Orchard House

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 that 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 42 (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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Although people’s care was regularly reviewed, the provider had not fully assessed or put in plans to mitigate the risks to the people they supported. This included around constipation, epilepsy and helping people to mobilise safely. Where people’s needs had changed the service had not always ensured that their needs were assessed to ensure the care being delivered continued to be appropriate. For example we observed one person’s mobility needs had deteriorated since their care plan was written, but the provider had not sought appropriate medical advice on how they could manage this safely.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We received some positive feedback from health professionals who worked with the service including one individual who stated “I have always had positive visits there with regards to physiotherapy. Staff have been engaging and welcoming and proactive in their approach. We have got referrals through to us in a timely manner and our recommendations have been adhered to”. We observed the provider had an awareness of national best practice models such as STOMP (stopping over medicationof people with a learning disability, autism or both with psychotropic medicines) and were implementing this in practice. However we found systems at the service were not always enabling evidence based care to be delivered in practice, for instance for those at risk of constipation people’s bowel movements were not being appropriately monitored and staff were not escalating appropriately for medical advice or have clear guidance on how to support healthy bowels.

The provider did not always work well across teams and services to support people. We noted that there were gaps in the information available to staff on how to support people, and areas where information was not consistently recorded or accurately which impacted how effectively staff worked together. Staff described how they would share information at handovers between shifts, and at regular meetings to understand when people’s needs had changed. One member said, “The handover gives me all the information I need, for example if a person had a seizure in the day we would do increased 30 minute checks at night, to ensure they are safe”. However staff were not always knowledgeable or trained in how to respond to a seizure, so we could not be assured that staff were working together effectively to support the needs of the people they cared for. The provider explained they were planning to move to electronic care planning systems which would assist with ensuring staff could access the information they needed.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support. There were key areas where people’s health was not supported in line with clinical guidance, for example people did not always have access to medicines when needed and staff did not have the knowledge around some health conditions and how they should be safely managed to allow people to live healthily. Ther were detailed “keeping healthy action plans” in place for how the service would support each person to stay healthy and well which included support in accessing external health services. However, these plans were not always being followed as staff were not always sufficiently knowledgeable, trained or have guidance in place to do so.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves. The service had systems in place to monitor people’s care was meeting their expectations, including regular meetings between people and the keyworkers to review how they wished to receive care. However, some areas of people’s care had not been appropriately monitored, for instance where people had their bowel movements recorded due to risk of constipation this was not consistently recorded or acted upon. Some care plans we reviewed still had references to restrictions put in place due to the COVID-19 pandemic, and needed to be reviewed to ensure they were current and reflected people’s care as it is currently being delivered, and the outcomes they wish from it.

The provider did not tell people about their rights around consent and did not always respect their rights when delivering care and treatment. In some cases where people had restrictions put in place in order to protect them there was appropriate best interest documentation to show how this decision had been reached, and how people were supported in line with their mental capacity. However, in other cases the provider couldn’t share evidence of this, and there was varying feedback from people’s representatives about if they were involved in decisions to ensure people had somebody advocating for them. But if these conversations did take place, they were not appropriately documented and one relative told us “No provider didn’t consult us, they just put this restriction in place themselves as they determined it was in their best interest”. We could not be assured that decisions such as around use of monitoring equipment, management of finances or use of restraints such as lap belts had taken all reasonable steps to ensure they were truly in a person’s best interest. We also observed some instances where staff could not clearly articulate how they would obtain a person’s consent. One staff member stated they were not aware of any particular ways people may need them to communicate to ensure they were get getting their explicit consent such as to undertake personal care, stating ““I’m not sure about this. I would just explain what I’m doing. I would say things like I’m about to wipe you so it may be cold”.