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

Leaders and senior staff made sure people’s care and support was effective by assessing and reviewing their health, care, well-being and communication needs with them. Although, there were mixed opinions from people as to whether they were involved in the planning and reviews of their care. A person confirmed, “I have had information about my health, and we have had some chats about my care in the past.” However, another person said, “I haven’t had any discussions about my health or progress or seen anything written down.”

Leaders planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. A member of the senior management team told us the process of how the provider ensured their care services had the most up to date guidance and legislation. They said, “The organisations quality team [named person] send the home managers updates.” This was then shared with the staff team including at the daily 10 at 10 senior staff meetings.

Leaders and the staff team worked well across teams and services to support people. They helped ensure that where required external health and social care professionals were involved in people’s care to promote their well-being. A staff member gave us an example of joint working with the district nursing team. They said, “District nurse visits for [people’s] wound care. Generally, yes, we work well together…if a [person] is high risk we ask for a district nurse to come in and assess [them]. They put in [specialised equipment] and continence assessments for continence aids. I feel I have a good working relationship with the district nurses’ team, occupational therapists and physios.”

Leaders and the staff team supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives where possible. People told us they received support to access healthcare both inside and outside of the service. A person confirmed, “We have a doctor, chiropodist, optician and hairdresser. They are all available to us.”

Staff routinely monitored people’s care and treatment to continuously improve it. Staff knew the people they supported well. They used a range of clinical tools to monitor and identify any risks to people. For example, ‘waterlow’ assessments, to assess people at risk of poor skin integrity. A staff member gave us an example of how they would support a person with a known risk. They said, “[A person] first comes in [to the service] and staff do a ‘waterlow’ score, if high, you ask for district nurses to come in and assess.” A person confirmed to us, “The staff will come and talk to you about health issues, and they will ask the surgery for advice.”

However, we found a lack of regular blood sugar monitoring checks for people with diabetes. This was not in line with the person’s care plan where it guided staff to undertake these checks. Whilst we found no poor outcomes to people, these monitoring checks helped promote people’s well-being. As such, this increased the risk to people’s well-being being managed safely and effectively. We fed this back during this assessment and the senior management team responded positively and took quick action. However, it is too soon to evidence that these improvements have been fully embedded and sustained.

Leaders and the staff team told people about their rights around consent and respected these when delivering person-centred care and treatment. Where appropriate, mental capacity assessments were undertaken and completed in line with the Mental Capacity Act 2005.

People confirmed to us that staff asked for their consent before supporting them and listened to and respected their choices. Where people lacked the mental capacity to make a choice, staff supported them in the best interest. A staff member told us about their understanding of best interest decisions. They said, “Decisions made on people's behalf if they can't consent. [You] look at whether they have Power of Attorney [in place]. Look at their history, so decisions are for them to live their life how they always lived their life.” A person confirmed to us, “They do ask my permission before they touch me although they don’t really need to.”