This unannounced inspection took place on 11 July 2017.

Orchard Close is a 14-bed service providing support and accommodation to people with mental health needs. At the time of the inspection 12 people were living there. The service is made up of two large houses in a residential area close to public transport and other local services. Each house accommodates up to seven people.

At our last inspection on 14 and 15 January 2016 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 ongoing monitoring that demonstrated serious risks or concerns.

The service had a registered manager in place. 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 remained safe at the service. There were systems in place to minimise risks and to support people to live as safely as possible. People using the service received their prescribed medicines safely and appropriately from staff who had been trained to administer medicines correctly. Staff knew how to identify abuse and what to do to safeguard people. Safe staff recruitment practices were in place.

Staff had the right skills and knowledge to work in their roles. They were inducted into the service and received relevant training in health and social care whilst employed. People’s needs and choices were assessed effectively by the service. Staff knew people’s needs and preferences and could support them. People were supported to maintain a balanced diet.

Staff communicated with each other to provide effective care for people using the service. People were supported to maintain good health and the provider had good links with healthcare services. People were supported to have maximum choice and control of their lives.

People at the service were treated with kindness and respect. All people we spoke with told us the staff were caring. People at the service were independent and able to do things they liked and wanted to do. Their privacy and dignity was respected by staff. Staff at the service respected people’s confidentiality. People’s personal information was kept securely in locked cabinets or on password protected computers. People at the service made decisions about the service and the support they received.

People at the service receive personalised care. Assessments covered people’s cultural and spiritual needs as well as their mental and physical health needs. The staff team knew the people well and what their needs were and how to respond to them. People were confident about raising concerns and complaints to the service and knew these would be responded to as needed.

The management of the service were well thought of. Staff told us they enjoyed working at the service, that they were supported and that it was managed well. People, their relatives and staff could direct and influence the way the service was run. The registered manager told us the service was involved with the local community. The provider used different systems to ensure that the quality of care, performance, management of risks and regulatory requirements were of a good standard and met.

This unannounced inspection took place on 14 and 15 January 2015.

Orchard Close is a 14 bed service providing support and accommodation to people with mental health support needs. At the time of the inspection 11 people were living there. There are two large houses in a residential area close to public transport and other services. Each house accommodates up to seven people. The ground floors of both houses are accessible for people with mobility problems. There are also accessible shower facilities in both houses. People live in a clean and safe environment that is suitable for their needs.

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 were safe at the service. They were supported by caring staff who treated them with respect. Systems were in place to minimise risk and to ensure that people were supported as safely as possible. A care coordinator told us that the manager was “on the ball” and made sure everyone was safe.

Systems were in place to ensure that people received their prescribed medicines safely and appropriately. When appropriate people were supported to take more responsibility for their own medicines.

People were supported by staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices and to provide an effective and responsive service.

The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed both in terms of their physical and mental health needs.

A social worker told us that staff had proved to be caring and friendly in their approach to working with people.

People were protected by the provider’s recruitment process which ensured that staff were suitable to work with people who need support.

People lived in a clean environment that was suitable for their needs. Improvements were needed to some of the bathing facilities and the provider was in the process of identifying funding to address this.

Staff supported people to make choices about their care. Systems were in place to ensure that their human rights were protected and that they were not unlawfully deprived of their liberty. Staff had received Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training. Deprivation of Liberty Safeguards is where a person can be deprived of their liberties where it is deemed to be in their best interests or for their own safety. Staff were aware that on occasions this was necessary. We saw that this was not thought to be necessary for any of the people who used the service.

People were encouraged and supported to maintain their independence and develop their skills. A care coordinator told us that people were empowered and encouraged to “do things.”

People were happy with the food provided and told us that they had access to drinks and snacks when they wanted these.

People were actively involved in developing their care plans and in agreeing how they should be supported.

The registered manager and the provider monitored the quality of service provided to ensure that people received a safe and effective service that met their needs.

At the last inspection of the service in November 2013 we found arrangements to manage medicines were not robust enough to ensure people were protected from the risks associated with medicines. On this follow-up visit we found that the provider had reviewed their medication administration procedures and changes had been made to ensure people received their prescribed medication safely. For example, protocols had been put in place to clarify when and how people’s 'as required' medication was to be administered. The required standard was met.

People were treated with respect and their care, health and welfare needs were met. They were supported and encouraged to be as independent as possible. One person told us “I like living here, the staff are very helpful. Everything is good.” Another person said “I am comfortable here and I feel safe. Staff help me with problems when I am not well.”

The arrangements to manage medicines were not robust enough to ensure people were protected from the risks associated with medicines. For example there was not clear guidance for staff as to when it was appropriate to administer “as required” medication and this placed people at risk of not receiving this medication safely or appropriately.

Staff received the training and support they needed to carry out their duties and to support people who used the service. A member of staff told us “there’s lots of training and regular supervision. You can discuss issues openly and I feel free to raise issues.”

People were protected from the risks of unsafe or inappropriate care because accurate and appropriate records were maintained.

When we visited Orchard Close we observed the environmental conditions of the buildings and the external areas as well as taking into account staff group interactions.

People who use the service generally spoke highly of the staff group and there was an awareness of the issues of choice, autonomy and advocacy. One person said that the staff were "very very good" and another said that they were "quite happy here". Another person said that the "staff always have time for you".

We also looked at the records held on site which demonstrated that individual needs were being assessed and reviewed on an on going basis. From the records and discussions with staff we noted evidence that the issues of choice and consent to care and treatment were being discussed and recorded appropriately.

People who use this service and their relatives were very positive about the care and support they received at Orchard Close.

People said:

“Staff are very good and it is quite flexible. You can more or less do what you want”.

“It’s all right, the food is all right and the staff are all right. Not much to complain about. Staff treat people properly. Staff looked after X well”. This referred to a person who had passed away recently following a long illness.

“It’s like living as a family unit. Key workers help with problems. I have got a good key worker who helps me sort things out. Staff treat people well. RCHL (the provider) are a good company and caring”.

“Yes I get help and support and staff do a difficult job. They treat people respectfully. You can come and go as long as you tell them what’s going on”.

A relative told us, “The service is very good and I feel that my son is fortunate to be moving in here. I think that it will be a good move for him. The staff are good”.