Orchard Manor Care Home

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 Good. This meant people’s needs were met through good organisation and delivery.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always make sure people were at the centre of their care and treatment choices.

Although people said staff treated them in an individualised way, with 1 person telling us, “They know that I’m different to a lot of the others” and another saying, “They know that I’m on my own and are very kind” we found this was not consistent. One person’s care plan recorded that the church was very important to them. They had previously been very involved in the church and attended regularly. They also watched Songs of Praise every week. Yet, having reviewed 6 weeks of this person’s daily notes, we could find no evidence of staff supporting or encouraging them to attend the local church, or arranging for them to watch Songs of Praise on television.

Although people’s care plans were comprehensive, we found some information quite generic, contradictory and not specific to the person. One person experienced distressed behaviours. Although their care plan stated this could present itself in the evening and staff should speak to them in a calm voice and try to distract them, it did not give any specific ideas on what distraction might work. One person was recorded as having no preference for a male or female carer in 1 place, but in another, it stated, ‘female carers only’. A further person’s care plan stated they slept well during the night; however, a review of their daily notes showed this was not the case. The person was often restless and up during the night. Some people’s plans referred to a different name of a person in places, such as 1 male had a female person’s name in their risk assessment for going out on trips. This same person was unable to use their call bell, and although they had a motion sensor in their room, there was no information on how often the person should be checked during the night to see if they needed staff, as the sensor would only sound if they got out of their bed. Furthermore, 1 person was on time-specific medicines, and although they had a medicines care plan in place, this did not make it clear that their medicines needed to be administered at a certain time.

However, people and relatives told us they were involved in the care plans, and they felt staff knew them. One person told us, “When [manager] came she asked me questions” and another said, “They bring me a ham sandwich and I ask them how did you know what I like and they say, we know you don’t like cheese.” A relative said, “(we have) 6 monthly face to face reviews.” We also spoke with staff and they were able to tell us about people and their individual needs. It was evident during our observations that the staff had a very good understanding and knowledge of people.

Staff understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The registered manager worked proactively with external health professionals to ensure people received the support they needed. One person who had been very agitated while living at home was referred to the community psychiatric nurse shortly after moving into Orchard Manor Care Home. Following this, some of the person’s medicines were reduced or stopped, resulting in an improvement in their wellbeing. In addition, the registered manager supported the family’s decision to adopt a cat, which provided the person with a focus and interest. As a result, they were now more settled and enjoyed checking on the cat each night.

There was a good range of activities seen on the day of our visit, from a yoga class to a discussion about Christmas. People were seen laughing and enjoying each other’s company, and when people were not engaged in group activities, individuals read books or played bingo with a partner.

Staff supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Where people required information in a different format, this was provided to them. For example, 1 person’s daily menu and activity timetable was produced in larger print for easier reading. Families were sent activity timetables each week, and they each had a link to access the service’s cloud-based platform where management uploaded information such as pictures of activities. A relative told us, “We love the regular photos and videos of all the excursions and entertainers that visit the home, which really helps put our minds at rest when we can see [person’s name] getting involved in crafts, music, dancing etc.”

Management communicated with relatives in a way that suited them. The registered manager told us, “Some families prefer emails, others prefer face to face conversations. We are happy to adapt. We also make sure that families know who to speak to should they have a query.”

Management made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

Management followed their internal complaints policy when receiving complaints or concerns about the service, and formal responses were sent. We had been made aware of some recent complaints, and the registered manager shared the outcome of these with us. One person told us, “I wouldn’t be worried to complain, but I’ve never had to.”

Resident and relative’s meetings were held where feedback was encouraged. As a result of 1 meeting, protected mealtimes were introduced, so people could eat in a quiet environment without interruption. In addition, at the request of relatives, a board had been erected in the lobby area to display who was in charge that day and which staff member was dispensing medicines. One person told us, “We have meetings, they ask about things we might need. They listen. I made 1 point about a meal and they listened.”

The service had received numerous compliments and good feedback on external social media sites.

However, further consideration was needed on how people who were living with dementia were supported to make choices of their own, particularly at mealtimes. Although the chef told us they went around to gather people’s views and choices it was unclear how people living with dementia were included in this.

Staff made sure that people could access the care, support and treatment they needed when they needed it.

There was a constant flow of communication within the service to help staff get to know people and to help ensure they received the most appropriate care. This included regular contact with the GP practice, pharmacist and other external health professionals.

We observed staff spending time with people, and the activities staff had a good knowledge of people’s likes, interests and hobbies. A relative said, “They provide activities that appeal to her.”

The registered manager told us, “Health professional input is a necessity, but we also ensure we give people choice in all that they do. One person wanted the freedom to do what they wanted, and we’ve supported them with that. Another likes to think of themselves as 1 of us, so we treat them as such. It has really helped in how they have settled into the service and reduced their agitation.”

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.

Despite people’s varying health conditions or needs, everyone was given an equal opportunity to participate in activities, either individually or as a group, or to go on outside trips. People said, “I join in most things. We make cupcakes, Christmas decorations, lots of things.” The activities staff told us they knew people’s likes and dislikes and had developed a system where each person had the same chance to take trips away from the service. One person told us, “We went to a castle and we went off with [registered manager]” and another said, “We went ice skating. We’ve been to garden centres and a big church. We go on the bus.” A relative told us, “Rarely do I find mum in her room, she is always in the communal areas, and loves the activities available along with the gardens for a stroll.”

People’s care was tailored to their needs. When 1 person moved in, they would ask to go home, and they would give the staff their address. In response, staff made a sign for the person’s door with their home address on it and when the person becomes anxious and asks to go home, they take them to their room and show them the address, immediately settling the person. A second person used to love yoga, and with staff support, they now run a yoga session daily for people. Relatives commented that they felt the arrangements within the home helped support people’s experience. They said, “Orchard Manor mix their residents, rather than having a dedicated dementia floor, which makes the home have a much better feel and environment”, “Mum has days when she can be lucid and therefore not being locked on a dementia floor (as before in her previous care home) and interacting with the wider community is a huge bonus” and “I was surprised they mix, but it works perfectly. [Registered manager] fought for it.”

People were not always 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 lives.

People had various care plans in place relating to the end of their lives. This included a risk assessment, palliative care plan and a death and dying care plan. But these did not always include details to help staff understand exactly how a person may wish to be cared for. For example, some people had basic information in their records, but there was no indication whether they would wish family to be present or what their preferences regarding care might be.

Staff worked with the local hospice as well as the hospital at home service to help support people during their end of life. The registered manager told us, “We manage end of life care here, so usually we can do this without too much involvement of external support.”