Orchard Nursing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 proactive and positive culture of safety, based on openness and honesty. Managers listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. For example, the provider had established robust systems for reporting and recording safety‑related events, including accidents, incidents and safeguarding concerns. Staff reported issues promptly, and notifications were made to external agencies in line with legal and local requirements. Managers reviewed events thoroughly, identified learning, and ensured improvements were communicated clearly and consistently across the whole staff team.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. For example, processes were consistently followed to ensure sufficient and relevant information was gathered and shared when people were admitted to, or discharged from, the home. This supported continuity of care and helped staff to understand and respond to people’s needs safely and effectively.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. For example, managers and staff had completed safeguarding training and demonstrated a clear understanding of their responsibilities to protect people from the risk of abuse. Allegations of abuse were promptly referred to the appropriate authority, and detailed records were maintained, including the immediate actions taken to ensure people’s safety and prevent further risk. People told us they felt safe living in the home, and relatives reported confidence their family members were well protected.

The provider worked with people to understand risks and managed risk. For example, people and, where appropriate, their family members were involved in the completion of risk assessments and in agreeing the measures put in place to reduce identified risks. Risk management plans formed part of people’s care plans and staff followed them consistently. Staff monitored aspects of people’s care where known risks existed, such as observing food and fluid intake for those at risk of malnutrition or dehydration and checking the functionality of sensor equipment for people assessed as being at risk of falls.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment supported the delivery of safe care. For example, some rooms used to store equipment, hazardous items and substances were not kept secure. We observed key‑pad locks on several rooms containing potential hazards, including storerooms and sluice rooms with the access codes written next to the keypads, meaning the rooms could be opened by anyone. In addition, call‑bell cords in some bathrooms had been tied up and placed out of people’s reach. This posed a risk as people would be unable to call for assistance if required. Managers took immediate action to ensure people’s safety after we raised our concerns with them.

However, valid certificates were in place confirming essential health and safety checks on equipment and utilities had been completed by competent persons at the required intervals.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. For example, a dependency tool was used to calculate the number of staff required on each shift, ensuring staffing levels and skill mix were aligned with people’s assessed needs. Staffing rotas showed the home was staffed in accordance with these calculations. Staff told us they felt there were generally enough staff on duty to meet people’s needs safely. However, several staff members said having an additional member of staff during the day would enable them to spend more meaningful time with people and enhance the quality of interactions. Staff also told us they received good support from managers and had access to training relevant to their roles, which helped them provide safe and effective care.

The provider did not always assess or manage the risk of infection. There was a risk essential equipment and personal protective equipment (PPE) were not maintained in a condition that supported safe infection prevention and control practices. For example, some dining chairs and items of equipment, including wheelchairs, crash mats, hoists and stand aids, were visibly unclean, with a build‑up of dried food debris, spillages and dust. We also found face masks stored across the home that had expired more than two years ago.

However, staff had completed infection, prevention and control training and they used and disposed of PPE safely.

The provider did not always ensure that medication administration and stock‑checking processes were followed consistently or safely. For example, a person’s medication records and the stock held for their prescribed pain patch showed discrepancies, and it was unclear whether the patch had been reapplied at the correct interval. Following further review by the manager, it was confirmed the person had not had their pain patch applied when due, meaning it had been omitted three days earlier. The manager acted immediately by consulting with the person, seeking medical advice, and raising a safeguarding concern in relation to the missed medication.

However, staff responsible for the management of medicines had completed the required training and competency assessments. Medicines were stored securely, and daily checks were carried out to ensure storage temperatures remained within safe ranges, helping to maintain their effectiveness. People told us they received their medicines on time and in the way they preferred.