Orchard Court

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• 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

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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulations in relation to governance.

This service scored 54 (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 did not always make sure people’s care was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Whilst a variety of assessments were in place, the information about people’s current needs was not always clear to help inform staff how to care for them. For example, for a person who required the use of a hoist for all their transfers, there was reference to other equipment which they were no longer able to use. For another person it was unclear about the level of support needed with their continence care.

It was noted, shortly prior to the assessment commencing, the electronic care planning system used was updated and lots of information had needed to be transferred over which potentially led to delays in documents being updated and included information that wasn’t relevant. Staff demonstrated an understanding of what people needed. Staff handovers were also completed to share how a person was and any significant information.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s care was not always planned with them. For example, 1 person told us, “They never discuss my care plan.” They went on to explain how they would like to shower more often but felt unable to ask. Records did not support that people were regularly offered baths or showers. The manager recently implemented a further overview to ensure people were regularly offered these. The records reviewed did not demonstrate people had been involved in discussions about their care or in developing their care plans.

The provider utilised recognised risk assessment tools to help assess people’s needs and ensure they received the relevant support in areas such as nutrition and skin care. Information was available about people’s medical needs including diabetes. We discussed with the manager how this could be strengthened by including more detail about how the medical condition presented for the person.

There had been some difficulties in appointing a head cook for the service, but one was due to start. Staff with training had stepped into this role in the interim and information was available about people’s dietary needs. We received generally positive feedback about the quality of the food, with a person telling us, “The food is marvellous, too good I’ve put weight on.” We observed choice was promoted, including using show plates, although some people fed back this was not consistent practice. The food looked and smelt appetising, and people appeared to enjoy it.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. A professional noted the significant progress in communication between the service and heath partners and confirmed the staff team were proactive in making referrals and completing the necessary follow-up actions. Staff told us they worked well as a team. For example, a staff member stated, "We communicate and we work as a good team. Any problems, I can go and sit and have a chat with [manager].” The manager was a visible member of the team.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Some people and their relatives told us there was a lack of activities and stimulation. A relative stated, “I think they could do more to engage with people.” A staff member highlighted activities as an area to be addressed at the earliest opportunity. For some people a lack of stimulation may have been further exacerbated by their room being in a part of the home with no communal area. Staff supported them to access other parts of the home. The nominated individual noted the actions being taken to address the layout of the building. They had also appointed a new activities co-ordinator who would be developing activities with and for people, including one to one support.

Staff were aware of people’s health needs; the records required further development to ensure they captured all the relevant information. Some relatives told us they had needed to escalate concerns a couple of times before staff responded. People’s relatives were informed if there were concerns about a person’s health. Health professionals including GP’s, district nurses and chiropodists regularly visited the home and staff contacted them for any advice or support. A professional told us, “The home are very proactive at contacting for residents if they have any issues or need to make a new referral.”

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met the expectations of people.

People told us their care plans were not discussed with them, and records did not demonstrate they had been involved. This meant people were not consistently afforded the opportunity to express how they wanted to be cared for, including their desired outcomes and wishes. Of the care plans reviewed, only one referred to the person’s goals and outcomes, and these were not specific. This did not demonstrate that care was consistently person-centred. In addition, some people and their relatives told us there was a lack of activities and stimulation. This meant people were not consistently supported to engage in meaningful activities or maintain their well-being.

Daily records and monitoring charts were used to document the support people received. However, whilst they contained some basic information, they were not always updated in a timely way and did not show people received care in line with their assessed needs. This included people who needed regular checks overnight and additional monitoring of their continence needs so staff knew when to administer medicines. This was discussed with the management team who acknowledged this and agreed to address it.

Records of capacity assessments lacked detail about how these were completed and how best interest decisions were discussed, to ensure people’s consent was appropriately obtained and their rights were upheld. However, the provider told people about their rights around consent and respected these when delivering person-centred care.

Records of people’s consent for their care and support were recorded on their care files. We observed staff explaining and seeking people’s consent before providing support.