Orchard House Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service was in breach of legal regulation in relation to the effectiveness of governance and quality assurance systems and processes.

This service scored 54 (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 have a clear shared vision, strategy and culture within the staff team. An important aspect of the care provided at the home was a concept called ‘Namaste care.’ This is included on signage and staff uniforms. Some staff were able to describe what this concept meant and how it translated to people’s care. However, other staff told us they did not understand what Namaste care meant or only had a partial understanding. We spoke with the registered manager about this who told us all the staff should understand. They explained the concept was an important part of the vision of care being offered to people. They told us they would add this to the induction to make sure all staff understood when joining the service. Although we saw examples of people’s diversity and equality being recognised and respected, the rights and views of people were not always considered regarding sharing rooms and the installation of CCTV. The registered manager told us about work the team had been doing alongside the local authority commissioning team, to focus on cleanliness and infection to control. Staff we spoke with understood what changes had been made and why they were important. All the staff we spoke with agreed on the importance of protecting people with safe and hygienic care practices.

The provider did not have sufficient oversight of the service to identify the key concerns we found during inspection. The registered manager told us the provider was very supportive and in frequent contact. However, they had not ensured the registered manager had the knowledge and understanding to have effective oversight of some aspects of people’s care. This included appropriate knowledge and understanding regarding the use of CCTV in the home, people’s rights under the MCA 2005 and how this informed consent to care. This meant staff teams also did not have the knowledge and understanding in these areas which impacted directly upon the care people received. The staff team told us the registered manager was always available if needed either in the home or by telephone.

Not all staff felt confident to speak up when things went wrong. We saw a couple of examples of equipment being damaged which was not reported to the registered manager in a timely way. Staff gave mixed responses on what they would do if something went wrong. Some told us they would tell a nurse; some said they would be worried to tell the manager. We saw documentation from a staff meeting and from a group supervision which addressed with staff when things had gone wrong. The documentation did not invite open debate or encourage staff to speak up if the proposed solutions were not practical or could be improved. We saw there were opportunities for staff to share feedback both formally and informally. However, we did not see evidence staff were actively encouraged to raise concerns. We saw complaints were logged and investigated. People and relatives told us they knew how to raise a concern or complaint if they needed to. Most people and relatives we spoke with told us they had not had cause to raise any complaint. One relative we spoke with told us they had raised concerns which had not been addressed. We shared these with the registered manager who said they would look into the issue.

The provider valued diversity in their workforce. The registered manager told us about guidance and support they gave to some staff whose first language was not English. The workforce supporting the home was diverse. The workforce ranged more in diversity than the people they supported or the local community. The registered manager explained they had recruited many new staff since joining the home. The diversity of the workforce reflected the candidates who had applied and successfully been recruited. We saw no evidence of discriminatory practices. We saw that risk assessments were completed when necessary for example when staff were pregnant, to ensure tasks were safe and appropriate.

The provider did not always have clear and effective systems in place to make sure care was consistently safe and effective. Systems did not support leaders and staff to identify some of the risks we found during our inspection. For example, systems did not identify the failure to monitor call bell responses and ensure people were receiving a consistently timely response. Systems did not identify some aspects of the safety of the environment had not been assessed to ensure risks were mitigated. Policies and procedures were not in place to guide staff in the use of CCTV to ensure safe and least restrictive practice. Policies to ensure people were adequately assessed and monitored to share rooms were not in place. Checks and oversight of the care provided did not identify it was not always person centred and tailored to people’s individual needs. We shared these concerns with both the provider and the registered manager. Some changes were made by the registered manager during the inspection to address the safety of the environment. We saw information of concern was shared consistently with external organisations such as commissioners and the safeguarding team.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly wherever possible for people. Commissioners told us the staff and management team had worked to improve in some areas of care identified. External health professionals spoke positively about the care team and praised their effective communication. We saw evidence of the staff team working in partnership with a wide range of health professionals. These included the tissue viability nursing team (TVN), occupational health, social workers, the speech and language therapy team (SALT), the local GP and the pharmacy. Care staff also accompanied people if needed to attend appointments in the community.

Although we saw the staff team were supported with induction and ongoing training, we saw areas where improvement was needed to maximise learning opportunities. We spoke with the provider and the registered manager about the potential reluctance of some staff to report when they had made mistakes and when things had gone wrong. They agreed they wanted the staff to feel they could report errors and issues quickly and feel safe and supported to do so. We saw examples of improved practice as a result of staff suggestions. For example, a staff member had proposed the introduction of key workers for people. Other staff and some relatives we spoke with told us this was a positive change. Staff explained it made sure checks were completed to confirm people had everything they needed day to day to receive good care. We did not, however, see examples of leaders encouraging reflection and collective problem solving. Staff failure to report damage to equipment in a timely way meant people were at potential risk for longer than necessary. The registered manager told us they would reassure staff they were safe to share concerns and say when things had gone wrong. The registered manager was aware of links to other external support for registered managers across the city but had not been able to make good use of these networks due to workload. Opportunities to meet with others who provide leadership in care could improve learning opportunities and help the registered manager keep up to date with changes and improvements in care practices.