The Orchards Residential Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

In this key question we looked at 2 quality statements relating to the involvement of people to manage risks and safe and effective staffing. People had appropriate risk assessments in place but staff were not always knowledgeable about these. Staffing levels appeared to meet people’s needs and staff treated people with kindness and compassion.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us staff worked with people to manage their risks and regain a sense of independence. One relative told us: “Carers haven’t stopped her moving around just to make their life easier, they have worked with her to feel a sense of achievement and independence again. It has been lovely to see.” Another relative told us: “We thought [person] was coming here to die, but all the carers have just rallied round. They get him washed, dressed, fed and in the day room. Each day they encourage him to do a little bit more for himself by interacting with him, having a bit of banter. The light is back in his eyes and he is trying to walk.” Some relatives told us they had asked if their relative could have bed rails fitted following their relative falling out of bed and were told this could not be provided. We raised this with the manager, who explained that bed rails are no longer used in the service due to the potential safety risks associated with them, but explained other steps were taken to keep people safe, such as using crash mats and sensor beams. The manager told us individuals were instead risk assessed for the use of the most appropriate equipment.

The manager explained how care and support plans were generated following risk assessments taking place, and how this information was cascaded down to staff. However, not all staff had a good knowledge of people’s risks. 2 people had been identified as having a risk of developing pressure areas however staff could not consistently tell us who was at risk.

We observed people had equipment in place to support their independence, such as walking frames. Staff supported people appropriately and in line with their needs.

People had risk assessments in place and information to help staff manage people’s risks was transferred to people’s care and support plans. These were regularly reviewed. However, we found staff did not always have a good understanding of people’s risks. For example, we asked staff who was at risk of choking, and some staff told us all people were at risk, whereas another staff member told us there was no one at risk of choking. During our assessment, we identified there were at least 2 people at risk of choking. However, we found no evidence of harm or impact to people as a result of this.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives described staff as kind and caring, and felt staffing levels mostly met people’s needs. Some relatives told us staffing at night-time was not as effective as it was during the day. One relative told us: “It does seem like some [staff] are very good with [person] and can get him on their side, while others from the night shift don’t seem to know quite what to do with him when he tries to get up.” Another relative told us: “There has only been about 10% of the time that we have found [person] not dressed properly in the morning and feel this might perhaps be due to lower staffing levels at night.”

All staff we spoke with told us there were enough staff within the service and felt there was enough training. The manager explained some staff had completed additional training and had shared this knowledge with other staff. The manager told us: “Some staff have taken on tissue viability roles within the NHS, called the skin care pathway training. Staff will then pass their knowledge over to other staff, so we don’t need to get district nurse teams involved every time.” The manager explained that if they felt further advice was needed, they would contact the district nurse team.

Staffing levels appeared to meet people’s needs and staff treated people with kindness and compassion. We saw people appeared to enjoy speaking and laughing with staff.

Staff had been recruited in line with national guidance. Staff had completed a wide variety of training courses which appeared to suit people’s needs. The manager had completed competency checks on staff following some training courses.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.