The Orchards

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

People were supported by a service which fostered a positive culture of safety, openness and continuous learning.

People and their relatives told us they felt safe living at the service and were confident that any concerns raised would be listened to and acted upon. Staff told us they felt comfortable raising concerns, reporting incidents and openly discussing lessons learned from events.

Systems were in place to review incidents, accidents and medication errors.
The registered manager and nursing team discussed events daily during handovers and shared learning through daily flash meetings, staff supervision sessions, team meetings and wider organisational forums.

Staff described an open culture where learning was encouraged, and concerns could be raised without fear of blame.
The organisation reviewed themes and trends monthly, using this information to identify areas for improvement and implement measures to minimise future risks.

Learning was shared across the organisation to support consistency and improvement in practice.
The registered manager provided an example of how a review of lessons learnt following a serious incident had led to a change of policy and processes for the assessment and suitability of people being referred to the service and where there had been a significant change in a person’s health or presentation following an extended absence.

These improvements were subsequently implemented across the organisation, demonstrating how learning from incidents informed service development and improved safety for people living at the service.
 

People experienced coordinated care when moving into and between services.
Comprehensive pre-admission assessments were completed to ensure people's needs could be safely met and to consider the impact on people already living at the service.
Information was shared effectively with staff prior to admissions to ensure continuity of care.

People and their loved ones told us they were encouraged to visit the service wherever possible before moving in, and staff visited people in their current setting to support a smooth transition.
One person told us, "Before I came here my family visited and took some pictures to show me. The manager came to see me and told me all about the home. When I moved in, they made sure I was ok and checked in with me a lot."

The provider used an electronic care planning system which supported continuity of care and ensured up-to-date information accompanied people attending hospital appointments or accessing other healthcare services.
Referrals to specialist services were made promptly when required, and outcomes were shared with relevant staff.
There was a key worker system in place to support continuity and develop positive relationships with people living at the service.

Staff accompanied people to healthcare appointments when relatives were unable to do so, particularly where people required additional support due to memory impairment.

Appointment outcomes were discussed at handovers to ensure any actions required were followed up promptly.

People were able to access the service on a respite basis, enabling their loved ones to have a break while also supporting people to determine whether the service was right for them before making longer-term decisions.
 

People and their relatives consistently told us they felt safe living at the service.

People were supported by staff who understood their individual needs, preferences and risks and worked with them to maintain their safety while promoting choice, independence and dignity.

Staff demonstrated a good understanding of safeguarding responsibilities and were able to describe how they would recognise, respond to and report concerns.

Staff told us they felt confident raising concerns and were assured that management would take appropriate action to protect people from harm.

The provider worked collaboratively with people, relatives, healthcare professionals and local authority safeguarding teams to ensure concerns were managed appropriately and people's wellbeing was protected. Staff understood the importance of balancing people's right to take informed risks with the need to keep them safe.

Records showed safeguarding concerns had been reported appropriately to the local authority and the Care Quality Commission where required. Investigations were completed thoroughly and actions were implemented to reduce the risk of recurrence.

Learning arising from safeguarding investigations was shared with staff through meetings, supervision and day-to-day discussions to support continuous improvement and help keep people safe.
Systems were in place to monitor safeguarding concerns, identify themes and trends and take proactive action where required. This helped to ensure people remained protected from abuse, discrimination, avoidable harm and neglect.

We found some people were subject to Deprivation of Liberty Safeguards (DoLS). We reviewed records and found appropriate mental capacity assessments had been completed and DoLS applications had been made where required, ensuring any restrictions on people's liberty were lawfully authorised and monitored.
 

The provider worked with people to understand and manage risks by taking a holistic approach. Staff provided care and support that was safe, person-centred and enabled people to continue doing the things that mattered to them.

People were involved in decisions about risks that affected their lives and were supported to make informed choices about their care and support wherever possible.

Risk management focused on promoting independence, choice and quality of life rather than imposing unnecessary restrictions.

Care plans and risk assessments reflected people's individual circumstances, preferences and desired outcomes. Staff demonstrated a good understanding of the importance of balancing safety with people's right to make choices and live fulfilling lives.

We saw evidence of positive risk-taking throughout the service. People were encouraged to remain active, participate in community activities, spend time outdoors and maintain their independence wherever possible. Staff were able to describe how support was adapted to reduce risks whilst promoting choice, inclusion and wellbeing. For example, we were told about a person who had been living at the service and was receiving palliative care. Due to medications, they were advised not to drink alcohol. One of the things they enjoyed was a tipple. Staff were able to explain how they had worked with the person, their loved ones and other professionals to seek advice so they were able to continue enjoying a drink.
Staff worked closely with people, relatives and healthcare professionals to review risks when needs changed.
We saw people being actively involved in managing risks relating to their health and wellbeing. For example, 1 person living with diabetes chose not to follow a low-sugar diet. Records demonstrated staff had discussed the potential impact of these choices with the person, including the risks associated with managing their blood glucose levels. The person was supported to understand these risks and make informed decisions about their lifestyle and dietary choices. Staff continued to monitor the person's wellbeing whilst respecting their right to make decisions about their own care.

We observed staff supporting a person living with sight loss and mental health needs in a way that maintained their safety whilst protecting their dignity, independence and inclusion within communal activities.
Some people living at the service enjoyed spending time with animals living at the service and sometimes animals such as dogs brought in by staff or visitors. We saw detailed risk assessments and planning to enable this to be available to people in the safest way possible.
These arrangements demonstrated a positive and person-centred approach to managing risk, where people were supported to understand and manage potential risks whilst maintaining choice, control, independence and quality of life.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home was clean, welcoming and generally well maintained.
People and visitors told us they found the environment comfortable and suitable to meet their needs.

Environmental safety checks were completed regularly and records demonstrated monitoring was undertaken consistently. However, we identified equipment being stored in an inappropriate location which could potentially create an environmental risk. This was brought to the attention of the management team and was addressed immediately. reducing any potential risk to people and staff.
Equipment servicing and maintenance were up to date, helping to ensure equipment remained safe and fit for purpose. The provider completed regular checks of key safety systems and acted promptly when issues were identified.
The environment supported the delivery of care and people had access to appropriate equipment to help maintain their safety, independence and wellbeing.
Staff understood their responsibilities for reporting environmental concerns and we observed issues being addressed promptly.

Some areas of the home appeared tired and would benefit from refurbishment. The registered manager was able to share plans and timescales for improvement works that were already in progress. This demonstrated ongoing investment in the environment and a commitment to continuous improvement.
 

The provider made sure there were enough qualified, skilled and experienced staff to meet people's needs safely and effectively. Staff worked well together to deliver person-centred care and support that reflected people's individual preferences and needs.

There were enough suitably skilled and experienced staff deployed to meet people's assessed needs. People and their relatives told us staff were available when support was needed and care was delivered in a timely manner.

The provider maintained an appropriate skill mix, including registered nurses and care staff, to ensure people received safe and effective care.
Recruitment processes included appropriate pre-employment checks such as references and Disclosure and Barring Service (DBS) checks. Nursing staff maintained their professional registration requirements and were supported to remain up to date with best practice.

Staff told us they received a thorough induction, regular training, supervision and competency assessments. They felt supported by the management team and were able to discuss their development needs.

Mandatory training compliance was high, and systems were in place to monitor training completion and staff competence.
Staffing levels were determined through a dependency assessment tool and were reviewed regularly to ensure they reflected people's changing needs.

The provider utilised additional staff where required to respond to increases in dependency, changing risks or occupancy levels. helping to ensure people received safe, consistent and responsive care.
 

The provider assessed and managed the risk of infection.

Systems were in place to identify, monitor and control the risk of infection spreading, and concerns were shared promptly with appropriate agencies when required.
The service had effective infection prevention and control procedures.

Staff used personal protective equipment (PPE) appropriately and demonstrated a good understanding of infection control practices, including procedures for managing outbreaks and reducing the risk of transmission. Staff received regular infection prevention and control training to support safe practice.

The home was visibly clean, well-ventilated and comfortable for people, despite the high temperatures experienced during the assessment. People and visitors told us they found the environment clean and welcoming.

Audits and checks were completed regularly by the infection prevention and control lead and were overseen by the management team. Findings were reviewed, and any actions identified were addressed promptly to support continuous improvement.

The service worked with relevant healthcare professionals and agencies where required to ensure infection risks were effectively managed.
These arrangements helped to ensure people lived in a safe, clean environment and reduced the risk of avoidable infection.
 

People told us they were satisfied with the support they received to manage their medicines and felt confident staff supported them safely.

Systems were in place to ensure medicines were stored, administered and monitored safely. Controlled drugs were managed appropriately, and regular medication reviews were completed with healthcare professionals to ensure medicines continued to meet people's needs.

Any changes to prescribed medicines were updated promptly on the electronic medication management system, helping to ensure staff had access to accurate and up-to-date information.

People were assessed to determine whether they were able to manage some or all their medicines and topical creams independently.

Promoting people's independence whilst ensuring appropriate support was available where required.

People had personalised protocols for medicines prescribed on an 'as required' basis, providing clear guidance for staff and helping to ensure medicines were administered consistently. Care plans contained detailed information about each medicine prescribed, including its intended purpose and any potential impact on the person's health and wellbeing.

We observed the management team actively reviewing medication stock levels and discussing medicines requiring re-ordering. This helped to ensure medicines remained available when needed and demonstrated ongoing oversight of medicines management processes.

During the assessment, we identified that medicines waste bins and controlled drug denaturing kits had reached capacity. Management addressed this immediately. Whilst this had not impacted people's safety, strengthened oversight of medicines disposal processes would further enhance the existing medicines management systems.