Orchard Manor Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 60 (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 treat people with kindness, empathy and compassion, or respect their privacy and dignity. In some people’s care plans, guidance around appearance, emotional support, and communication were limited and generic, with limited guidance on how to maintain dignity or individuality. For example, one person’s continence care plan did not clearly say when staff should offer support. Personal items and continence products were found left out in communal areas and people’s rooms in full view, compromising dignity and confidentiality. Privacy was not always respected due to inappropriate observation windows in some people’s bedroom doors. Although some observation windows had netted curtains on them, we could still see through them into people’s rooms. We observed several people wearing soiled clothing. Examples of isolated unkind interactions with staff were described by people. We fed this back to the provider who took immediate action to investigate. A relative told us they had found their family member had been left for an extended period without being changed, resulting in a noticeable smell. When they raised this, they felt staff did not respond sensitively to their concern and were dismissive. Some relatives raised issues with missing belongings and staff not caring about ‘the little things that matter to people’. One relative described staff interaction as sometimes ‘childlike in tone’, which did not promote dignity. Professional partners told us people were treated with dignity and respect. Comments included, “Staff are patient and kind” and “They respond with credit in demanding situations.” Staff emphasised the importance of person-centred care, dignity, and respect and were able to give us practical examples around assisting people sensitively, respecting autonomy, and understanding preferences. People’s care plans included personal details such as their preferred clothing and routines. Some people’s care plans were comprehensive and compassionate, referencing people’s faith, family relationships, and emotional needs. Most people and relatives spoke positively about the kindness of staff. Some relatives highlighted acts of compassion, such as washing a person’s gifted item before returning it clean, and staff ensuring a person could attend an event that was important to them. Other comments included, “The carers seem, without exception, to be very kind and attentive” and “From residents arriving to residents sadly passing, they receive person-centred care from start to finish.”

The provider took steps to treat people as individuals and make sure people’s care, support and treatment met people’s needs and preferences. They made efforts to take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. Staff expressed pride about supporting dignity and individuality. One staff member told us, “We strive to personalise our involvement to the benefit of each resident. Each resident is wonderfully unique. ”Activity coordinators showed us there were lots of resources for activities, both for group and one-to-one sessions with people. Some people’s care plans showed autonomy was supported, for example, allowing people to choose meals and where they wished to eat. Activity records showed flexibility for people who did not enjoy group sessions. Some people’s care plans contained strong life-history information. One person’s plan described their love for their hobby and the importance of regular visits from their relative. Although care plans reflected individuality in areas such as nutrition and end-of-life preferences, several people’s emotional-support sections used generic wording, such as ‘allow time to talk’ and ‘offer reassurance’. They did not describe what distress looked like for each person or the specific strategies that helped them. While more person-specific information about distress and de-escalation was recorded in some Positive Behaviour Support Plans, this was not consistently reflected within the emotional-support sections of care plans. For example, one person’s lifestyle plan stated they ‘enjoy chats and music’, but there was no detail about what type of music they liked or how staff could provide emotional support when their relative was not visiting.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing. While staff understood the importance of enabling autonomy, we observed opportunities to promote people’s independence were sometimes missed, for example, social engagement, managing hydration needs and personal care. Some relatives felt their loved ones did not have enough independence or stimulation. One relative told us their loved one’s routines, such as bathing, were unclear and they were unsure whether choices were genuinely offered or influenced by staffing levels. One relative said, “There isn’t much going on, certainly nothing for those in bed.” The provider shared activity plans and records that showed activities, including bedside engagement, were offered. Some relatives described positive support for independence, including people who no longer had capacity being helped to get up, showered and dressed in the way they would have chosen. One relative said, “[Name] can’t get out of bed, but staff make sure he gets up in the hoist, showered, and dressed smartly as [Name] would have wanted.” Some people’s care plans showed examples where staff did promote autonomy. One person was supported to complete upper body hygiene and some personal tasks independently, with staff providing help only when needed. Some people were supported to choose whether they wished to dine privately in their room.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. While many people said they were looked after well, we observed variation in people’s experience across the service. Some people were up and moving around the home and engaged with staff, while we found, and people reported, being in bed for long periods without stimulation. Some people were cared for in bed following assessment; however, they lacked stimulation and engagement during these periods. We found some people’s care plans lacked defined steps for de-escalation or clinical review. Some people’s care plans relied on vague phrases such as ‘provide reassurance’ without defining when or how staff should escalate if a person became distressed or withdrawn. One person said, “I don’t have any engagement.” People and relatives reported staff had turned off call bells without confirming needs, and we observed call bells and floor sensors that were non-functional or incorrectly positioned at the time of the assessment. We found a person’s floor sensor had been turned off and the sensor placed the wrong way around. Floor sensors were not functioning effectively for two other people. We observed drinks were placed out of some people’s reach. Some people could not drink independently; however, some people were able to but couldn’t access their drink. Staff did not notice or intervene to support until prompted by inspectors. Several people told us they were thirsty, including both those who required support to drink and those who could drink independently but could not reach their drinks. Several relatives expressed concern their family members were left without drinks, stimulation, or personal interaction. Comments included, “Residents don’t seem to have drinks available. I must get [Name]’s,” and “[Name] is struggling to drink without help. I worry as when I come, [Name] is thirsty.” We reviewed people’s recorded fluid intake and found, in most cases, the amounts recorded by staff were sufficient, with only occasional shortfalls. However, this did not consistently assure immediate access to drinks at the time of observation.

The provider cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care. Senior staff described accessible professional development, including leadership qualifications and specialist dementia training. Staff told us refresher training was frequent and easy to access. Staff reported positive morale and a family-like working culture. One staff member described the team as ‘supportive and cohesive’. Other comments from staff included, “For a large workforce, we still feel like family who look out for and help each other” and “Working here is like a big family. Everyone listens to one another.” Staff said they felt able to speak openly with managers and were confident they would be listened to. One staff member said leaders promoted, “An open-door policy and a supportive culture.” One member of staff said, “Our current home manager started as a senior carer. It shows the company invests in people.” Staff told us they felt encouraged to share ideas and develop their skills. They said they were supported through shadowing and had access to external development opportunities. There were fair performance management processes, including welfare meetings and adjustments where staff needed support.