HF Trust - Orchard View

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This assessment did not assess all quality statements within this key question. For the quality statements we did assess, improvements had been made. However, the overall rating for this key question remains requires improvement based on the findings at the last inspection. Checks were carried out on people’s care. Where issues were found, action was taken to address the areas of concern. The provider had a service improvement plan which was monitored to ensure actions to develop the service further were implemented. Records demonstrated managers carried out regular observations of staff competency to ensure support plans were consistently followed and good practice maintained. The governance systems had ensured the provider was now meeting regulatory requirements and previous breaches of regulations had been addressed. Records were maintained in good order and information was easily accessible. Governance processes had also ensured improvements in involving people in decisions about their care and improving outcomes for people had been achieved. Staff told us managers were visible, approachable and they were encouraged to ask for guidance when they needed it. Staff reported positive improvements over the 12 months prior to our assessment. Staff told us the culture within the service had improved so it was more inclusive and there was more positive engagement between people and staff. Staff told us they were now working with more permanent staff and consistent temporary staff supplied via an agency. They told us teamwork had improved and there was motivation to improve the quality of care people received. The majority of staff described an open and supportive environment where they felt able to raise concerns, confident they would be listened to. However, some staff were not always clear how they could escalate concerns within the provider group when they felt issues they had raised not been fully responded to. There continued to be no register manager in post.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us the culture within the service had improved so it was more inclusive, there was more positive engagement between people and staff and staff were working in a more person centred way to ensure people’s individual and diverse needs were met. Staff told us people were living better lives because they were being given opportunities to do the things they enjoyed and try new activities. A staff member told us, “They [senior staff] want the best, the very best for people, for one-to-one time to be respected and for you to dedicate your time to them. For you to try new things with them.” Staff told us they were now working with more permanent staff and consistent agency staff. They told us teamwork had improved and there was motivation to improve the quality of care people received. One staff member said, “We are now working as a team to make the service better.” A temporary staff member supplied via an agency told us, “Its so nice here because you do feel included and very welcomed.”

The provider's values were displayed in the office. Records of team meetings evidenced there was a culture of staff being encouraged to give their suggestions for developing the service and to understand the unique needs of each person, and how best to support them. Processes were in place to support staff to reflect on their practice through regular meetings with their line managers.

The majority of staff had positive experiences and described an open and supportive environment where they felt able to raise concerns confident, they would be listened to. One staff member told us, "They [senior staff] want the best, the very best for people, for one-to-one time to be respected and for you to dedicate your time to them. For you to try new things with them.” However, other staff felt there was a lack of commitment from the manager towards the service and to become registered with CQC. Some staff were not always clear how they could escalate concerns within the provider group when they felt issues they had raised had not been fully responded to. We shared this with the provider who acknowledged our feedback and assured us action would be taken to improve staff understanding of escalation routes available.

Insight prior to our inspection evidenced a registered manager was still not in post. The manger had been leading the service since February 2023. They advised us they had submitted an application to become registered with CQC in August 2023, but the provider advised us they were unable to confirm the application had been submitted and referred the matter through their own internal HR processes. The provider told us they would review their internal CQC application tracker process to mitigate risk of any reoccurrence for other new managers. The provider had restructured the senior leadership team to enable a more effective governance and oversight structure to positive effect.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told they had the guidance they needed to understand people's physical, emotional and social needs and to provide person-centred care. This guidance was in people's individual care and support plans, through a communication book and effective handovers. Staff told us managers were visible and approachable and they were encouraged to ask for guidance when they needed it. Staff understood their role in recording and reporting any accidents, incidents or potential safeguarding concerns so they could be dealt with in accordance with the provider's policies and reported to external organisations as required.

Audits and checks were carried out on people’s care and where issues had been found, action had been taken to address the areas of concern. The provider had a service improvement plan which was monitored to ensure actions to develop the service further were implemented. Records demonstrated managers carried out regular observations of staff competency to ensure support plans were consistently followed and good practice maintained. The governance systems had ensured the provider was now meeting regulatory requirements and previous breaches of regulations had been addressed. Records were maintained in very good order and information was easily accessible. Governance processes had also ensured improvements in involving people in decisions about their care and improving outcomes for people had been achieved.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us learning was shared with them through handover, a communication book and regular meetings. One staff member explained there were regular staff meetings which considered any barriers people may experience to achieving their goals. This staff member explained, “We are listened to if we make any suggestions. The [staff] team try to improve people’s care. This makes me want to spend more time at work.” Staff gave us examples showing how learning was communicated across all the provider’s services. This included additional tools to monitor people had enough to eat to remain well.

There were systems and processes in place to manage and follow up on accidents and incidents. Managers monitored these events, to identify possible learning and ensure action had been taken to mitigate individual and service level risks. The provider had processes to share learning across the wider provider group, for example, new processes had been introduced in relation to the monitoring of people's weight. In addition, the provider had introduced weekly quality and improvement drop in calls, to share learning across locations. These gave staff the opportunity to raise questions ad share learning and improve practice.