The Old Orchard

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.

This is the first assessment for this service. This key question has been rated outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them and families where appropriate.

The provider demonstrated outstanding practice in assessing people’s needs. Staff recognised that needs could change at any time and conducted ongoing assessments, including hourly, daily and weekly reviews. This highly responsive approach was possible because staff knew people exceptionally well and understood their communication styles, behaviours and emotional cues. We saw how the impact of this approach had improved the clinical safety of people as staff were able to recognise early indicators of a decline in physical health and take appropriate action at the earliest opportunity.

The registered manager ensured assessments were thorough, accurate and person‑centred. People, families and relevant professionals were actively involved to build a full understanding of needs, preferences and communication. Previous assessments and restrictions were carefully reviewed and, where necessary, challenged to avoid unnecessary or overly restrictive care.

Staff continued to assess people in all situations, including periods of distress or anxiety. They carefully observed how people expressed discomfort, what reassured them, and how environmental or sensory factors affected wellbeing. This ensured support was compassionate, effective and delivered with the least restriction.

Continuous assessment enabled staff to adapt support immediately as needs changed. Whether responding to small day‑to‑day decisions or reviewing long‑term goals, staff consistently demonstrated skill, sensitivity and a deep understanding of everyone.

The provider always planned and delivered people’s care and treatment, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

We observed that care and support were delivered using strong, evidence‑based approaches that consistently met people’s individual needs. The registered manager and staff used structured, research‑informed methods to support people’s development, communication, and emotional wellbeing, adapting these approaches effectively to reflect each person’s abilities, preferences, and goals. For example, staff used positive behaviour support and personalised communication tools, such as visual timetables, to support a person who found changes difficult. This enabled staff to recognise early signs of distress and respond proactively, resulting in reduced anxiety and increased engagement in daily life.

Staff provided planned, step‑by‑step support to help people develop social interaction and communication skills. This included gradual exposure to social situations, modelling communication strategies, and maintaining predictable routines. As a result, people who had previously found group environments challenging were able to attend friendship groups and day services with increased confidence and enjoyment.

We observed that communication focused support was embedded into everyday practice. Staff used routine interactions, shared activities, and daily conversations as opportunities to promote engagement, understanding, and communication. In one example, staff took personal initiative to learn about a person’s cultural needs, including meal preferences and important wedding practices, to ensure support was respectful and meaningful. Staff also implemented assistive technology to better support the person’s communication, enabling them to express their views, choices, and preferences more effectively.

Overall, we observed care that was highly effective, delivered by staff who combined professional knowledge with a deep understanding of each person, resulting in positive outcomes and improved quality of life.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The provider demonstrated outstanding practice in how staff, teams and external services worked together to support people. Staff maintained strong knowledge of community and specialist services and were well prepared to seek timely external input should people’s needs change.

We observed strong partnership working with external services and social workers, which enabled highly person-centred care planning. Staff demonstrated excellent advocacy, early identification that a proposed day centre could not meet a person’s communication needs. By confidently challenging the placement, they protected wellbeing, and ensured future support was tailored to the person. This reflected a clear commitment to achieving the best outcomes.

In another example, staff demonstrated highly effective coordination of care planning across two services for a person attending a day service. They ensured robust communication between teams, consistency in routines, and a shared, detailed understanding of the person’s preferences, risks, and support needs. This continuity of care enabled a seamless experience for the person, significantly reducing anxiety, enhancing safety, and promoting confidence and engagement. This reflected the service’s strong commitment to delivering safe, joined-up care that achieved consistently positive outcomes.

Internal communication was highly effective, with staff sharing information throughout the day to ensure care was seamless, consistent and responsive. Team meetings and handovers were used proactively to review progress, anticipate needs and plan coordinated responses.

We observed excellent partnership working between staff, families, and professionals, with seamless coordination of care. This ensured people received the right support at the right time, leading to highly effective, person‑centred outcomes.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported to live healthier lives and when possible, make positive, informed choices about their wellbeing. People were supported to engage in regular physical activity and healthy routines, including walking programmes, gardening, swimming, and a structured weight‑management approach that promoted balanced nutrition and sustainable lifestyle changes. These opportunities supported people to stay active, build confidence, and improve overall health.

Across the service, staff consistently promoted healthy lifestyles by supporting people with nutrition, physical activity, emotional wellbeing, and community involvement. Support was delivered in a respectful and personalised way, based on a good understanding of each person’s individual needs and sensory preferences.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent.

We saw that the provider had highly effective systems for monitoring progress and improving outcomes, ensuring support remained responsive to people’s changing needs. Each person had 2 named keyworkers who met with them weekly to review wellbeing, reflect on progress, and set small, achievable goals. Records demonstrated how these discussions supported people to build confidence, develop skills, and make measurable progress towards outcomes that mattered to them. For example, one person wished to visit the shops with staff support. Through a thoughtful and realistic plan, staff supported the person to achieve carefully structured goals, and they were now working towards paying for items themselves.

We saw that people who did not use words to communicate were fully included in outcome monitoring and reviews through the consistent use of personalised communication tools, including Picture Exchange Communication System (PECS) and visual supports. This resulted in outstanding care because people were able to express their choices, preferences, and emotional responses, ensuring outcomes reflected their wishes and experiences.

We observed that outcomes were reviewed in more detail through regular four weekly Multidisciplinary Team (MDT) meetings. These brought together daily records, Positive Behaviour Support (PBS) data, professional input, and the person’s own views. This enabled staff to evaluate what was working well, identify areas for development, and adapt support plans promptly to improve outcomes. Changes were clearly communicated across the staff team to ensure consistent practice.

We observed strong management oversight of outcomes, with leaders analysing patterns, reviewing PBS effectiveness, and using this information to drive improvements. Progress was recognised and celebrated, and any barriers to achieving outcomes were addressed swiftly through collaborative MDT working, resulting in highly effective, inclusive, and continuously improving support.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff consistently respected people’s rights around consent and ensured decisions about care were made in ways that were accessible, meaningful, and person‑centred. They demonstrated a clear and confident understanding of the importance of gaining consent before providing any care or support, and this was evident in everyday practice.

Many people communicated non‑verbally or through subtle behaviours. Staff showed strong skills and attentiveness in understanding each person’s individual communication style and used personalised communication profiles, alongside body language, facial expressions, and behavioural responses, to recognise consent, hesitation, or disagreement.

Where verbal consent was not possible, staff used well‑established, person‑specific approaches, offering choices in accessible formats and allowing sufficient time for people to process information. Staff adapted their approach sensitively, providing reassurance, space, or alternative communication methods as needed. This ensured people remained actively involved and in control of decisions about their care and support.