Orchard Nursing

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.

This is the first assessment for this newly registered service. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. For example, managers at all levels demonstrated a clear understanding of their responsibilities under the duty of candour. Staff consistently described shared values, beliefs and goals, and spoke positively about the culture within the home. They told us there had been meaningful improvements, resulting in a more open, supportive and collaborative working environment. Comments from staff included: “Everything is out in the open; we learn from mistakes and improve,” “Everyone gets on well now and works effectively together. We love the residents and want the best for them,” and “Our priority is to make sure residents are safe.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. For example, staff described managers as supportive, inclusive and caring. Their comments included, “[Manager and deputy manager] are amazing, they take on improvements we suggest” and “Managers are good, very approachable and see them all the time, take time to speak to you, check everything is ok. Really feel they listen. Family members told us, “Communication from the home is good, any issues, I get a phone call straightaway” and “The home is good at keeping me informed about [relative].”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. For example, there were systems and processes enabling people, family members and staff to express their views, including regular meetings and surveys. A suggestion box had recently been introduced to encourage anyone to submit comments or concerns anonymously if they wished. People and family members told us they felt comfortable raising issues and believed staff and managers would listen and respond. One person told us, “I’d definitely let them know if I wasn’t happy about something,” and a family member said, “I’m happy to share anything, good or bad.” Staff echoed this confidence, with comments including, “You can go to them about anything, their door is always open,” and “I’m not afraid to speak up, I know managers will listen and take things seriously.”

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. For example, staff had access to the provider’s policy outlining its commitment to equality, diversity and inclusion within the workplace. Staff told us they were treated fairly and felt valued and respected by managers. They spoke positively about the personal support they had received, particularly when facing personal challenges, and described managers as approachable and understanding. Staff comments included, “I feel listened to and so valued” and “[Manager] is very fair and treats us all as equals.”

Governance systems were not always used effectively to manage risk and to deliver good quality, sustainable care, treatment and support. For example, although the provider had a comprehensive framework of governance processes, these were not consistently applied in practice to assess, monitor and improve the quality and safety of the service. Audits and routine checks had failed to identify issues relating to environmental and equipment safety, infection prevention and control practices, and mealtime experiences. As a result, areas of concern were not always recognised or acted upon in a timely way.

However, managers at all levels acknowledged the need to strengthen elements of the governance arrangements and provided assurances these improvements were being taken forward. A new manager was appointed in November 2025 and has since submitted an application to the CQC to become the registered manager. Additional senior management posts had also been recruited to enhance leadership capacity and oversight across the service. Managers had clearly defined roles, responsibilities and systems of accountability, and demonstrated a sound understanding of their duties to notify the CQC and other relevant agencies of significant events occurring within the home.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. For example, managers and staff worked in partnership with a range of external organisations to support people’s health, wellbeing and safety. This included close working relationships with local authority commissioning and safeguarding teams, dietitians, mental health services and speech and language therapists. Multidisciplinary team (MDT) meetings took place regularly and were attended by relevant health and social care professionals who provided advice, shared information and contributed to improvements in care delivery.

The manager told us they also attended various provider forums and routinely met with managers across the organisation, which enabled the sharing of learning, good practice and updates relevant to service improvement. There were established links with the local community, including nearby schools and churches, whose members visited the home to perform, engage with people and offer companionship.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. For example, there were systems and processes in place to support learning and continuous improvement. These included regular training sessions, meetings and supervision for both managers and staff. Lessons were learned and shared following incidents, accidents, safeguarding concerns or complaints to support improvements in practice and reduce the likelihood of similar events occurring. A service improvement plan was in place, which was routinely reviewed and updated, and clearly demonstrated ongoing learning and progress across the service.

Improvements were also informed by feedback from people, family members and staff through satisfaction surveys. The provider shared responses and actions taken in a transparent and accessible way, including through a ‘You said, we did’ information board displayed within the home. Records from quality assurance visits undertaken by the local authority commissioning team further evidenced improvements were ongoing.

During our visits, managers acted promptly to address issues we raised in relation to the environment, infection prevention and control practices and mealtime experience.