The Orchards

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good: This meant people’s needs were met through good organisation and delivery.
 

This service scored 82 (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.
People received highly personalised care which reflected their choices, preferences and what mattered most to them.

Staff demonstrated a detailed knowledge of people's lives, interests and support needs. Where people chose to make decisions, others may consider unwise, staff supported them to understand risks whilst maintaining their rights and independence.

People's preferences were respected in all aspects of daily living. For example, we observed a person who preferred their main meal later in the day being supported to follow their preferred routine. This required coordination between care and catering staff and demonstrated a flexible, person-centred approach to care.

People's personal environments reflected their lives and interests. Rooms contained personal belongings, photographs, memorabilia and displays linked to hobbies and interests. During our assessment many people had decorated their rooms and doors in relation to the football World Cup and were actively participating in activities organised around the event.

The service placed significant importance on emotional wellbeing and quality of life.
Staff looked beyond people’s assessed care needs and actively supported people to maintain interests, experience meaningful engagement and achieve outcomes which were important to them, for example One person living with dementia was provided with a lifelike doll, which staff told us offered reassurance, comfort and opportunity for nurturing interaction. Throughout our visit we saw the positive impact this had on the person’s emotional wellbeing and engagement.

The maintenance staff told us following service user’s requests for a gardening club, they had developed a raised allotment area in the courtyard and supported service users to grow their own veg. They told us how this veg was then given to the cook and service users would make suggestions of what they would like the produce to be used for.

We saw a group activity where the activity lead demonstrated a highly inclusive approach, actively encouraging people who were quieter or living with communication difficulties to participate.

One person who was unable to verbally communicate responded positively to this support, smiling and showing visible signs of enjoyment and engagement when encouraged to take part. This helped ensure activities were meaningful and accessible to people regardless of their abilities or communication needs.

Staff also recognised the importance of helping people maintain a sense of purpose. A member of the housekeeping team explained how they supported a person living with dementia to participate in cleaning and tidying their room. Rather than completing these tasks for the person, staff encouraged their involvement because this reflected activities they had previously enjoyed and helped maintain their independence, identity and a sense of contribution within their home.

Staff demonstrated a culture which showed understanding that meaningful occupation, inclusion and purpose were important to people’s wellbeing.

Staff consistently spoke about supporting people to continue enjoying opportunities that mattered to them rather than focusing solely on meeting their care needs.

Staff also supported people to achieve personal aspirations. For example,1 person had always wanted to keep pet birds but had limited family support to make this possible. Staff worked with the person to overcome these barriers and supported them to keep birds in their room, with members of the activity team and care staff helping ensure they were cared for. We saw the positive impact this had on the person’s wellbeing, providing enjoyment, companionship and a sense of purpose.
 

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 was exceptionally well connected to its local community and actively supported people to maintain meaningful relationships, interests and social networks.
Local primary schools attended at different times in the year which gave opportunity for intergenerational learning. Students from local high schools and colleges had the opportunity for work experience.

The cook told us how they buy local to support local small businesses.

Staff understood that remaining connected to local life was an important part of people's wellbeing, identity and sense of belonging. Relatives and professionals described the service as an active part of the local community, creating opportunities for people to continue engaging with others rather than becoming isolated following their move into residential care.

There was a strong sense that the home was part of the wider community rather than separate from it.

People were encouraged and supported to remain connected to activities, groups and relationships that were important to them. Community events and activities were planned with consideration of people's preferences and participation was always based on individual choice.

Staff explained how people were able to engage in ways that suited them, whether this was attending events, helping with preparations, spending time with visitors or observing activities from a quieter environment. We saw that any plans for events and activities were discussed with residents and their families prior to them being organised through resident meetings, relative meetings and newsletters.

The registered manager explained that the service was located within an area of social deprivation and sought opportunities to support both people living at the service and the wider community. They went on to say how careful consideration was given to the potential impact of community events on people living at the service, particularly those living with dementia.

Risk assessments and event planning took account of people's individual needs, preferences and sensitivities. For example, during Halloween celebrations, staff considered how decorations, costumes and activities might affect people's wellbeing and adapted the environment and activities accordingly. This helped ensure people could enjoy community events in a way that was safe, inclusive and responsive to their individual needs.

People had access to a wide range of community resources and visiting professionals, including healthcare providers, hairdressers, chiropodists and opticians. The service worked collaboratively with healthcare providers and partner agencies to ensure people experienced coordinated care and had timely access to services when required. This helped support continuity and reduced the risk of people experiencing delays in receiving support.

Several people had initially accessed the service through respite placements before choosing to move in permanently. Staff explained this was often because people and their families had developed trusting relationships with staff and experienced care that reflected their individual needs and preferences. This demonstrated the provider's ability to respond flexibly to people's changing circumstances whilst maintaining continuity of care and support.

A relative told us: "[Name] was in a different home to here and they were closing it. They were really settled and I didn't know how it would go. They came here and this is even better, I'm so happy they are here."

Relatives described maintaining positive and lasting relationships with the service, including continuing to participate in activities and events following the death of their loved one. This demonstrated the strength of the relationships developed between people, families and staff and reflected the inclusive culture promoted throughout the service.
 

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

The provider ensured people, relatives and professionals had access to clear, timely and relevant information to support informed decision-making and involvement in care.

Information was shared in a way that reflected people's individual communication needs, preferences and abilities.

Care records contained detailed information about people's communication needs, preferred methods of communication and how they expressed consent, wishes and choices.

Staff demonstrated a good understanding of individual communication needs and adapted their approach to help people understand information and remain involved in decisions affecting their lives.
People and their relatives told us they received regular updates about care and support. Relatives consistently described being well informed about changes in their family member's health and wellbeing and felt involved in discussions about care planning and decision-making. One relative told us they were contacted regularly and always felt aware of what was happening with their loved one.

We observed staff sharing information with people in a respectful and supportive manner and taking time to explain care and treatment options
 

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.

People were encouraged and supported to express their views in ways that suited their individual needs and communication preferences.

People and their relatives were involved in discussions about care and support wherever possible. Relatives told us they were kept informed and actively involved in decision-making. One relative explained they were regularly contacted about their family member and felt well informed about their care

Information relating to people's communication needs was clearly recorded and staff demonstrated a good understanding of how to support people to express their views and make decisions about their care.

Regular reviews ensured care remained responsive to people's changing health, care and wellbeing needs and supported positive outcomes for people living at the service

Complaints and concerns were taken seriously and investigated appropriately. Records showed actions were taken in response to issues raised and learning was shared with staff to support continuous improvement.

People and relatives told us they felt comfortable raising concerns and were confident they would be listened to and acted upon.
Residents and relatives were actively involved in life at the service and had opportunities to influence how the service was developed. This included participation in resident and relative meetings, community events and recruitment activities.

The service involved people in interviewing prospective staff members, helping to ensure new recruits shared the values and qualities important to those living at the home.

Feedback was sought regularly through conversations, meetings, surveys and day-to-day interactions. Staff and managers demonstrated a commitment to listening to people's views and using feedback to improve people's experiences.

The provider actively encouraged people, relatives and members of the local community to participate in events and activities at the service. This helped people remain connected to others and ensured their views and experiences were valued.

Throughout the assessment, we observed a culture where people's opinions mattered and where staff took time to seek feedback, listen to concerns and respond positively to suggestions. This helped ensure people remained at the centre of decisions about their care, support and the development of the service.
 

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

The provider demonstrated a strong commitment to ensuring people had equitable access to care, treatment, services and opportunities regardless of their health needs, disabilities, communication requirements, background, beliefs or personal circumstances.

People's needs were comprehensively assessed prior to admission to ensure the service could meet their individual requirements and provide appropriate support. People and their loved ones were encouraged to visit the service before moving in and staff visited people in their current setting to support smooth transitions and ensure people were able to make informed choices about their care.

People had timely access to healthcare professionals including GPs, specialist nurses, opticians, chiropodists, Speech and Language Therapists (SaLT) and other healthcare services. Referrals were made promptly when changes in need were identified and recommendations from healthcare professionals were incorporated into care planning and daily practice.

The provider actively identified and addressed barriers which could affect people's ability to access areas of the home, activities or services. For example, a person who was living on the first floor had begun to decline in their health. The registered manager told us; “we saw [name] declining and becoming frailer. We had a room become available on the ground floor and supported them to move to somewhere more suitable.

The service promoted inclusive access to activities and social opportunities for people with differing physical, cognitive and sensory needs.

During the assessment, we observed people with a wide range of abilities participating together in activities, social events and community opportunities. Staff adapted support where required to ensure people could participate in ways which were meaningful to them.

The provider also recognised potential inequalities within the wider community and sought to improve access to opportunities beyond the service itself. Community events, including Halloween celebrations and Christmas activities, were designed to be inclusive and accessible for people living at the service, their family members and local residents. The registered manager described how these initiatives were particularly important within an area of social deprivation and helped provide opportunities that may otherwise be difficult for some families to access.

The service worked collaboratively with healthcare professionals to explore ways of improving access to responsive healthcare within the home, this was particularly beneficial for people living with dementia and those receiving end-of-life care, for whom hospital admissions could be distressing and disruptive.

These examples demonstrated that the provider actively considered barriers to access and took practical steps to reduce inequalities.

People were supported to access care, treatment, activities, relationships and community opportunities in ways which reflected their individual needs and promoted positive outcomes.

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.

The provider demonstrated a strong commitment to ensuring people experienced equitable care, support and outcomes regardless of their age, disability, health condition, background, culture, beliefs, identity or personal circumstances.

Leaders and staff understood the importance of recognising people's individual differences and adapting support to meet their specific needs.
Care planning reflected people's diverse needs, preferences, strengths and protected characteristics. Staff demonstrated a good understanding of people's cultural backgrounds, personal identities, communication needs and life experiences and adapted their approach accordingly.

We observed people being supported in ways which promoted dignity, choice, inclusion and independence.
The provider actively sought to remove barriers that could prevent people from fully participating in daily life. This demonstrated a commitment to listening to people and ensuring they had equal access to opportunities within the service.

Staff demonstrated creativity in supporting people to achieve positive outcomes. We saw activities which were adapted to ensure everyone who wished to participate was able to do so.

The service promoted equality, diversity and inclusion in meaningful ways. Different cultures, identities, backgrounds and beliefs were recognised and celebrated throughout the year. The registered manager told us how they decorate a Christmas tree for Halloween in October, they then redecorate with poppies for Remembrance Day in November before decorating it for Christmas.

Staff explained how people were supported to participate in celebrations according to their own wishes and preferences. This helped create an environment where people felt respected, valued and able to be themselves.

Leaders worked with healthcare professionals and community partners to improve outcomes for people. The service explored opportunities for people to receive responsive healthcare interventions within the home where appropriate, helping to reduce avoidable hospital admissions and minimise distress, particularly for people living with dementia and those receiving end-of-life care.
These examples demonstrated a strong commitment to equity, inclusion and person-centred care.

The provider actively identified and addressed barriers, adapted support to meet individual needs and worked to ensure people experienced positive outcomes regardless of their circumstances.
 

People were supported to plan for important life changes and future decisions, enabling them to express their wishes, preferences and priorities for their future care and support.

Staff recognised the importance of having sensitive conversations early so people had sufficient time to make informed choices about matters that were important to them.

Care records included detailed advance care planning information where people wished to discuss and record their future preferences. This included information about people's care wishes, significant relationships, cultural and spiritual needs and preferences for future healthcare and end-of-life care.

People receiving end-of-life care were supported with dignity, compassion and sensitivity.

Staff worked closely with healthcare professionals, people and those important to them to ensure care reflected the person's wishes and promoted comfort, dignity and wellbeing.
Staff received training in end-of-life care, enabling them to provide compassionate, person-centred support during what can be a difficult and emotional time for people and their families.

Appropriate documentation, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and ReSPECT forms, was completed where required and was readily accessible to staff. The service had implemented a discreet system to ensure staff were aware of important end-of-life documentation and support needs using different flower symbols displayed on the outside people's rooms. This promoted timely and appropriate responses whilst maintaining people's dignity and privacy.

Relatives spoke positively about the support they and their loved ones received during difficult times. One relative told us, "I am able to visit [loved one] whenever I like. The staff are always just popping in checking I'm ok too. I can be involved in helping with the care of [name]; sometimes it can be too much, and the staff tell me to take some time and they stay there." This demonstrated the service's commitment to supporting relatives as well as the person receiving care.

Another person told us, "My daughter used to look after me before I came here, now we have quality time where she doesn't feel like my carer." This reflected the positive impact the service had on family relationships, allowing loved ones to focus on spending meaningful time together rather than solely providing care.

Staff demonstrated a good understanding of people's individual wishes and were able to explain how they adapted care to ensure people's preferences continued to be respected as their needs changed. Care plans were reviewed regularly and updated to reflect people's current wishes and circumstances.

The provider recognised that planning for the future was about more than healthcare decisions and included maintaining relationships, personal wishes, cultural preferences and individual choices. This helped ensure people remained at the centre of decisions affecting their lives and future care.

The provider also recognised the emotional impact that bereavement can have on staff. Staff told us they were offered support following the death of a person living at the service, acknowledging the meaningful relationships that often developed between staff, people and their families.

The provider also ensured information was shared effectively with relatives, healthcare professionals and community partners where appropriate. This supported joined-up working, continuity of care and positive outcomes for people.
These arrangements helped people and those important to them feel reassured that future care and support would be delivered in accordance with their wishes, values and preferences, whilst preserving the relationships that mattered most to them.