place to ensure the safety of the people who used the service regarding the control of substances hazardous to health.

Prior to our inspection we had received information from an anonymous source via the Care Quality Commission (CQC) website, telling us that people were not always treated with dignity and respect and that staff training and managerial support was poor. We carried out this inspection in response to these concerns.

We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not able to tell us about all of their experiences. We spent time with people using the service, observed the care and support they were receiving and reviewed care records and quality assurance systems. We also looked at feedback relatives had given, spoke with staff and looked at staff supervision and training records.

We did not find any evidence to support the concerns raised. We found that people’s needs were understood by staff and they were supported to maintain their independence and to have access to the wider community. People were treated with dignity and respect and their care plans were current, personalised and detailed. Staff felt supported and well trained for their roles. Relatives were satisfied with the care provided at Sevenoaks. One relative said care was of “The highest degree. No concerns whatsoever.” Another said, “I am very happy with the standard of care it is excellent”.