Orchard Manor Care 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 remained 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.

This service scored 57 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Leaders took steps to promote a supportive and inclusive culture. Staff described open-door management, fair leadership, and strong teamwork. They described the home as ‘homely’ and ‘family-like’ and said they felt valued and listened to. One staff member told us, “Working here is like a big family. Everyone listens to one another.” The provider had recognition systems, commendations and awards to celebrate good practice. Some staff had progressed internally into senior positions which helped to promote shared experience within leadership. Professional partners praised the providers partnership working and communication. One health professional told us, “The staff know the residents well and are able to give clear, concise updates.” Another professional partner said leaders were, “Professional and open to collaboration."

Not all leaders consistently demonstrated an understanding of the context in which the provider delivered care, treatment and support, or how this translated into day-to-day leadership assurance. While leadership culture was described as supportive and staff told us they felt listened to and valued, leaders did not always ensure that their oversight and leadership practices resulted in consistently safe, accurate and person-centred care planning. Leaders had systems in place to support quality and safety, including audits, walkarounds and management oversight. However, these were not always effective in identifying risks and issues proactively, which limited leaders’ ability to provide consistent assurance and timely direction to staff. Some relatives said leaders were available to discuss issues. Other relatives did not feel leaders were always visible. One relative said, “I never see them.” This was not the experience of all relatives or staff. Staff told us managers were visible, approachable and led by example, and that they felt supported to raise concerns.

People did not always feel they could speak up and their voice would be heard. Staff and leaders described a culture where staff were encouraged to raise concerns and reported that whistleblowing and confidential reporting routes were in place. Feedback from relatives was mixed. It was concerning the feedback we received from some people and their relatives regarding the conduct of some members of staff only reaching management following CQC involvement. This feedback from relatives is contextual and reflects how concerns were escalated, rather than a direct measure of staff whistleblowing culture. One relative said, “Management do listen.” Another relative said, “I have tried to question issues but you kind of give up eventually, sadly.” The provider had processes for addressing staff concerns and performance issues, and staff welfare meetings encouraged openness. Leaders told us they promoted a culture where staff and families were encouraged to raise concerns and share ideas. The registered manager said, “We have ‘Feedback Fridays’, surveys, and an anonymous suggestions box. There’s an open-door policy, and staff know they can speak in confidence. We follow the whistleblowing policy, have a confidential email to head office, and hold regular meetings where staff can raise issues.” One staff member said, “All of the management team are very easy to approach, there is an open-door policy, and no problem or concern is too big or too small.”

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 provider actively promoted workforce diversity and inclusion. Staff were provided with guidance and awareness materials on supporting LGBT+ people and overseas colleagues. We found recruitment processes and internal policies reflected inclusive values. The provider employed staff from a range of backgrounds and provided equal access to training and development. The provider promoted inclusivity and recognised and celebrated achievements. 

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. We found governance systems were not consistently effective in identifying concerns and driving the necessary improvements to the quality and safety of the service. Some people’s care plans were lengthy and difficult to follow, which made it harder for staff to quickly understand needs. We found care plans and risk assessments contained repetition, contradictory information and template wording that had not been identified or corrected through review. For example, one care plan contained conflicting dietary instructions, stating the person should avoid crisps and cake but also they enjoyed eating crisps and cake. In another, both Level 4 pureed and Level 7 easy-to-chew diets were listed. This increased the risk of choking or dehydration, particularly where support was provided by unfamiliar or agency staff. Guidance was often too broad within care plans. 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. Templates were being reused without meaningful review, and key clinical information was sometimes located under incorrect sections. Some audits and risk assessments had been completed only after issues were raised during this assessment. For example, flammable cream risk assessments and bedroom safety checks were implemented retrospectively. This indicated the provider’s governance systems did not reliably identify or address risk and that improvements were reactive rather than proactive. 

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. The provider maintained strong links with community groups and external professionals. Professional partners described positive collaboration and open communication. They shared information and learning with partners and collaborated for improvement. The provider worked positively with community organisations to support people’s wellbeing. There were established relationships with local groups and schools, Chester Zoo and animal therapy providers. These links supported meaningful, intergenerational and social activities. One staff member told us, “Families and the community are invited to our summer festival with live music, animals, and mobility bikes.” Professional partners described strong partnership working. One professional partner said, “Staff contact our service if they feel they need advice to ensure residents are fully supported.” These partnerships promoted inclusion and supported continuity of care. 

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. Although people’s care plans referenced national frameworks such as NICE guidance and the Mental Capacity Act, this was not always reflected in practice. NICE stands for the National Institute for Health and Care Excellence. Their guidelines are official advice for health professionals about the best ways to diagnose, treat, and care for people. They help ensure everyone gets the best possible care and treatment based on evidence. Problems like poor upkeep and cleanliness, unclear rules for when to escalate issues, and care plans that were duplicated, wrong, or inconsistent had not been fixed, even though regular audits were done. Where concerns were identified during this assessment, leaders introduced new processes such as bedroom safety audits and infection control reviews. Some people and relatives told us there have been improvements since CQC’s visit. Another person said, “There is more activity now you are here.” A relative told us ,“I have seen improvements since CQC came in.” The provider did actively contribute to safe, effective practice and innovation, including participation in a pilot evaluation project and working with external partners and community groups. However, learning from audits and known issues was not consistently embedded into practice before our assessment.