Orchard House Care Centre

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed 4 quality statements within this key question. Staff knew people well and understood their individual needs. Staff recognised people’s independence and respected their rights to privacy. However, we received mixed feedback from people and relatives about the kind and caring nature of the staff. Some people and relatives did not feel their choices and preferences were respected, for example on where they spent their time or if they preferred a bath or shower. We noted a difference in the experience for people able to join in social and group activities and those cared for in their rooms. There appeared to be limited opportunity for meaningful interaction for those cared for in bed. Workforce wellbeing and development was promoted. External health and social care professionals told us they felt the service was caring.

This service scored 65 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and relatives in relation to the caring nature of staff. People and relatives’ comments included, “Some of the staff are very nice”, “They’re very kind”, “Half of them are caring. Some come in when you’re waiting on a cup of tea and they just drop the tea on your table and don’t stop for a chat” and, “Some of them are grumpy, they’re not nice people. Some of them are very brusque and not very friendly.”

Staff told us they had developed good relationships with the people they support. They spoke with kindness about people and described how they supported and encouraged them. The registered manager described processes used to review the quality of care provided to people. These processes included gathering regular feedback from people and relatives, quality assurance questionnaires, observations of practice and people and relative meetings. We received some negative comments from people and relatives about staff attitude. We discussed this with the registered manager who agreed to talk to staff.

We received feedback from 4 health and social care professionals all of whom were positive about the service and the kind and caring nature of the staff. One healthcare professional said, “I have always felt welcome when I have attended Orchard House. Staff are friendly and go out of their way to assist both myself and their residents.” Another told us, “I have witnessed staff managing some very challenging behaviours in a calm and appropriate way, and staff always seem to know the residents well.”

We observed staff speaking to people with kindness and people appeared relaxed and comfortable. We observed positive interactions between people and staff. For example, a staff member spoke to a person using their preferred name and knew what books they liked, offering to get these for them. Staff would speak to people at eye level and offer choices in relation to what they would like to drink and where to sit. We observed lunch being provided. People were not rushed and were given time to make choices about what they ate. Discussions between staff showed they knew people’s preferences.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

People told us they were not always offered a choice about what they did or where they spent their time. Comments included, “They keep on eye on him. They’re scared he’ll harm himself. They keep him in bed a lot, but because they’re all in their own rooms it’s hard for them to keep an eye on everyone. He’s in bed most of the time, I don’t like to make a fuss about the amount of time he spends in bed” and, “Whenever I visit [person] they are in bed, they don’t need to be, I find it really upsetting.” People also told us their preferences were not always respected in relation to bathing and showering. A person said, “I don’t have a bath. I have a shower or a wash. I would love to have a bath.” Another person told us, “I don’t like a shower. I ask to have a bath and they say, ‘tomorrow’ and then tomorrow never comes, but I do have a darned good wash. If you get a bath you get it in the morning, I used to have one in the evening at home, it was relaxing.” People told us staff respected their privacy and we observed staff knocking on doors before entering. People confirmed they were supported to be independent, and we observed equipment in place to support with this, including specialised cutlery and walking aids. One person said, "They let you do as much as you want to. They help when you need it, they get to know what you need help with.”

We discussed concerns people raised about lack of choice with the registered manager who confirmed they would investigate the reasons people were being cared for in bed. The registered manager stated they would also review how staff encourage people who could potentially get out of bed to be more motivated to do so. From discussions with staff and leaders it was evident they knew people well and understood their needs and abilities. Staff were able to describe how they supported people to be independent.

Orchard House Care Centre was divided into three separate units, which supported people with particular needs. We observed care provided on each of these units. Throughout the inspection we noted most people were cared for in bed within the units on the ground floor and interactions between people and staff were limited and mainly task focused. We did not witness any activities for people in their rooms and saw very limited engagement with people who were cared for in bed. This was discussed with the registered manager during our assessment visits and following the assessment the registered manager said they had reflected upon this, and work is being done with the activities and care staff team to support with improvements in this area. However, observations within the memory unit were positive with lots of staff engagement with people. People were included in their care and involved in making choices on what they did and how they spent their time. We observed people’s privacy was respected and staff knocked on people’s door before entering and explained what they were doing politely and respectfully. For example, we heard, “I’m just putting your clothes away.” We observed some group activities taking place on the ground floor. These included chair exercises, a book reading session and a religious service. We saw evidence of other activities, including trips out, arts and crafts and gardening. People’s comments included, “You can play games and listen to music. They have all kinds of things” and, “We go out occasionally, we go out on a trip. Whether it’s to Tesco or to a beauty spot, it’s good because you feel like you’re back in the world again.”

Whilst processes were in place to review the quality of care to people, these processes had not consistently enabled people to make choices regarding all aspects of their care. Processes were in place to review the quality of care provided to people. These processes included resident meetings and annual quality assurance questionnaires. However, when we discussed our findings with the registered manager in relation to people's comments about choice and control, the manager confirmed feedback gathered by the provider had not indicated any concerns in relation to contact/interaction for people cared for in their rooms. This was further discussed during formal feedback with the registered manager who said they had reflected upon this since the assessment and work was being done with the activities staff and care staff to support with improvements in this area.

People told us staff were not always available to respond to their immediate needs. Some people told us they had to wait for staff when they used their call bells. One person said, “Sometimes they [staff] come very quickly when I ring my call bell, but it varies, especially at night when they’re probably dealing with someone else”. Another told us, “They don’t come quickly. Sometimes I wait a long time.” However, others told us there were plenty of staff and they received support when needed.

The staff are leaders were confident they had time to respond to people’s immediate needs in a safe and responsive way. A staff member told us, “We have enough time to do our jobs and talk with people.” Another staff member said, “If the care staff are supporting people, the nurse would be around to answer [call] bells.”

Throughout the inspection, we observed periods where staff did not always appear available to respond to people’s needs in a timely way. Safety alert equipment, such as pressure mats, were not always positioned correctly to alert staff when a person may be at risk of falls. However, people’s care records demonstrated medical support was requested in a timely way.

Staff were positive about working at Orchard House Care Centre and said they would recommend it as a good place to work. They felt supported by the management team and felt their views, opinions and suggestions would be listened to. Staff confirmed they had received induction and ongoing training. They felt they had the necessary training to provide good, person-centred care for people.

There were robust processes were in place to ensure staff views were sought, listened to and acted on where required. For example, staff completed a ‘your voice’ survey which was reviewed by the management team. This demonstrated actions were taken where required. Staff received regular support and supervision with a member of the management team. Monthly staff meetings, one-to-one supervisions, group supervisions and staff support groups were also available to staff.