The Orchard Care Home

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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

We assessed all quality statements in the effective key question. People’s rights and consent was not always assessed in line with the Mental Capacity Act. People were subjected to restrictions on their daily routines, without clear mental capacity assessments having been completed. This is an ongoing concern from our last assessment. Peoples care plans did not always include enough detail to guide staff. This is an ongoing concern from our last assessment. While staff communicated well between themselves, this information had not been written in care plan documents. People were supported to live healthier lives. Staff communicated with external health and social care professionals Staff kept clear documentation on people’s daily care. This allowed staff to monitor people’s wellbeing and ensure they had good outcomes.

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.

People were unable to explain how their needs were assessed. However, records showed us that people had been encouraged to be involved in planning their care. Whilst people were involved in planning their care, the care records were not always sufficiently detailed.

We identified that care planning documents did not always contain enough guidance to guide staff. While staff told us they had time to review these care plan records, we were not assured that reading these documents would always be effective to improve their knowledge.

Care plan documents did not include enough detail on how to meet people’s needs. While some information was recorded and passed over in daily handover meetings, there is a risk that the poor recording in care plans would mean staff were not always able to understand how to support people. We would expect people’s needs to be clearly documented in care plans for staff to reflect back on.

People were not able to answer questions about evidence-based care. As we had concerns about the processes at the service we were not assured that people had a good experience.

Staff understood how to work with external health and social care providers, to provide support in the most effective way.

People’s health needs were not always clearly described in care plans, this could impact whether they received evidenced-based care and treatment. People were given opportunities to live as healthy as possible. This included supporting people to eat healthy and exercise. People’s nutrition and hydration needs were supported in line with current standards. Staff monitored people’s weight if needed.

People were not able to answer questions about how staff and teams worked together. However, we observed staff working well with each other and contacting external health professionals. We were therefore assured that people had a positive experience.

Staff were able to explain how they completed daily handovers to pass over information about people’s changing needs. Whilst this was effective, we saw that care plans did not always keep clear details on people’s care needs. This could impact effective team working.

We did not receive any feedback from partners about this.

People who lived at The Orchard had a variety of physical health conditions. Details of these conditions and how to support them, were not recorded for staff to understand. For example, one person regularly went to the hospital for routine follow ups of a life limiting condition. The care plan did not include detail of how often the person attended the hospital, what symptoms staff should monitor in between hospital visits or when staff should call for medical advice. When we spoke to staff, they understood the person’s medical needs. However, not having this written down risks new or agency staff not having this detailed information to read and learn from.

People were not able to answer questions about living healthier lives. However, we observed people were offered healthy food options and support to exercise. We therefore assessed that people received a positive experience.

Staff were able to explain people’s health conditions and how best to support this. For example, one person had a health condition that required a specific diet. Staff were aware of how to alter food to meet this health need.

There was a culture at the service to promote healthy lives. Records showed that staff supported people to take suitable medicine, stay clean, and follow a healthy lifestyle.

People were unable to understand and respond to questions about improved outcomes. However, records showed us that people’s needs were monitored to support positive outcomes.

Staff were able to explain people’s needs and how they were monitored. For example, a person’s health condition meant they were at risk in the bathtub. Staff described how they would monitor the person’s health to support a safe bath.

Staff kept clear records on how they had supported people and at what time. This allowed changes in a person’s needs to be identified and improvements made to their planned care. This allowed for people to have better outcomes.

People were unable to understand questions about consent to care and treatment. We found mental capacity assessments were not always in place, and deprivation of liberty safeguards were not clearly recorded for staff to understand. This would impact people having a positive experience.

Staff understood the principles of the Mental Capacity Act. They were able to explain the need to ask for consent before completing tasks. They understood that if a person was assessed as not able to make a decision, then staff could support in their best interests. Whilst staff had good knowledge, this had not resulted in the correct application of the Mental Capacity Act at the service.

At the last inspection, we observed that mental capacity assessments were not completed to current standards. At this assessment, we found ongoing concerns. People were subjected to restrictions on their daily routines, without clear mental capacity assessments having been completed. For example, one person was only able to use clear nail polish to allow staff to see dirt in their nails. This is restrictive on the person’s freedom and less restrictive options had not been considered. We reported this back to the management team, and they removed this guidance for staff. Some people at the service had a deprivation of liberty safeguard. This is a lawful procedure to ensure people’s freedom and liberty are only restricted when it is in their best interest. We found that detail of people’s deprivation of liberty safeguards were not recorded in people’s care plans. This can impact staff understanding of who has a safeguard in place and how this would impact the person’s care.