The Orchard

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the provider and manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People had complex care needs and limited verbal communication and relied on other ways of communicating their needs and preferences. Staff had assessed people's specific communication needs and were familiar with the ways people communicated. People were able to get involved in a variety of activities with staff support. Staff observed people's reactions which indicated whether they enjoyed particular activities. Staff encouraged families to tell them about any concerns or complaints. People could remain at The Orchard when heading towards the end of life, with familiar people to support them.

People were helped 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. Staff assessed

people's capacity to make decisions and supported them with decision making. People saw healthcare professionals promptly to assist their health and wellbeing. Staff supported people to receive sufficient nutrition and were familiar with people's dietary needs. The design of the home met people's needs. Staff had been appropriately trained and supported and had the skills, knowledge and experience to provide good care.

The service applied the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff provided care that met people's different needs and preferences. People and their relatives were involved in planning their care and encouraged to make decisions. People indicated they were happy with their care. Relatives said their family member was treated with respect and consideration.

People indicated staff involved them in decisions and asked them for their views. Relatives told us staff listened to and acted on these. The registered manager worked in partnership with other services and organisations to make sure they followed good practice and people in their care were safe. The management team monitored and audited the service to check on the quality and make sure staff were providing good care. They understood and acted on legal obligations, including conditions of CQC registration and those of other organisations.