The Old Orchard

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.

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

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice, and continuity of care.

This service scored 93 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service demonstrated outstanding person-centred care. Staff had an in-depth understanding of each individual and consistently tailored support to reflect people’s preferences, communication needs, life histories and aspirations.

For example, staff adapted communication methods using gestures, symbols and other preferred approaches to ensure people could make choices and express their views. Support was flexible and responsive, with staff recognising changes in mood or anxiety and using personalised strategies such as quiet spaces, music or walks to provide reassurance.

People were supported to live meaningful lives based on what mattered to them, including accessing community activities, maintaining relationships and enjoying culturally meaningful food and events. Staff promoted independence by supporting individuals to take part in daily living tasks such as cooking, shopping and household activities at their own pace. Positive risk-taking was encouraged to help people build confidence and try new experiences.

Staff were strong advocates for people. They challenged and escalated concerns when proposed care arrangements did not meet people’s needs and worked in partnership with health professionals to ensure concerns were fully explored. Where necessary, staff persisted to ensure people received appropriate assessments, treatment and outcomes. For example, one person had been assessed as having difficulties swallowing and a Speech and Language Therapist (SLT) advised a soft textured diet to mitigate the risk of choking. However, staff noticed the person was not enjoying their food as they had previously which diminished their quality of life, so worked collaboratively with the person and their family, the SLT and other professionals to develop a safe, risk‑managed diet that balanced swallowing safety with enjoyment and choice. The person regained their pleasure in eating, demonstrating the staff’s commitment to well-being and quality of life while maintaining safety.

Staff consistently celebrated people’s achievements and recognised progress, however small. As a result, people received highly personalised care that promoted choice, dignity, independence and a strong sense of identity and belonging.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service demonstrated outstanding practice in delivering integrated, consistent and person-centred care. Staff worked proactively with health and social care professionals to ensure people experienced seamless, coordinated support. For one person, this meant working collaboratively with another service provider to facilitate a shared understanding of the person’s communication, emotional and behavioural support needs to ensure they received consistent, quality person-centred support from staff of both agencies and a seamless experience across services for the person.

People were supported to access essential healthcare services, including GP appointments, opticians and hospital care. Where appropriate, staff arranged for healthcare professionals to attend the home, reducing anxiety and ensuring people received care in a familiar and comfortable environment. Appointments were well planned; staff prepared people in line with their communication needs and ensured any follow-up care was completed promptly.

Care extended beyond meeting basic needs, enabling people to live full and meaningful lives. For example, staff supported people to access funding and opportunities for activities such as horse riding, swimming, holidays abroad and attending music events, based on their preferences and goals.

Continuity of care was maintained through consistent staffing, detailed care planning and effective communication. Staff advocated strongly for people, ensuring external services understood and met their needs and that support remained consistent, even during periods of change.

Overall, people benefited from a highly coordinated approach where healthcare, social support and meaningful activities were fully integrated, resulting in improved wellbeing, stability and an enhanced quality of life.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service demonstrated outstanding practice in providing information in ways that were accessible, meaningful and person-centred. Staff ensured communication was tailored to people’s needs, enabling people to make informed choices and express their preferences confidently.

For example, staff used social stories to help people understand upcoming events, changes in routine or healthcare appointments, reducing anxiety and promoting understanding. Information was provided in line with the Accessible Information Standard, using clear, easy-read formats, visuals and personalised communication tools.

Staff actively encouraged choice and involvement in decision-making, including the use of PECS (Picture Exchange Communication System), symbols and other visual aids. This enabled people, including those who did not use words to communicate, to express their wishes about daily activities, meals and broader life decisions.

Overall, people were consistently supported to understand information, communicate effectively and be actively involved in their care, promoting independence, choice and control.

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.

The service demonstrated consistent practice in listening to and involving people and those close to them in all aspects of care. Staff used person-centred approaches such as ‘important to’ and ‘important for’ alongside clear reference guides detailing preferences, communication styles and triggers, ensuring highly personalised and consistent support.

People were actively involved in decisions about their care, including choosing their keyworkers and which staff supported them on holidays, promoting trust and meaningful relationships. Staff were highly skilled in recognising and responding to non-verbal communication, for example identifying when a person was unhappy with a new day service and adapting support accordingly.

Relatives mostly described excellent communication and involvement. Comments included, “They [staff] are always ready when you want to speak with them,” “There’s constant contact,” and “I’m definitely involved in decisions, I’ve seen the care plan and my comments are added in.” Families also valued regular reviews, updates and contact from staff, which helped them feel reassured and involved.

Overall, people and their relatives were fully engaged in shaping care, with staff listening, responding and adapting support to ensure people felt heard, respected and in control.

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

The service demonstrated outstanding practice in ensuring equitable access to care, support and opportunities. Staff provided exceptional personalised support to remove barriers, reduce anxiety and enable people to access services and activities that enhanced their wellbeing, independence and quality of life.

People were supported to access healthcare, education and community opportunities in ways that felt safe and predictable. Staff used careful preparation such as advance visits, visual supports and gradual introductions to build confidence. This enabled people, including those who previously found external settings distressing, to attend appointments and activities successfully and receive the health care support they needed to maintain health.

People were also supported to engage in meaningful everyday activities of their choice, including shopping, gardening and trying new experiences within the community. Staff took a proactive and creative approach to ensure opportunities were accessible and enjoyable for everyone.

Where accessing the community was not appropriate, staff arranged for services, including healthcare professionals, to visit people at home. This ensured people received essential care and treatment in a way that reduced distress and promoted comfort.

Overall, the provider ensured people had equal access to opportunities and services, with support tailored to their needs, enabling them to live fulfilling and inclusive lives.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff and leaders demonstrated outstanding practice in promoting equity in people’s experiences and outcomes. They had a detailed understanding of factors that could impact people, including communication barriers, sensory sensitivities such as noise, past trauma and reduced confidence, and consistently adapted support to minimise these and promote positive outcomes.

For example, staff created calm, low-stimulation environments for people sensitive to noise and used trauma-informed approaches to ensure people felt safe, secure and understood. They also carefully planned journeys and routines, avoiding specific routes or situations known to trigger distress or trauma, ensuring people could access the community in a way that felt safe and manageable.

Communication was highly personalised, using tools such as symbol boards, visual timelines, objects of reference and simplified language to support understanding and enable people to express their views and choices.

Leaders actively monitored people’s experiences and outcomes, identifying and addressing any inequalities promptly. Effective strategies were shared across the staff team to ensure consistency and continuous improvement.

As a result, people received highly individualised, responsive support that reduced anxiety, improved engagement and enabled them to achieve meaningful, equitable outcomes aligned with their needs and aspirations.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including what made people feel safe and comfortable during periods of illness.

People were supported to plan for important life changes in a way that was respectful, sensitive and person-centred. Staff approached conversations at a pace that suited people, recognising that some people and relatives may initially find these discussions difficult.

For example, staff used gentle and informal approaches, such as focusing on what helped people feel safe when unwell or exploring preferences during keyworker sessions using visual aids and prompts. Where people chose not to engage, this was respected and revisited at an appropriate time.

Staff ensured people’s preferences were clearly recorded, including wishes around care during illness, hospital admissions and who they wanted involved. This was based on both direct input and staff’s understanding of individuals’ communication styles and behaviours.

The registered manager supported staff to develop confidence in having these conversations, promoting a culture where future planning was seen as an important part of personalised care. As a result, people had plans in place that reflected their wishes, while maintaining dignity, choice and control.