Orchid Woodlands Healthcare Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

There was not always person-centred care at the home and complaints were not always handled appropriately.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us a number of activities were provided. Comments included, “There are activities regularly but I don’t do them anymore, that’s my choice” and “I enjoy joining in with the singing and activities.” The home used a handover sheet, on which key information about people’s needs was recorded. This document was given to agency staff, as a visual aid to support them when on shift. We found information on the handover sheet contradicted what was stated in people’s care records. For example, the sheet stated 1 person required repositioning every 4 hours, their care records said every 2 hours. Another person was listed on the handover as requiring a modified diet, there was no reference to this within their care records. The provider’s electronic care planning system contained sections for recording person centred information about people. This included information about their life history, likes and dislikes and interests. We found these had either not been completed, or information was limited. The manager had identified this shortfall upon commencing post, and had circulated ‘This is me’ forms to relatives at the relative meeting in April 2024, to try and gather this information.

Staff provided mixed views, with some telling us they did not think people had enough activities to do each day and when the activity coordinator was off, they stated very few if any activities were provided. We were told the coordinator had only just returned from an extended period of absence.

The quality and quantity of information varied across the care plans we viewed during the assessment. One person’s care plans were all blank, another only had 1 completed care plan on the system, with the review section in 3 others stating, ‘no change to care plan’, despite them being blank. Where care plans had been completed, we found some contradictory information or a lack of detail. For example, one person’s care plan referred to them as having a pressure sore, being at risk of developing one, having the potential to develop one and having an area of redness. Another person’s care plan stated they were not prescribed ‘as required’ pain relief, but to take analgesia as required. The manager confirmed this person was prescribed ‘as required analgesia’, which meant the care plan was wrong. We noted the home had an activity board, on which weekly activities could be advertised. On the first day of assessment, the activity board was blank. Activities were later added for that day, but not for the rest of the week. On the 2 subsequent assessment visits, we found the board was again blank. During each assessment visit we observed activities taking place in the larger of the lounges during both the morning and afternoon. However, as these were not advertised, it was not clear if what was being done had been planned in advance or done ad-hoc. We also saw no evidence people’s views on what types of activities they wanted to do had been sought, to ensure what was offered met people needs and wishes. Record keeping linked to activity completion was sporadic. As a result, we could not determine if activities had been completed consistently, what had been offered and who had attended.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We were not able to determine whether information was provided to people in a way which was accessible to them. We asked the provider for evidence of how information was available in an accessible way, to meet people differing needs. The manager shared a poster with us, which asked people to let staff know if they required information in different formats. However, not only was this poster written in such a way, that people with a visual or cognitive impairment would likely have difficulty reading and understanding it, it was also not displayed anywhere within the home.

The manager had created an ‘easy read’ version of the complaints process, which although quite lengthy, did explain the process in an easy to understand way. However, this was also not displayed anywhere within the home, so was not accessible to people.

From reviewing people’s care records, whilst some did contain information about their communication skills, such as how staff should speak to people and how people were able to communicate with others, there was no evidence to show AIS needs had been considered at assessment and information be available and provided to people in line with this.

The current manager had been proactive in seeking the views of people and their relatives by introducing the completion of separate resident and relative meetings. At the time of our assessment only one of each had taken place, but we noted dates for further meetings during 2024 was on display. Prior to these, we found no evidence meetings had occurred.

The provider circulated annual surveys to gather the views of people and relatives about the care provided, the staff and home overall. The last survey was dated December 2023, with 19 people and 23 relatives providing a response. The surveys were sent to relatives via email, with people being asked the questions directly by staff members. We noted overall feedback was positive, with 95% of respondents stating they would recommend the home. The manager told us, “I have recently sent some more surveys out to relatives, but have only got one back so far. Going forward, we will send out questionnaires twice yearly. These will be analysed and fed back in a meeting.” The manager had also informed relatives they would start to receive a monthly newsletter, so they could see what had been going on in the home. We asked the manager what was in place to communicate what actions had been taken in response to people or relatives feedback in meetings or through surveys. They told us, “There is nothing in place currently, but we are thinking about implementing a ‘you said, we did board.”

At the resident meeting held in May 2024, people had asked for more fluids and snacks to be offered, more activities to be provided, a quiet room to be provided and being able to access drinks and breakfast if up early. Due to there being no formal process for reporting on progress, it was not clear what actions had been taken or if any of these requests had been met.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Nobody was currently receiving end of life or palliative care with the home. The deputy told us the majority of people who had passed away recently had done so in hospital. We asked the deputy if we could look at the care plan of the last person to have passed away in the home. The deputy provided the care plan of a person who had passed away in December 2022. Although this pre-dated our previous inspection, we used it to assess the quality of information made available to staff to ensure they could met this person’s needs and wishes.

We asked the manager how staff were supported to provide appropriate care to people at the end of their life. They told us, “I assume we involved Bolton hospice and there will be district nurse involvement. The deputy would be better placed to answer this, with me being new to the post.”

The end of life care plan contained some good person centred information relating to this person’s wishes at the end of their life, such as where they wanted to be, who they wanted to be with them. However, information on how this person should be cared for was more limited. A separate ‘final day’s’ care plan was in place, which contained more information about the provision of personal care, and ensuring staff washed and dressed the person, provided hair and nail care and supported with continence care. Again. Although the care plan explained what care should be given, there was no guidance on how this should be done, and whether this changed as the person’s condition deteriorated. We also noted reference to the person being nil by mouth due to risk of choking. There was no additional information about how this person would receive nutrition and hydration, nor whether mouth care was required, for example ensure lips were kept moist.