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 Requires Improvement. At this assessment the rating has improved too Good.

The culture of the service had improved and was positive, and one where learning was part of everyday practice. The manager was available and approachable to staff, people and families. The staff team said they felt valued and well supported in their roles, that communication had improved and, things had settled down. They felt enabled and able to ask anything and make suggestions for improvement of the service. There were systems in place to monitor the quality of care.

This service scored 68 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff spoke of the vision of the service, they told us enjoyed working at Orchard House and were very proud of the care they delivered. One staff member said, "We have come a long way in the last few months, it was a real change going into nursing, a new manager, but things are now going well, I have learnt a lot, we are now a tight team. Values of the service is about continuity of care, I love working here, I nearly left last year but I am definitely staying now, good team to work with, supportive and knowledgeable."

We were told that the new management team listened, and that it made them feel valued as a staff member. They also said that the manager was very knowledgeable professional and committed to her role. A staff member also said, "Lots of new strategies in place, real improvements seen and I have learned a lot from them."

Processes were in place to promote a positive learning culture at the home and ensure staff and management had the same shared direction. The management team spoke of their vision for the service and how they shared this with staff through supervisions and team meetings.

Staff were supported to gain qualifications and extend their role, for example, becoming a champion. Staff were supported to be become champions of different areas of care such as oral health and infection control.

The manager and staff received training in equality and diversity this had ensured that any inequalities were identified and immediately actioned. Staff felt that they could approach the management team if they had changes in their life that impacted on their current role, and they would be listened to and supported. Any risks to the service, interruption to normal service and delivering of care were discussed with staff, people and families and an action plan put in place to ensure safe care delivery.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff told us the management team were approachable, supportive and promoted an inclusive work environment. Staff admitted the changes had not gone smoothly and that it had been an unsettling time, but it had settled. Staff said the teamwork was good and they all worked together to learn and deliver the 'best care'. One staff member said that they had learnt a great deal in the last few months under the new leadership. Other staff comments included, "The manager gives good support, I can definitely go to her and the provider." and "I love coming to work here."

The manager operated an open-door policy and ensured that they spent time on the floor meeting people and staff. A newly appointed clinical lead was in post, and they were supernumerary but also worked on the floor. They had a good knowledge of all the staff and knew their strengths and weaknesses. There were systems and processes in place to support staff development and progression within their roles. Regular supervisions, spot checks, competencies and values-based supervisions took place. All senior care staff have had supervision training to enable to undertake supervisions with their team. This had improved communication. Every morning leaders of different roles met to discuss the day, any problems and to check in with each other. The provider visited the home regularly and provided support and supervision to the manager. The manager told us she attended organisational manager meetings which enabled learning across the organisation to be shared and relevant lessons learnt implemented within the home. The provider supported the manager and staff to attend external training and meet with other providers and managers to network through various forums.

People had not always felt they could speak up and that their voice would be heard.Staff had not always felt confident or free to speak up. Staff told us they would raise concerns that were related to people and their care to ensure safety. However, they would not raise other concerns to the management team as they had felt that they were not listened to.

However, from talking to staff during the inspection process, we were confident that the new leadership had lowered barriers and staff told us, “We can go the manager and provider, things are much more open now, I feel supported.”

The manager told us they had an open-door policy where staff could talk to them at any time. There were staff meetings and supervision. During the inspection process the provider told us about new measures that had been implemented to support staff and regain their trust and confidence.

There were whistleblowing and safeguarding policies in place and staff understood both the responsibility they had to use them, and how to use them.

Staff told us that felt able to raise concerns. The provider and manager understood their responsibilities under the duty of candour. The Duty of Candour is to be open and honest when untoward events occur.

Since the manager was appointed, we have received notifications as required. We were not fully assured that we had received notifications prior to that for some months due to lack of documentation. During our assessment, we found that the management team were open and transparent about the difficulties of mislaid files and documents during the change of management team. They admitted things had gone wrong in this respect and demonstrated how they had used these to make improvements.

People and their relatives confirmed they knew how to complain, and a copy of the complaints policy was available in the home and on the service website. Relatives told us; they would make a complaint if they needed to but would talk to staff first. There were no records of any complaints, and a new record of complaints log had been introduced in the service.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The manager said that the mental health and wellbeing of staff were regularly discussed since the change of management to ensure staff felt supported through changes. The home was proud to be inclusive and supported both staff and people that used the service. The manager said the staff team was multicultural and everyone was respectful of each other.

Staff felt they were treated as individuals and their needs were taken into consideration, such as shift times being re-arranged to fit in with family commitments if required.

The provider had procedures in place to promote staff well-being and worked to ensure flexible working conditions if required. There were robust measures in place to monitor, maintain and promote good mental well-being across the staff group. There was a formal recruitment process and equality, diversity and inclusion policy in place to guide equitable and fair recruitment and selection procedures. Staff were encouraged to undertake training in equality and diversity.

The provider had clear responsibilities, roles, systems of accountability and good governance. However, the systems had not been robust enough to raise awareness with the provider when there were issues within the service.

At the beginning of the year the provider contacted us to share the outcomes of a recent audit undertaken in December 2024 by the newly appointed manager. The audit identified areas of concern which reflected concerns raised by whistle blowers. An action plan was supplied at that time with actions immediately taken and actions with a planned date of completion. The introduction of providing nursing care had also been a concern. This issue had been resolved with the appointment of a clinical lead and dedicated nurses.

There were now robust quality assurance and governance systems which had been used effectively to improve, sustain and consistently develop the service. It was acknowledged there was still a lot of work to do, to ensure care plans and risk assessments were up to date and reflected peoples’ needs in a person-centred way. There were some shortfalls in the maintenance records for hot water temperatures and the frequency of fire drills needed to be reviewed to ensure staff were confident and competent. Staffing levels needed to be reviewed to ensure peoples nursing needs, especially when approaching end of life, were met.

The management team worked well as a team to ensure there was oversight and effective governance at the service. There were computerised systems and processes to assess, monitor and improve the quality and safety of the service provided. This included health and safety, accidents, incidents, complaints, medication management and staff documentation. Staff were knowledgeable and could tell us of safeguards put into place to mitigate risk, low level beds and sensor mats.

We discussed individual peoples’ daily notes as they were minimal and did not reflect staff interaction and peoples’ mood. This had been identified through audits and was being monitored, and staff were being given guidance on how to add this vital information to the computerised system.

The manager demonstrated a good understanding of the regulatory requirements. Staff understood their role and responsibilities. They all had job descriptions, contracts and received support from the management team to ensure they had the necessary training. Training was on going and the manager reviewed training monthly to ensure staff were up to date and completing the training.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Not everyone was able to share their experiences, but those that could told us, "Staff help me keep in touch with family and friends," and "I'm going out today, to an appointment." Relatives told us," Activities are very good here, the activity person is lovely and engaging, some people do not actively join in, but they seem to enjoy being there, it’s always a good feeling in the communal lounges."

We were also told by relatives that their loved ones had appropriate referrals to other health and social care professionals when required.

The manager told us how they worked with other healthcare professionals to ensure continuity of care. Health and social care professionals visited the home regularly and were able to assess people following their admission to the home from hospital or their own home. Staff had access to the tissue viability team, falls team, dieticians and other specialist services as necessary.
The leadership team engaged with local partners to ensure that they were kept up-to-date on best practice. One health care professional said, “I visit people there, staff are proactive in asking for support when needed in a timely manner.” Another said, "Communication has improved over the past few months, Staff are good at contacting us when needed, they manage people well."

People received ongoing support from various external health and social care professionals who represented them. Staff and leaders understood their responsibilities to work in partnerships with external care professionals to ensure people received joined up care.

There was evidence in the care plans and daily notes the provider had liaised with various health professionals to ensure safe care and treatment for people living in the service.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Discussions with the management team and staff demonstrated they recognised the importance of learning lessons and continuous improvement to ensure people received care and support that was safe and effective.

People and their relatives had opportunities to feedback their views about the service and quality of the care they received. People and relatives all described the staff and management of the service as open and approachable. Staff told us they had opportunities to drive improvements and learnt from incidents which occurred. The provider and manager had oversight of accidents and incidents. Trends and patterns were identified and addressed. For example, introduction where appropriate of crash mats and sensor alarms. We were given examples of lessons learnt following incidents which occurred within the service. Reflective meetings were held with staff to give opportunities to discuss development points to encourage improvement in practice. The manager encouraged staff to speak up about positive ideas.