Orchard House

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 that the provider met people’s needs.At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery.

The service was in breach of legal regulation in relation to person centred care

This service scored 64 (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. We identified concerns about how people or their representatives had been involved in decision making around any restrictions put in place, which meant we could not be assured these decisions were person centred or in people’s best interests. However, there was a strong focus on supporting people in achieving the things that mattered most to them, and the service worked creatively to help people achieve these goals. We saw one example where a person had been supported by staff to attend a local theatre which had been a long-standing wish. Another person expressed that they were anxious to leave the service or go outdoors, so staff had planted up a nearby area of the garden which enabled this person to sit by the open door and still receive the benefits of accessing the outdoors. There were monthly meetings with key workers to ensure staff understood people’s wishes, and to collaboratively decide what people would like to achieve in the following month. We observed that these were regularly reviewed and followed up. Care plans were written in a way which emphasised people’s strengths, interests and differences and allowed staff to respect and support these.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. People were supported to access health and social care services as required, and there were clear plans of how the service would work collaboratively with partners to ensure people’s health and care needs were met. The management team generally worked well with other professionals and ensured they communicated with them when needed. But in some cases the service had missed opportunities to seek specialist health advice or support where people’s needs had changed, or due to gaps in oversight of how they were being managed.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The provider could demonstrate how they were communicating with people in an accessible and person-centred manner. Where people were asked to give feedback on the care they were receiving, the service used surveys in an easy read format to ensure people were able to articulate any feedback clearly. Recently staff described how they were supporting a person who was receiving treatment from specialist radiotherapy services. The information this service was giving them was not accessible to the person they were supporting, so staff visited the service themselves to talk to health professionals to understand the information they were being told. Following this they created they own summary in “easy read” for this person, to allow them to be fully involved in their treatment and make informed decisions regarding their own health.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. There were several different opportunities for people to feedback about their care. Each person had a key worker in place, and met with them monthly to discuss what happened in the previous month, and what they would like to achieve in the following month. People had goals in place to support them take part in the things that mattered to them, and these were closely monitored to understand any support they needed to achieve them. There were also regular meetings for people living at the service which were well attended. Clear actions were taken from these, for example people expressed they had enjoyed a recent barbeque, so the service were planning to hold these more often. Yearly surveys were shared with people and their families and loved ones, to ensure the service was identifying any areas where people thought improvements could be made.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. The service missed opportunities to ensure people received the care they needed, as medical advice had not always been sought in a timely manner and staff were not always aware of how to support the people they worked with. However there were regular visits from health professionals including opticians, chiropodists, physiotherapists and dieticians to ensure people received equitable access to health and care services. The environment was accessible to all people including those with physical or sensory impairments, and where people wished to do so they were supported in accessing and engaging with the wider community.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. The were regular opportunities for people to talk to staff about the care they were receiving. Where people had communication difficulties, people told us staff understood these and how to engage with people to give them the maximum opportunity to be involved in their own care. For one person staff told us “(Name) can’t communicate verbally, however we understand his facial expressions and can show this person objects to allow them to make choices”. A relative told us “Staff know my relative well and are able to communicate with him, and involve in him in his care”

People were 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. Where people wished to, staff worked closely with them to help them express their wishes for the future. This included detailed plans for how people’s personal and spiritual needs could be met at the end of life. Plans included details of how people may wish to be buried, which music they would like to be played at their funeral and whether they would wish to be resuscitated. These plans were regularly reviewed with people to ensure that they were up to date and reflected people’s current wishes.