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Blood Simple is the quest you take if you choose to find orianna rather than going to find Syanna. You’ll follow Orianna to the orphanage and then be asked to hunt down the beast that attacked.
Use your Witcher senses to investigate the area. You’ll spot 2 bodies inside the building that you can examine and one outside. There’s also claw marks on the outside of the building, a body by the tree, a body under the arch, footprints, blood on a rock ledge and a green spot on a pillar near to the entrance. Once you find the green spot Geralt will pick up a scent.
Follow the scent to some tracks and follow the them over a ledge to find another body. Once you investigate it Geralt will conclude that the beast is an Alpha Garkain.
Examine the wagon tracks and call Roach so you can follow them. The tracks will eventually go off the road. Dismount and follow the tracks to a small rut.
Examine the horse and the woman’s body. Use your Witcher senses to pick up a sound to the northwest. Make your way there for a cutscene and then the fight will begin.
Once the Garkain has been defeated you’ll grab the Garkain Trophy. Search the body near the bridge to find Orianna’s Letter that seems to imply Arnaud was beating the children and skimping on costs.
Return to the orphanage and after a conversation you’ll be given the Magic Key that can be used to open the cave to the Unseen Elder. Talk to the birds nearby and they’ll fly off to let Regis know you’re ready.
Make your way to the Docks to meet Regis. This is your last chance to change your mind and search for Syanna instead. If you continue to the Unseen Elder then the quest What Lies Unseen will begin.