Orchard Nursing

We undertook this assessment following concerns we received about the care people received. We carried out a comprehensive assessment and assessed all 34 quality statements from all the key questions we ask, is the service safe, effective, caring, responsive and well-led.

There were some inconsistencies in identifying and addressing all environmental and infection‑control risks. Some unsafe practices were observed, including unsecured hazardous areas, inaccessible call bells and unclean equipment. Medicines management required improvement following a missed application of a pain patch. However, there was a generally positive culture of openness, transparency and learning, with a commitment to improving the safety and quality of care. Managers and staff were knowledgeable about safeguarding and reported concerns promptly.

Care was effective, with detailed assessments, personalised care planning and appropriate use of evidence‑based assessment tools. Staff worked well with external professionals, and people received timely referrals and coordinated support. Staff understood and applied the Mental Capacity Act appropriately, and best‑interest processes were followed.

While many staff interactions were kind and supportive, and family members praised staff for being attentive, practices were not always dignified or person‑centred. People were observed sitting in a darkened lounge due to sensor‑based lighting, and prolonged waiting during mealtimes occurred with limited staff engagement. People were not routinely offered meaningful choice regarding meals, and pre‑plated food sometimes resulted in unmet preferences.

The provider encouraged feedback and maintained clear, accessible information for people, families and advocates. Complaints were taken seriously and addressed appropriately. People had good access to healthcare services, and staff tailored care for individuals at risk of health inequalities. End‑of‑life planning was offered sensitively and supported informed decision‑making.

Governance systems were not always effective; however, the leadership team had begun to strengthen oversight. Senior managers had recently been appointed to support the home manager, and progress had already been made as a result. Staff described significant cultural improvements, increased morale and better communication. Leaders were visible, approachable and responsive, and partnerships with external agencies were positive. Managers were receptive to our feedback during both site visits and took immediate action to make improvements in response.