Orchard House Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to seeking consent from people.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.At the time of our assessment there were 4 larger rooms at the home which could be shared. Six people were living in shared rooms. There was no evidence to show how their needs had been assessed to decide sharing a room with a person they did not know was right for them. Care plans contained no guidance for staff on how to support people sharing rooms in a personalised way which was considerate to their roommate. There was no guidance for staff around how to monitor the effectiveness of people sharing a room with others. There were no prompts for staff to consider when to review the effectiveness of people sharing rooms. For example, there was no evidence the time-of-day people liked to get up or go to bed, or how easily they may be woken by noise and light from others was reviewed or considered. This meant people were at risk of changes to their day and their care which were not appropriate or preferable to them. We were able to speak with some people who were sharing a room with another person. They told us they did not mind sharing a room. We saw some evidence that 1 person preferred not to be in a room alone. However, there was no evidence people’s views and wishes about sharing rooms had been sought or reviewed over time. Staff we spoke with told us they did not have the time they needed to read people’s care plans and relied on verbal updates and handovers in place of this. This increased the risk of people receiving inconsistent care which did not reflect their current needs and preferences. When reviewing care plans, we found some contained incorrect guidance. In these instances, staff we spoke with were aware care needs had changed, but records had not been updated to reflect this. For example, 1 person’s care plan stated they had a specific medical condition. However, when this was mentioned to the registered manager, they told us the person had been deemed to no longer have this diagnosis by their GP. These inaccuracies meant there was a risk staff would rely on written records and not provide the correct care to people. Care plans provided guidance for staff about their communication needs. Relatives told us they were regularly invited to participate in reviews of their loved one’s care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We saw varying levels of quality of care provided to people regarding support they received to eat and drink. We saw some people who could not eat without assistance being supported with patience to finish their meals. We saw some people had their meals taken when they had said they were finished, having eaten very little of their meal. We did not see in these cases, offers of other main meal options or encouragement to try their food. We saw some people were offered a choice of what to drink whilst others were not. We saw some people were not asked if they had eaten enough or if they wanted extra food or drink. We also saw that in a couple of cases, records about what people had eaten, and drunk were incorrect. We saw 2 examples of records showing people had eaten a lot more of their meal than they did. One record did not report the correct meal for a person or the correct amount they had drunk. We shared our observations with the registered manager. They said a particular member of staff was new and would be given more support and training to ensure the right care was provided to people. They also said they would put in place measures to check food and fluid records were accurate.

The staff team generally worked well with other services to make sure people received the support they needed. However, communication practices to ensure important information about people was always shared between teams and services could be improved. Most staff we spoke with told us they did not have time to read people’s care plans and risk assessments. This meant staff could not be sure they were fully aware of any changes to people’s care. Staff told us they relied upon sharing updates with each other to keep themselves updated. Staff knowledge about people’s care needs and risks was generally good. However, newer staff and staff who had been away from the service for a while were at risk of missing important updates which should be recorded in people’s care plans. We shared this finding with the registered manager who said they would look into allocating time for people to read care plans and risk assessments.

The provider supported people to manage their health and wellbeing. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. We saw examples of people showing significant improvement in their wellbeing following admission to the home. For example, during a hospital admission one person was assessed as needing end of life care. However, many months on they had shown significant improvement and end of life care was no longer deemed necessary. We saw people and relatives were involved in reviews of their care. One relative told us, “[My loved one] goes through her own care plan and makes any changes she sees fit.” Another said, “We get called for meetings over the care plan. They discuss everything with her.” People’s health was monitored, and action was taken early when things changed to try to prevent further deterioration. For example, everyone had their weight monitored. If a person’s weight had dropped, staff would seek medical support to review this change and take steps to try to help people regain weight.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff used evidenced based clinical guidance and tools to help them monitor people’s health and wellbeing. These tools helped them assess people’s needs around issues such as the health and condition of their skin and their possible risk of falls. These tools were used regularly to help staff monitor for any signs of deterioration. Care staff we spoke with told us about how they would look out for any signs of a person’s health deteriorating. Care plans also gave staff guidance about what signs to look out for, for example how to identify if a person’s skin was at risk of becoming sore or damaged. One relative told us about the improvement they had seen in their loved one since moving to the home. They said, “[My loved one] looks well, she is better than she has ever been.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Assessments for people who were being considered for room sharing did not evidence their consent to sharing a room with another person. Some of the people living in shared rooms could not consent to do so as they lacked capacity to make more complex decisions. Capacity assessment for these decisions were in place but were not in line with the Mental Capacity Act (MCA) 2005. They did not detail whether a less restrictive option than sharing with someone else was possible. They did not demonstrate how the person’s wishes, beliefs and preferences had been considered. We discussed this with the registered manager who told us formal consent would be sought from those who could give it. They also told us they would review the capacity assessments and best interests’ decisions for those who could not consent to room share and would make sure they were in line with the MCA 2005. We also found that closed circuit television (CCTV) had been installed in shared areas of the home, including the lounge, dining and hallway areas. There were no cameras in bathrooms or people’s bedrooms. We saw no evidence that the introduction of these cameras into people’s home was done with their consultation or consent. This meant people’s right to privacy had not been respected and they were at risk of unwanted and unlawful restriction. We reviewed care records for a person who could get distressed sometimes during personal care. The guidance for staff did not include recognition that distress, for people who cannot easily verbally communicate their needs, can be a way of refusing care. However, when we spoke to staff, they did show an understanding of this. We saw staff seeking consent from people to attend to their daily care needs. Care staff were able to tell us about the importance of seeking consent and whet steps they would take if a person refused consent to a care intervention.