Orchard Manor Care 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 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.

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 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 in a way that was consistently reflected in care planning documentation, including how people’s preferences, agreed outcomes, and associated risks were recorded and managed. We found some clinical guidance within people’s care plans was too broad. For example, in one person’s care plan it stated they were to be repositioned every 4–6 hours. In another person’s care plan, it instructed they were to have 1–2-hour safety checks. Links between key risks, for example, nutrition and behaviour, were sometimes missing. This reduced staff’s ability to recognise deterioration. One person’s emotional support reviews were repeated over three months with no evaluation. Some relatives raised concerns about delays in support. One person told us, “I have been in bed for four months. I want to sit up, but I haven’t been supported,” which reflected their experience, although some people were cared for in bed following clinical assessment and multidisciplinary input. In these cases, care plans did not always clearly record how people’s choices, the risks of declining recommended interventions, and the agreed outcomes were discussed and managed to guide staff practice. Staff told us care plans were reviewed regularly and updates were supported through daily handovers. One staff member said, “Care plans are updated regularly, and the review section shows when changes were made and why.” Another member of staff told us, “I read handover notes at the start of each shift. Care plans and risk assessments are updated by the nursing team.” Professional partners confirmed the provider was proactive in seeking advice when people’s needs changed and used recognised clinical tools to support nutritional needs. Leaders told us pre-admission assessments were completed to ensure care plans were person-centred. People’s care plans and risk assessments were held on a digital system, which supported information sharing; however, this did not always result in sufficiently specific guidance within individual care plans.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We found people’s pain and distress were not consistently assessed using validated tools. Although person-specific indicators of distress were described in some behaviour support plans, care plans did not consistently direct staff to use a validated pain assessment tool when pain or distress was suspected. Staff relied on observation and reassurance, rather than structured assessment tools. For example, one person’s care plan instructed staff only to “observe for signs of pain,” and another to “monitor.” This made it difficult to recognise and respond to changes in health. We found infection and catheter care guidance in people’s care plans repeated procedural notes rather than providing ongoing care instructions and did not clearly state monitoring and escalation guidance. This made it difficult for staff to follow a single evidence-based approach and increased the risk of delayed treatment. Care plans demonstrated multidisciplinary input. One professional partner told us, “Staff have always been attentive and follow specialist advice.” We saw references to Speech and Language Therapy (SALT) and dietician recommendations, including the International Dysphagia Diet Standardisation Initiative (IDDSI) guidance for safe swallowing.

The provider worked well across teams and services to support people. We found the provider worked well with dietitians, GP’s, mental health teams, tissue viability nurses (TVN) and speech and language therapists (SALT). Professional partners told us the provider communicated effectively with them, and referrals were made in a timely way. One professional partner said, “The staff contact our service if they feel they need advice to ensure residents are fully supported.” Another professional partner told us leaders were open to collaborative working, commenting, “Leaders and staff even agreed to take part in a pilot evaluation project.” We found staff shared information consistently during handovers, which helped keep people safe. We found in some peoples care plans advice from professionals was recorded correctly, however in others sometimes recorded in different parts of people’s care plans. This made it harder for staff to see the full picture and understand all the clinical guidance in one place.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. One person with a dietary requirement told us the food they were able to eat was ‘very overcooked and not very appetising’. A relative said, “They had [Name]’s food choices incorrect.” Other comments included, “They could have given [Name] finger food. It [their meal] was stone cold, so [Name] had been left a long time without support to eat” and “Sometimes when I watch them trying to feed [Name], they don’t support them in a way that is on [Name]’s terms.” Some relatives we spoke with said they did not always feel confident their loved one’s personal care was delivered sensitively.  Comments included, “I found [Name] was sat just looking at the door on their own. Staff were just sitting at a table. I don't see some staff interacting with residents much. Other staff are run ragged,” “Sometimes I worry about going in. Am I going to find [Name] on their own facing the wall. Some staff are good, but some don't communicate well with residents. Some tell people to just sit down” and “[Name] can't get out of bed. They cannot do anything for themselves, and I do worry that [Name] is often just left.” One relative said, “[Name] has taken part in lots of activities like the zoo and intergenerational activity. The activities coordinators are amazing. I cannot praise them enough. [Name] is bedridden, but they don't leave her out. She has her hair done.” Another relative said, “The activities team seem to do their best and the two people that I have seen [Name] and [Name] have been lovely. I do wonder whether that's the only time [Name] really has anyone caring about them.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or met both clinical expectations and the expectations of people themselves. We found review entries within care plans were often repetitive. For example, ‘no change’ or ‘plan remains effective’. Reviews looked at tasks completed but did not analyse outcomes, meaning they reflected process, not progress. Where monitoring tools were in place, such as weekly weights, Malnutrition Universal Screening Tool (MUST) assessments, and personalised nutrition plans, and where referrals to external professionals were made, care plans did not consistently demonstrate how staff used this information to evaluate outcomes or improve or adapt care over time. A MUST assessment is used to check if someone might be at risk of being undernourished or not getting enough of the right food. People who could not verbally express pain were not assessed using a validated pain tool, which limited staffs’ ability to detect and respond to discomfort. One relative we spoke with said, “I feel someone should check if [Name] is in pain more often.” Professional partners reported positive clinical outcomes, particularly in wound management and nutrition. One professional partner told us, “The home is very responsive in referring patients at risk of malnutrition.” Another said, “These patients have been well cared for and have positive wound care outcomes.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We observed floor sensors had been installed in one area of the home and were being used routinely as a blanket approach. The registered manager told us every person affected had a Mental Capacity and Best-Interest assessment in place authorising the use of the sensors. After reviewing documentation, we found one person’s relative had only been involved in consultation after the restrictive measures had been implemented. Several relatives confirmed they had not been asked about the sensors beforehand and some only found out when they accidentally triggered them when visiting their loved one. Generic signage referring to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were displayed in people’s bedrooms and communal areas. This was not personalised and was compliance driven instead of a rights-based approach in what was people’s home. Some relatives felt people’s choices were respected. Other relatives raised concerns around consent. One relative stated, “I hear them [Staff] telling [Name] and other residents to just sit down.” We were not assured recorded decisions always reflected people’s wishes. One relative told us, “They said [Name] refused to go to activities, but that’s not so.” During a SOFI observation, we saw four people sitting together in the lounge in the early afternoon, actively watching television. When staff asked if they wanted to go to bed, one person said yes, two did not verbally respond, and one said no. Despite this, all four were taken to bed. A staff member told the person who refused, “But you are tired.” This meant care was provided without valid consent and disregarded the persons clearly expressed wishes. Leaders told us they review DoLS and mental capacity assessments monthly. We found an example of good practice, where one person had refused to have a floor sensor in place. The provider had respected their decision and upheld the person’s autonomy appropriately.