The Orchards

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's needs were assessed comprehensively on admission and reviewed regularly to ensure care continued to meet their changing needs.

The service used recognised assessment tools to evaluate people's physical health, nutrition, hydration, mobility, skin integrity, dependency levels and risk factors. Care records contained detailed information about people's health, wellbeing, communication needs, diabetes management and mental capacity.

Assessments were used to develop personalised care plans which reflected people's individual preferences, strengths and support needs.

Risks associated with people's health and wellbeing were identified and managed appropriately, with regular resident of the day reviews undertaken, or when needs changed following significant events.

Staff monitored people's health and wellbeing and made timely referrals to appropriate healthcare professionals when changes in need were identified.

We saw evidence of healthcare recommendations being incorporated into care planning and daily practice. For example, 1 person's diet had been amended following an assessment by a Speech and Language Therapist (SaLT), ensuring staff were aware of how to support the person safely and effectively.

During the assessment, we identified a care plan relating to stoma care required additional detail regarding monitoring requirements and signs of potential infection. The management team addressed this promptly during the assessment. The immediate action taken demonstrated a responsive approach to care planning and a commitment to continuous improvement.

The provider planned and delivered people's care and treatment in line with current legislation, recognised best practice guidance and evidence-based standards. Care planning reflected what was important to people and supported staff to deliver personalised care that met individual needs and preferences.

The service demonstrated effective clinical oversight and worked collaboratively with GPs, specialist nurses and other healthcare professionals to ensure people's care remained appropriate and responsive to changing needs.

Staff knew people well and demonstrated a detailed understanding of their individual needs, preferences, routines and health conditions. This helped to ensure care was delivered in a consistent and person-centred way.

Care records reflected guidance from healthcare professionals and recommendations were incorporated into people's care and support plans where required.

Care plans contained detailed information regarding people's nutrition and hydration needs and included monitoring arrangements and risk assessments where required. This included support for people with poor appetites, specialised diets, swallowing difficulties and people receiving end of life care. Staff monitored people's intake where appropriate and acted when concerns were identified.

Both care staff and catering staff received training in International Dysphagia Diet Standardisation Initiative (IDDSI). This helped to ensure people received meals and drinks that met their assessed needs, where modified where required and reduced risks associated with eating and drinking.

People who required support with eating and drinking were provided with dedicated staff assistance during mealtimes to ensure they received support safely and at a pace suitable for them.

We observed a person living with dementia who was reluctant to eat and drink. A staff member supported the person by facilitating a video call with their loved one, who was able to encourage them during the meal. The staff member told us, "It's really important we get [person] to eat and drink, especially as it is so hot. [Name] responds well to their loved one." This demonstrated a creative and person-centred approach to promoting the person's health, wellbeing and hydration.
 

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.

Communication within the service was effective and supported the delivery of coordinated care. Staff used handovers, daily flash meetings, daily care notes and informal discussions to share important information, discuss changes in people's needs and ensure care was delivered consistently.

We observed inclusive daily walkaround handovers involving staff from across the service. Information about people's wellbeing, changing needs and planned activities was shared, and staff were allocated specific responsibilities based on people's assessed needs. This included supporting people with personal care, dressing, pressure area care, meals and hydration.

These arrangements helped to ensure people received timely and coordinated support throughout the day.
We saw staff greet each person during the handover. During the morning handover we observed staff asking questions and sharing additional information across all team members.

Daily flash meetings brought together a nurse and care or nursing assistant from all departments. The meetings were attended by the registered manager and clinical lead, who reviewed each person's wellbeing, healthcare appointments, identified risks and actions required. demonstrating a proactive and coordinated approach to care delivery and ensured important information was communicated effectively across teams.

Healthcare professionals described the service as welcoming and collaborative.

Staff spoke positively about one another and demonstrated a shared commitment to supporting people. Throughout the assessment, we observed a culture where staff worked together to achieve positive outcomes for people and did not limit their support to their specific roles or responsibilities.
For example, we saw housekeeping staff responding promptly when people requested assistance in their rooms. We saw members of the care team supporting catering with the serving and delivery of food.

We saw the registered manager and other members of the management team providing direct support and reassurance to people whilst walking around the service. Staff consistently demonstrated a willingness to help one another and work collaboratively to meet people's needs.

These observations demonstrated excellent communication, teamwork and cohesion across the service and helped ensure people received coordinated, person-centred care from staff who shared responsibility for their wellbeing.
 

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.

Relatives told us they were kept informed of important developments relating to their family member's health and wellbeing and were involved in discussions about care where appropriate.

The service supported people to live healthier lives by promoting both physical and emotional wellbeing. Staff monitored people's health and wellbeing and responded promptly to changes in need, seeking advice and support from healthcare professionals where required.

People were encouraged and supported to remain active and participate in meaningful activities both within the home and the wider community.

Activities available included gentle exercise sessions, games, gardening clubs and opportunities to engage with local community events. These activities reflected people's interests and promoted both physical and emotional wellbeing.

During the assessment, which took place on one of the warmest days of the year, we observed a number of people with varying levels of ability enjoying time outside under a canopy in a safe and comfortable environment.

A range of activities were taking place including nail care, singing, social interaction and refreshments. People were laughing, chatting and engaging positively with one another whilst enjoying drinks and ice lollies. The atmosphere was relaxed, inclusive and enjoyable, and staff actively encouraged participation whilst respecting people's individual choices.

The service had a number of pets that lived both within the home and in the outdoor areas, providing people with opportunities for companionship and meaningful interaction. We observed a person living with dementia respond positively to a dog that had been brought in to visit by a staff member. The person smiled, engaged with the dog and appeared visibly relaxed throughout the interaction.

Staff demonstrated a good understanding of the importance of meaningful activities, social engagement and maintaining relationships in supporting people's overall health and wellbeing. People were supported to remain connected to others and participate in activities that enhanced their quality of life and reduced the risk of social isolation.

The service took a person-centred approach to supporting healthier lives, recognising that health and wellbeing extended beyond physical care needs. People's emotional wellbeing, independence, social connections and personal goals were actively promoted to help them achieve positive outcomes.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider routinely monitored people's care and treatment to ensure it remained effective, responsive and reflective of their changing needs.

Systems were in place such as resident of the day to review people's care, identify changes in need and support continuous improvement.
Meetings and clinical reviews enabled staff to discuss people's wellbeing, identify emerging concerns and ensure actions were allocated appropriately. This supported timely decision-making and helped ensure people received coordinated care from staff who were aware of people’s current needs and priorities.

The service regularly monitored outcomes relating to people's health, wellbeing, nutrition, hydration, mobility and overall quality of life. Information gathered through care reviews, risk assessments, audits and discussions with people and their relatives was used to inform care planning and improve support.

The service demonstrated a commitment to achieving positive outcomes for people and adapting support when needs changed.

Staff worked collaboratively with healthcare professionals to enable people to remain living at the service wherever possible, even when their health needs became more complex.

Care and support arrangements were reviewed and adjusted to promote continuity, independence and wellbeing.

The registered manager described how they were working proactively with local nursing teams and GP practices to explore options for people to receive responsive treatments, such as intravenous (IV) fluids and antibiotic therapy within the service where clinically appropriate. The aim of this approach was to reduce avoidable hospital admissions, recognising that hospital stays can cause additional distress and disorientation for some people, particularly those living with dementia or those receiving end of life care. This demonstrated a commitment to achieving outcomes that reflected both people's clinical needs and their wellbeing.
 

The provider promoted people's rights to make decisions about their care and treatment and ensured consent was sought and respected in line with relevant legislation and guidance.

Staff consistently sought people's consent before providing support and demonstrated a patient, respectful approach when offering care.

We observed staff explaining what they intended to do, checking people were happy to proceed and respecting people's choices where they declined support.

Care records contained detailed information about how people communicated consent, including where verbal communication was limited.

Staff demonstrated a good understanding of people's preferred methods of communication and used this information to support people to express their wishes and make decisions about their care.

Capacity assessments were completed when there were concerns about a person's ability to make specific decisions. Where people lacked capacity, best interest decisions had been completed appropriately and involved relevant professionals, relatives and representatives where required. Records demonstrated decisions were made in the person's best interests and reflected the least restrictive approach.

Staff received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and demonstrated a good understanding of the principles. Staff were able to explain how they supported people to make their own decisions wherever possible and how they balanced people's rights with the need to keep them safe.

Care planning and risk management reflected people's choices, preferences and desired outcomes. We saw examples of positive risk-taking where people with capacity were supported to make informed decisions about their care and daily lives. This helped to promote independence, dignity and choice whilst ensuring appropriate safeguards were in place.
These arrangements supported people to remain involved in decisions about their care and treatment and helped ensure their rights were respected and upheld.