Orchard Manor Care 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 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 provider was in breach of the legal regulation in relation to person-centred care. Individual preferences were not always identified or incorporated into everyday care. Some people received less personalised interaction then others. Some people’s rooms lacked personalisation and did not reflect their identity or preferences.

This service scored 50 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Some care plans were not up to date or did not reflect recent changes in people’s circumstances. One person’s care plan continued to describe a relative as a regular visitor, despite the fact they recently passed away. People’s rooms in some areas of the home appeared clinical and bare, with few personal items or décor reflecting identities and preferences. Some relatives felt individual preferences were not always recognised. One relative said, “I think they get the residents mixed up. A staff member said [Name] has been dancing and singing. They are immobile.” Some relatives shared examples of personalised care, such as staff supporting a couple to celebrate their 70th wedding anniversary, and ensuring a person was dressed in the way they preferred to improve their wellbeing. Person-centred elements were within some peoples care plans, for example, their preferences about grooming, wearing a dignity apron, and reassurance. Some people’s care plans contained biographical detail, including people’s personal histories, cultural background, faith, and family relationships. One person’s plan described their heritage, career and faith, and another person’s care plan recorded their enjoyment of a particular film genre and visits from their friends and animals.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Some care plans contained inconsistent communication guidance. For example, one person was described as both ‘able to communicate verbally’ and ‘speech confused and unreliable’, but there were no structured tools such as picture prompts or agreed strategies for staff to interpret their wishes. One relative we spoke with told us, “They don't use chat boards or anything like that. They don't adapt their communication style.” Some relatives told us the provider’s communication with families was inconsistent, and they were not always informed of changes in health, appointments or hospital admissions. One relative said, “I wasn’t told [Name] had been diagnosed with an infection.” Some relatives told us they had to ask for updates as information was not shared with them routinely. One relative said, “I feel I have to ask them rather than information coming through.” Another relative said, “I am not kept up to date with changes. They only let me know to top [Name]’s pocket money. They don't tell me about [Name]’s appointments. They don't inform me when to replace toiletries.” Other relatives told us there was limited access to management or office-based staff at weekends from their perspective, which they felt affected communication. One relative told us, “No management or office staff are in at weekends. I don’t know them.” Some relatives told us they were involved in discussions and kept informed. One relative said, “There are regular relatives’ meetings about plans for the future, and we are kept informed of changes.” Relatives’ meetings were held, but the timing did not suit some relatives. Another relative said, “Relatives’ meetings are only in the afternoons. Working relatives cannot attend.” Some relatives described positive experiences of involvement and felt well informed. One relative said, “We are always kept informed. They tell us when medication is under review.” This variation in experience did not assure us the provider’s communication systems were effective.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Some care plans contained inconsistent communication guidance. For example, one person was described as both ‘able to communicate verbally’ and ‘speech confused and unreliable’, but there were no structured tools such as picture prompts or agreed strategies for staff to interpret their wishes. One relative we spoke with told us, “They don't use chat boards or anything like that. They don't adapt their communication style.” Some relatives told us the provider’s communication with families was inconsistent, and they were not always informed of changes in health, appointments or hospital admissions. One relative said, “I wasn’t told [Name] had been diagnosed with an infection.” Some relatives told us they had to ask for updates as information was not shared with them routinely. One relative said, “I feel I have to ask them rather than information coming through.” Another relative said, “I am not kept up to date with changes. They only let me know to top [Name]’s pocket money. They don't tell me about [Name]’s appointments. They don't inform me when to replace toiletries.” Other relatives told us there was limited access to management or office-based staff at weekends from their perspective, which they felt affected communication. One relative told us, “No management or office staff are in at weekends. I don’t know them.” Some relatives told us they were involved in discussions and kept informed. One relative said, “There are regular relatives’ meetings about plans for the future, and we are kept informed of changes.” Relatives’ meetings were held, but the timing did not suit some relatives. Another relative said, “Relatives’ meetings are only in the afternoons. Working relatives cannot attend.” Some relatives described positive experiences of involvement and felt well informed. One relative said, “We are always kept informed. They tell us when medication is under review.” This variation in experience did not assure us the provider’s communication systems were effective.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. Some relatives felt concerns or requests were not always followed up or that outcomes were not always clearly communicated. One relative said, “Do I feel that my views are listened to? Not really. Whenever I try and ask for help, apart from the weekly call from the activities team, nothing else ever gets achieved.” Another relative said, “I have questioned things several times but eventually gave up.” Some relatives reported delays or lack of feedback when informal concerns were raised. Comments included, “I don’t feel my concerns are taken seriously,” and “I was never told of the outcome.” The provider sent out surveys and told us they used informal feedback to help improve the home. The provider also described having a range of formal and informal systems in place to support communication and feedback, including reviews, meetings, and complaints processes. Records showed that formal complaints were logged, investigated and followed up in line with policy timescales. Some relatives told us they felt listened to and involved. Comments included, “They never just assume things. They ask us first and we have a discussion. They always give us options and ask for permission,” “All of the staff are very approachable and will help with any enquiry,” “The key worker team will proactively come to see us when we visit just to say hi and update us,” and “They can always tell me what [Name] has been doing.”

The provider did not always make sure people could access care and support. We found people with higher dependency needs and those cared for in bed were less likely to participate in activities or social engagement. Some people had fewer opportunities to maintain independence, choice and wellbeing. While the activities team was praised by some relatives for creativity and intergenerational events, others raised concerns about unequal access. Several relatives told us some people who remained in bed were not always included in activities or photos. Some relatives said they felt their family members were overlooked. Comments included,“[There is] not much going on” and “[Activities] only happen on one side of the home.” Some relatives said people were not taken outside regularly. Comments included, “The garden area is neglected. I ask for [Name] to be taken out but they [staff] say they haven’t got enough staff.” We found people’s experience of daily life varied depending on which side of the home they were living. We observed a lack of activity provision and social interaction on one unit in comparison to the other. The provider shared activity plans and records that showed 1:1 and in-bed engagement was offered for some people, however, this did not consistently result in equitable access to meaningful activity and social engagement for all people. Some relatives told us their loved ones did have access to meaningful activities. Comments included, “Yes there is always something going on. [Name] is kept occupied” and “The team knew [Name] liked classical music and supplied a radio so they can listen to it.”

Staff and leaders did not always actively listen to information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. Feedback from people and their relatives highlighted a variation in dignity and experience. One relative said, “I think all the residents are treated the same.” Another relative commented, “Sometimes staff don’t mean to, but they can come across a bit childlike in how they speak to some people.” Some relatives highlighted inconsistencies in listening to and empowering people. Several relatives felt refusals to participate in activities were not accurately explored or recorded. People’s choices, including refusals, should be respected. However, we were not assured that refusals were consistently explored or recorded in a way that identified any unmet needs or barriers to inclusion. Some relatives told us they felt they were involved in their loved one’s reviews. One relative said, “I am always involved [in reviews].” However, other comments included, “It varies on how often the reviews happen,” “One disappointment was not getting a review. Even a five-minute update would have been a nice” and “I am never invited to take part. Only time was when I complained.” This inconsistency meant we were not assured people, and their relatives always experienced the same level of involvement in decisions about their care. Professional partners we spoke with told us they trusted the provider to manage people with complex needs with social care teams and are reassured by the providers approach and documentation in meeting diverse needs.

People were not always 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. The provider did not always plan effectively for people’s changing health needs. Some people’s end-of-life documentation contained only brief statements such as, ‘preferred place of care is Orchard Manor Care Home’ or ’DNACPR in place’, with no evidence discussions had taken place with the person or their relatives. In some peoples care plans there was no indication plans had been reviewed as people’s needs changed. DNACPR stands for Do Not Attempt Cardiopulmonary Resuscitation. It is a medical decision made when trying to restart someone’s heart or breathing would not help them or could cause more harm than good. One person’s care plan referenced deteriorating mobility and symptoms associated with a progressive condition but did not include forward planning for end-stage management or family involvement. We found for end-of-life care, the provider focused on dignity and comfort. A caring culture and promoting dignity at end of life was evident in people’s care plans. Some peoples’ care plans contained compassionate and personalised end-of-life wishes. We saw examples of good practice and thoughtful and responsive planning. One person’s care plan clearly recorded their wish for a priest to visit, their relative to be present, and their final days to be free from plan. Anticipatory medication and comfort focused care was documented.