Orchid Woodlands Healthcare Ltd

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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

Effective governance systems were not in place and accurate and contemporaneous records were not always maintained.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

People and their relatives also provided positive feedback on the current running of the home. One person stated, “The manager is very easy to talk to and I would go to them if I had any issues.” A relative told us, “The manager is good at their job and keeps us informed of everything and they are always on the other end of the phone if they need us or we need to ask anything.” Staff commented on there being a high turnover of manager’s and having to adapt to each new manager and their way of working. However, all staff spoke positively about the current manager, even though they had only been in post for a couple of months, with them reporting to be both approachable and visible. Comments included, “The home is well managed now, I feel confident approaching [manager] and feel listened to” and “The service is miles better since [manager] was put in place. We work much better as a team.”

There had not been consistent leadership at the home for some time, due to the number of managerial changes within the last 12 to 18 months. The current manager was the third new manager since we last inspected in January 2023. We noted the current manager had over 13 years’ experience as a residential care manager and had worked in a number of different health and social care services, which had allowed them to develop different skis which they could bring to their role at Orchid Woodlands.

Staff we spoke with understood their responsibilities and were able to tell us how they would raise concerns. The majority stated they would initially go to their senior, before escalating concerns to the manager or provider. Should they not be listened to, staff would report their concerns eternally, for example with the local authority.

The provider had up to date whistle-blowing policy and procedures in place, which explained how staff could raise concerns and ‘speak up’ should they identify or see any poor practice.

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.

The providers audit and governance process was not robust or completed consistently. An audit schedule was in place, which detailed each audit to be completed. The audit schedule was in the form of a spreadsheet and indicated each audit should be done monthly. We asked the manager about the auditing process. They told us they had completed some audits in April 2024, but due to focussing on other issues had not completed any in May 2024. We asked to be provided with any audits completed since our last inspection in January 2023. Aside from some recent medicines audits, only blank copies of audit documents were shared. As such, we could not be assured the provider was effectively assessing and monitoring the safety and quality of the care provided. Following the assessment and provision of written assessment feedback, the manager told us the home had a file which contained a range of audits which dated from August 2023 up to March 2024. We completed another visit to the home to review this file. Although a number of audits had been completed, the type and frequency varied each month. We also noted action plans were not used effectively, and the same issues appeared on subsequent audits, which indicated improvements were not being made in a timely way.

Senior staff working for the provider had completed a full home audit on 18 April 2024, where a number of significant issues had been identified. Documentation completed during this audit was reviewed at the same time as the audit file. We noted a number of the issues we identified during our assessment had been identified during the whole home audit. As such, improvements had either not been made in a timely way or where they had, sustained over time. We also identified issues with the quality and contemporaneousness of record keeping. We identified gaps within daily notes and monitoring charts, which meant we could not be assured people had received care and support in line with their care plan. We asked the manager about record keeping and whether this had improved since our last inspection. They told us, “Daily notes are getting better, but they are still no great. It’s a work in progress and isn’t going to happen overnight.” We asked staff about record keeping. They told us, “The system is down quite often”, referring to the electronic device they used to record notes and complete monitoring. The manager confirmed this was an issue. At these times, staff had documented care on pieces of paper. Despite staff sometimes having to manually document care was a known issue, there were no standard templates in place for staff to use, with each staff creating their own. As a result, the quality and quantity of information varied.

We did not receive any specific feedback from people in this area.

We did not receive any specific feedback from staff in this area.

We did not receive any specific feedback from partners in this area

The provider shared limited examples of how the home worked in partnership with other organisations and the local community, to benefit people living at the home. We were told the activity coordinator had made some calls to local schools about getting involved with the home, such as visiting to complete activities or sing for people, but was waiting to hear back from them. The manager told us the home had made links with a local college, regarding sending students studying health and social care qualifications, for work experience. The manager told us they were in the process or setting up a formal agreement relating to this.

A service improvement plan (SIP) was in place. This contained sections which explained the issue, root causes, planned actions, due date, who was responsible and current status. We noted a number of the issues we identified during the assessment were listed on the SIP. These included, reporting around incidents & accidents, care and support plans lacking detail, person centred care, wound care plans requiring more accurate completion, MCA and best interest process not being effective, consent not authorised correctly and overview of compliance not being available. Prior to our assessment, the local authority had carried out a number of quality assurance visits to the home, and had identified a number of issues which also reflected those included on the SIP. The local authority had informed us they were meeting regularly with the provider and manager to review progress. We asked the manager about the SIP and how it had been produced. They told us the local authority had requested the provider complete an audit of the home, which was completed in April 2024. The outcome of this audit, along with issues identified by the local authority had been used to complete the initial SIP. However, this was a working document and was constantly being added to. Although a number of issues we noted on assessment were included on the SIP, not all shortfalls we identified were. The lack of effective auditing would be a contributory factor to this.

As part of this assessment, we reviewed the issues noted at our last inspection to check for improvements. We found work was still required with staff supervision and appraisal, staff training, record keeping, audit and governance processes, gathering people’s views and/or feedback and the complaints process. Although they had only been in post for 2 months, we asked the manager about the work which had been completed and the continued gaps in practice. They told us, “We need to improve massively. I am aware we had an inspection 15 months ago and it appears as if not much has been done in the interim period. I have started to look at these and am working through the action plan.”