Orchid House

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• 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

We reviewed 2 quality statements for this key question. During our assessment of this key question, we found the systems in place ensured people’s capacity and ability to consent had been adequately assessed and planned for. The systems and processes in place ensured people’s care plans were up to date. We found one care plan with conflicting and confusing information in one section. The registered manager told us that this was an error in the writing of this specific part of the care plan and it would be dealt with immediately.

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.

Relatives told us that people had access to healthcare and social support when required. We observed during the on-site assessment that some people were not having their immediate needs met by staff (see independence, choice and control for more information).

The systems and processes in place ensured people’s care plans and assessments was up to date. We reviewed 3 people’s care plans, mental capacity assessments and Deprivation of Liberty Safeguards (DoLS) assessments. The mental capacity assessment tool used for best interests are specific to the decision that needs to made. They showed involvement from others where the person lacks mental capacity. The care plans guided staff towards appropriate care and support for people and professionals to contact. We identified one care plan where there was conflicting information. The registered manager told us this was an error in the writing of this specific part of the care plan and it would be dealt with immediately. Daily record sheets showed a variety of activities and events for people. They showed evidence of people being asked what they would like to do and evidence of people communicating with staff about what they wanted to do. There is an Accessible Information Standard (AIS) policy in place which meets the standards. The risk-taking policy outlined the need to allow people the opportunity to take risks which increased their independence and encouraged personal growth.

Staff told us they were always assessing people’s needs and when things change, they need to be responsive. One staff member told us “they talk about people during handover meetings. People have their daily diaries and the things they like to do. I know what people like to do and the things they don’t like. People have their own goal scrapbooks which looks at short term and long-term goals.” One staff member told us a person wanted to go and see a musical or go to the pantomime. They had to plan for this as it can be overstimulating for the person. They chose the “relaxed session where there was a calm down area to access if we needed it.” Staff also told us “I talk to people about they want” and “most of the resident in our care home are non-verbal. During medical appointments and meetings with the behavioural team we act as a voice for them in their best interest.” One staff member told us there is an “easy read format which read aloud the information to the residents in a quick and easy format. We have a; do you understand this picture, a happy face means yes, sad face means no.”

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 How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

During the assessment we observed in most cases that staff were asking for people’s consent. However, we also observed some staff members not gaining ongoing verbal consent from people. This meant people were not always consenting to the care and treatment they wanted.

Deprivation of Liberty Safeguards (DoLS) authorisations and assessments were in place to support decision making and any restrictions to people’s liberty. People’s capacity to make decisions through verbal or non-verbal means were well documented. Consent forms were completed for each individual area of support needs and showed involvement from others. The consent to care and treatment policy highlighted where people should give consent, people who are unable to give consent and consent to physical interventions. The policy review date was December 2023.

Comments from staff showed a good understanding of gaining ongoing verbal consent from the residents. They include " I knock on the door, ask them always, don’t presume you know what the answer will be."