Orchard House Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to ensuring people’s care was personalised and tailored to their specific needs.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although people were involved in reviews of their care, more could be done to ensure care was person centred. We saw some people’s rooms were bare and lacked any personalisation such as art, photographs ornaments and furnishings reflecting people’s preferences. For some people little effort had been made to help people feel their room was their own personalised space. Little effort had been made to personalise people’s doors to help them orientate themselves in their home and identify their own room. Most doors had simply a name and a room number upon them. People living with dementia may not be able to use a number and their name to help them identify their room. Some rooms which were occupied did not even have the occupant’s name on them, with no evidence this was the person's preference. The registered manager told us the activities team were working to help people label their rooms in ways which reflected their identity and their preferences. Most relatives told us they felt staff knew their loved ones well and supported them in line with their specific needs. One relative told us they had asked for their loved one to have additional help in adjusting to a change in their care with which they were struggling. They told us this extra support had not been provided. We spoke with the registered manager about this who said they had not been aware of the request but would make sure the extra support was provided. Records showed 1 person was using the call bell a lot throughout the day. The registered manager told us the person had emotional needs which could be met by more frequent contact with the staff team. The registered manager told us about a change which they had proposed to the person’s care to help them feel closer to the staff team, which the person declined. There was no evidence any other steps had been taken to consider ways to meet this person’s needs. Following our discussion, the registered manager made some changes to the person’s care which were met positively by the person. People’s care plans did contain some information about their lives, wishes and preferences to help staff learn about them. However, staff we spoke with indicated they did not have time to refer to people’s care plans. Care staff we spoke with could tell us about the ways in which people preferred to be supported.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported continuity. We saw evidence people were supported with a variety of health needs, from tissue viability to the speech and language therapy team (SALT). People were supported by regular visits from their local GP whom they spoke positively about. Staff coordinated care with other health professionals to ensure instructions and recommendations were followed.

We found the provider generally supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Most of the relatives we spoke with praised the communication of the staff team. One relative told us; “Communication is outstanding.” However, one relative told us they felt staff could take extra steps to ensure effective communication with their loved one. We shared this feedback with the registered manager. Information was displayed around the home in pictures and symbols to support communication with people living with dementia. For example, information about the day, date and time was always clearly presented to help people orientate themselves to time and place. Information about the meal options available was always accurate and showed large visual images of the choices people could make. Activities available for the month were also presented in picture and symbol format. Picture cards were available to aid effective communication.

Overall, the provider took steps to support people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care or tell them what had changed as a result. People and relatives we spoke with told us they knew how to raise a complaint. Most relatives we spoke with told us they felt if they raised concerns they would be listened to. However, we did not see any evidence of information about to complain or complaints forms in an easy-read format. This would, for example use pictures and symbols to explain how people would be supported to raise a concern or complaint. This meant more could be done to support people living with dementia in understanding their right to complain and what action they could expect to see in the event of raising a concern.

The provider made sure that people could access the care, support and treatment they needed when they needed it. Adaptions had been made to the building to ensure people living there could access the areas they wanted to. People were provided with equipment which was maintained safely to enable them to move around their home and be comfortable. Equipment to enable people to sit out of bed was used to promote their ability to leave their room and mix with others if they wanted to. Equipment was used to help people eat their meals and drink independently with others. Efforts were made by the staff team to ensure communication with people and with health professionals was effective, to promote timely and appropriate care.

The staff team generally listened to people and their loved ones and made efforts to ensure their views were considered. Surveys were created for people to seek their views on the quality of care provided. People who might struggle to complete these were supported by loved ones where possible. The opportunity to give anonymous feedback was provided by the use of a feedback box in which people could anonymously post comments, praise and suggestions. We saw evidence of changes made as a result of suggestions and requests. For example, the conservatory area was generally used as a quieter area of the home and people often took their visitors there for some privacy. Relatives had commented that it would be nice for there to be more comfortable seating for them and this had been purchased. The registered manager also told us they would speak to people about meal choices before designing the next season’s menus. They would add meals if people wanted them. They also noted any meals which seemed to not be well received and removed them from the menu if people were not enjoying them. In this way, even if some people could not communicate their views about meals verbally, their response to them was noted. Meetings were held for people and relatives. However, some relatives told us, and records suggested that these were not always opportunities to ask questions or raise concerns. We spoke to the registered manager about this. They explained that the quarterly meetings were accompanied by seasonal celebrations to bring together friends and family. There was not always a lot of time to answer questions. However, the registered manager did invite people to come to speak to them privately and advised that loved ones were invited to all care reviews and asked for feedback alongside those receiving care.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Care plans showed that people’s wishes about end of life care had been discussed and recorded. They were also consulted about their possible need for future emergency care and treatment. This information was stored so staff could access it easily in the event of an emergency. At the time of our assessment no one was receiving end of life care. Staff had received training in end-of-life care. Records showed previously pain management medicines had been sought and stored for people in case they needed them.