Orchard View

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

We reviewed 2 lessons learnt following incidents with reflection documents, discussion and consideration of changes in approach with no complaints or compliments noted during the review period.

Staff were provided with appropriate inductions, supervisions, and competency checks, demonstrating a structured approach to workforce development and maintaining standards of care.

Evidence of learning is present. A lesson learned from a previous organisation relating to mattress management has been identified, showing some reflection on past practice.

Systems were in place to support people when moving into or between services. Pre-assessment paperwork was completed, and hospital passports were in place to support continuity of care. These systems helped staff understand people’s needs during transitions.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately

Policies for safeguarding, whistleblowing and mental capacity were available.

People appeared safe and at ease with staff, and safeguarding information was accessible in easy-read formats.

Staff had received safeguarding and Mental Capacity Act training, and Deprivation of Liberty Safeguards were in place where appropriate. Staff demonstrated a clear understanding of safeguarding.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were supported to understand and manage risks in ways that promoted independence. Risk assessments were in place for areas such as falls, community access and pets. Staff demonstrated positive risk-taking to support people to access the community safely and independently. However, we identified that one person using an emollient cream did not have an individual risk assessment in place, relying instead on a generic assessment. This presented a risk of improper use and increased the potential for harm and non- compliance with care standards. This gap was discussed during the assessment, and the RM assured us an individual risk assessment would be put in place.

Positive Behaviour Support (PBS) plans were in place where appropriate, and staff demonstrated a good understanding of unwise decisions, respecting people’s rights while managing risks.

Staff were observed responding appropriately to behaviours of distress, recognising these as communication of need and acting in a supportive manner. Relevant policies were in place to guide practice.

Overall, people are appropriately involved in managing risks, with a generally person-centred approach. This could be further strengthened by ensuring all risks are individually assessed and clearly documented.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The environment was generally safe, with safety certificates, fire records and equipment checks up to date. Personal emergency evacuation plans were current, and window restrictors and secured furniture reduced environmental risks. However, we identified that one person’s bathroom was not suitable for their mobility needs, and there was no grab sheet in place to support staff in an emergency. These issues were discussed and actioned during the assessment. However, this demonstrated the environmental risks had not always been identified proactively.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had safe staffing arrangements that met people’s needs. There was no use of agency staff meaning people were supported by staff who they knew well.

The staff recruitment practices were robust. People were involved in staff interviews. Staff rotas showed sufficient staffing levels were in place.

Staff received inductions, training and regular supervision. Staff told us there was always enough staff to support activities and outings, with additional cover arranged when needed. One staff member told us, “There is always enough staff for people to do activities. People can go out in the evenings – if we need more staff then someone is asked to come in.” During this assessment we observed sufficient staffing levels and people were supported to go out as preferred.

Relatives consistently described staff as well trained, responsive and attentive to people’s safety and wellbeing.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

Infection prevention systems were mostly effective. Cleaning schedules were complete, the home was clean and free from odours. Staff reported having adequate supplies of personal protective equipment.

However, we found food items without opening or best-before dates, including sauces that were over 12 months old. We also identified missing hand towels and soap in some bedrooms. These issues were addressed immediately, but they showed inconsistent application of infection prevention practices and oversight needs to improve.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We observed the medicines room left open, missing equipment such as a medicine counting tray, and topical creams without calculated expiry dates. We were not assured that medicines were always given as prescribed, including required timing before food. This was discussed with the registered manager during this assessment, who took immediate steps such as ordering a new counting tray and staff supervision.

Medicines systems and policies were in place but were not always followed. Medicines were stored correctly, records were complete, and staff had completed relevant training and received regular competency observations. There was evidence of excessive medicines being returned to the pharmacy and there was evidence of a person-centred approach to reducing medicines, supported by positive feedback from a relative. One relative told us, “They support (relative) not to take medication, which I agree with.”