Orchard End

When we last visited the service we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was, at that inspection rated as inadequate.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well led to at least good. At this inspection we found the provider was no longer in breach of regulations, but still required further improvements and these needed to be sustained over a period of time.

There was a registered manager in post who was available throughout the 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.

The person living at the service was protected from harm as the provider had robust processes in place to ensure their safety. Staff supporting the person were aware of their responsibilities in relation to protecting them from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

The risks to the person's safety were clearly identified with measures in place to reduce these risks. The environment and essential equipment were well maintained and met the needs of the person who lived there.

The person was supported by well-trained and competent staff in sufficient numbers to keep them safe. Their medicines were managed safely and the person was protected from the risk of infection through good hygiene practices, and staff knowledge of reducing the risks of cross infection.

The person's needs were assessed using evidence based tools and their rights were protected under the Equality Act. Staff were supported with appropriate training for their roles. The person was supported to maintain a healthy diet, with staff showing good knowledge of their nutritional needs.

The person received support to manage their health needs through well-developed links with local health professionals.

Staff sought consent from the person before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). The person was 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.

The person was treated with kindness and care by staff who supported them with respect and dignity. Staff developed positive relationships with the person in their care.

The person was able to maintain relationships with people who were important to them and relatives felt their views and opinions about their loved one's care were listened to.

The care the person received was person centred and met their individual needs. However, when treatments had been changed for one of their health conditions the information had not been up dated in their care plan. The person was supported to take part in a range of social activities to prevent isolation. There was a complaints procedure in place and the person knew who to complain to should they have any issues.

The service was well led, the registered manager was visible and supportive towards the person, their relatives and the staff who worked at the service. The quality assurance systems in place were used effectively to monitor the majority of aspects of care. The registered manager and provider responded positively to changes and used information to improve the service and care people received.

The five questions we ask about services and what we found