Orchid Woodlands Healthcare Ltd

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

Staff did not always receive adequate training and supervision to support them in their role. Medicines were not always managed safely. Consent to care and treatment was not always sought in line with legislation.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People living at the home did not make any specific comments about assessing needs.

We asked the manager about the process for new admissions. They told us they used information provider to them by the local authority and/or commissioners, to decide whether they could meet people’s needs.

People’s care records contained limited evidence of their needs being assessed prior to moving into the home. Where this had been done, the quality and quantity of information varied. The electronic care planning system used by the provider contained a section for assessments. Within this was a pre-admission / history section. For one person, this section contained a brief medical history and stated they had resided in care previously, otherwise all sections of the assessment were blank. For another person, it explained reason for admission and some information on needs in relation to decision making, communication and falls, but little else. As such, it was not clear where information was taken from to assist in the completion of people’s care and support plans.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not receive any specific feedback from people in this area.

We did not receive any specific feedback from staff in this area.

We did not receive any specific feedback from partners in this area.

There were systems in place to ensure people received care from other services when they needed it such as dieticians, district nurses and GPs.

We noted an example of good practice, when staff had responded promptly to signs of illness in a person. Staff had identified concerns, contacted emergency services, the GP and person’s next of kin and ensured they received prompt medical attention.

We asked the manager how they ensure people’s health needs were met, including dental care. They told us, “With people’s healthcare needs, we refer to the necessary professional as required. I don’t think people living here have all got dentists, but I would have to check.”

Where people required admission to hospital, we looked at what information was available to be sent with them, to ensure their needs could continue to be met. The home used a hospital transfer document, which contained 5 sections, which included information about reason for admission to hospital, what was important to the person, their likes and dislikes, along with any supporting documentation such as medical records, risk assessments etc. We were provided with a copy of one person’s transfer document. Although this explained why the person was being admitted, and contained extracts from the care plan to explain their key needs, all of the person centred sections were left blank. Record keeping to evidence staff had effective oversight and people were receiving the required support to ensure they remained well, required improvement. For example, where body maps indicated people had an area of redness or a potential pressure sore, a related care / wound plan was not always present, or where it was, information was limited. Where risk assessments had indicated monitoring or specific interventions needed to be completed, these were not done consistently. For example, due to risks relating to their skin integrity, one person’s care records stated an assessment of pressure ulcer risk needed to be done monthly. This had last been completed in October 2023. They also required repositioning every 4 hours. Repositioning records from 1 to 11 June 2024, showed this had not been done. Only 6 instances of the person being repositioned were documented over this 11 day period. We were unable evidence people received the required support with washing, dressing, continence care and other personal hygiene tasks, which would help promote a healthy lifestyle, as record keeping was sporadic.

We didn't receive any feedback from people living at the home in this area.

Care records did not evidence people, or their legal representative, had been involved in reviews about their care to ensure they meet their needs and expected outcomes were being achieved. We asked the manager about this. They told us, “In theory they [people] should be invited to review meetings, but I’m not sure if they have taken place. We will need to invite them moving forwards.”

Monitoring to confirm care and support was being provided in line with assessed needs required improvement. Clinical monitoring tools, such as the Malnutrition Universal Scoring Tool, and the Waterlow Score had not been completed each month as per guidance. For some people, these had not been completed at all. Where these had been done, recommended actions had not always been followed through. For example, for one person due to having a MUST score of 2 in March 2024, should have moved from monthly to weekly weights, to ensure their weight was monitored more closely. However, they had only been weighed twice since 22 March 2024. Monitoring of food and fluid intake, to ensure people were eating and drinking enough to either maintain or increase weight and remain sufficiently hydrated, were not completed consistently. Care records contained no information about how much people should drink per day or what staff should do if these amounts were not achieved.

People living at the home did not provide any feedback in this area.

Staff understood the need to ask for people’s consent before providing care. During the assessment, we heard staff asking people for their consent before giving assistance.

The provider’s consent process required improving. Care records contained contradictory information about people’s ability to consent to their care, and family members were sometimes listed as a decision maker, without any evidence they had the legal powers to act in this capacity, e.g. had lasting power of Attorney for Health and Welfare. One person’s care records stated they had verbally consented to all aspects of their care and support. However, the DoLS application for this person referred to them lacking capacity and insight into their own safety. There were no capacity assessments on file, to explore what, if any decision this person could make, nor any evidence the best interest process had been used. The provider’s electronic care planning system included a cognition care plan. Where these had been completed, information tended to focus on how to manage people’s behaviours, rather than refer to decision making and ability to consent. We asked for evidence of mental capacity assessments being used to determine if people had capacity to make their own decisions. However, the example shared was from June 2022, which pre-dated our previous inspection.