Orchid Woodlands Healthcare Ltd

This assessment was completed to follow up on enforcement action we issued following our last assessment in 2024. At the assessment in 2024, we found the provider was in breach of the legal regulations in relation to person centred care, seeking consent and adherence to the mental capacity act, management of complaints and staff training. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

At the last assessment in 2024, we also found the provider was in breach of the legal regulation in relation to governance and record keeping related to medicines. Improvements in governance and record keeping were noted at this assessment; however, we found the provider continued to be in breach of the legal regulation in relation to the management of people’s medicines.

People’s medicines were not always managed safely. We identified issues with use of thickening powder and guidance relating to as required and covert medicines. Accidents and incidents were documented and action taken to ensure people were safe, however more work was needed to ensure lessons were learned and incorporated into practice. Risks to people and the environment had been assessed, with guidance in place for staff on how to manage these. Safety checks had been completed in line with guidance to ensure equipment was safe to use. Staff received sufficient training and supervision to ensure they could carry out their roles safely and effectively.

Assessments were completed prior to admission, to ensure the home could meet people’s needs. People received support to stay well, with access to medical professionals as and when required. The provider monitored the care and support provided to people, although we identified some gaps in monitoring charts and/or checks not being completed consistently in line with guidance. The provider had identified these shortfalls in their most recent audits. The provider and staff sought people’s consent as and when required. Decisions around care and support were made with people or in their best interest, where they lacked capacity to contribute to the decision-making process.

Care plans explained how people wanted to be supported, and included details of their likes, dislikes and interests. However, for some people information in the care summary section did always not match what was written in their care plan, mostly following a change in need when the care plan had been updated. We received mixed feedback regarding activity provision, with some people feeling more could be offered, whilst others were happy with what was provided. Information was provided to people in ways they could understand. People’s views and opinions were sought, with regular consultation meetings held. The provider was mindful of the importance of good end of life care and had formed links with a local hospice to ensure staff received the necessary training.

People, relatives and staff felt the home was well run and commented on noticing changes and improvements over the last 6 to 12 months.People and staff felt safe and confident in speaking up and that concerns would be listened to. The provider worked in partnership with a number of other organisations, community groups and schools, to ensure the community was involved in the home and improved the quality of people’s care. The provider and registered manager assessed the quality and safety of the care provided via a range of audits. However, management audits had not consistently identified all shortfalls. Similarly, whilst the majority of actions identified through quality monitoring processes had been addressed some issues had carried across multiple audits, which suggested action had not been taken timely. The registered manager took action to address this during the assessment process.