CQC report explained · a nursing home
What the CQC found at Orangery Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and risks were assessed and managed. Inspectors found suitable staffing, safe medicines processes, good cleanliness and learning from incidents.
- Effective?
- Good
- People's needs were assessed and staff had suitable training and supervision. Food, drink, healthcare support and legal requirements around capacity and consent were managed appropriately.
- Caring?
- Good
- People said staff were kind and respected their privacy, dignity and independence. Inspectors found that staff did not always offer every person a choice between the two hot lunch options.
- Responsive?
- Good
- Staff understood people's needs and the home provided activities, spiritual support, complaint handling and end-of-life care. Some written care plans and daily notes did not yet give a full, individual picture of people's lives and experiences.
- Well-led?
- Good
- The home had an established management structure and systems to monitor quality. People, relatives and staff were involved in meetings and surveys, and improvements were tracked.
What inspectors found, May 2018
Manor Place Nursing Home was rated Good; inspectors found safe, kind care, with some records and choice arrangements still being improved.
The inspection was unannounced and took place on 10 and 11 April 2018. Inspectors spoke with people living in the home, relatives, staff and outside professionals. They reviewed care plans, staff files and records about how the home was managed.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough suitable staff, safe medicines processes, clean surroundings, suitable training and good access to health professionals.
People said staff were kind, respectful and welcoming. The home offered activities, supported people's choices and provided end-of-life care. However, some care plans did not yet fully describe people as individuals, and staff did not always explain all lunch choices.
The home had improved since its previous inspection in March 2017, when it was rated Requires Improvement overall. Refurbishment and other improvements were still under way at this inspection.
Kind and respectful staff
People said staff were kind, patient and gentle. Inspectors saw staff helping people to stay comfortable and treating them with dignity.
“They are all good and kind. They don't talk down to me.” from the report
Safe care arrangements
Risks such as falls, skin damage, choking and moving around were assessed. Inspectors saw staff use safe moving and handling techniques.
“A range of risks to people had been assessed and care plans put in place to manage them” from the report
Good support with health and nutrition
People were weighed, supported with their dietary needs and referred to health professionals when needed. Staff worked with outside health and care services.
“People's nutritional and fluid intake needs had been identified and met.” from the report
Activities and end-of-life support
The home offered daily activities, outings and spiritual support. People and families were involved in planning end-of-life care, with hospice support when appropriate.
“People's needs for social and spiritual stimulation had been met.” from the report
Improving management
Inspectors found a positive culture and a visible manager. Audits, meetings, surveys and tracking systems were used to identify and act on improvements.
“There was a clear and well-established management structure and responsibilities and legal requirements were understood.” from the report
Care plans were not always fully personal
needs fixingSome written care plans did not contain enough information about people's backgrounds and preferences. Daily notes also did not always describe the person's day or mood fully.
“Not all written care plans consistently contained sufficient information about the person and their background to make them fully 'person centred.'” from the report
Meal choices were not always explained
needs fixingNot all staff consistently offered people a choice between the two hot lunches. Picture menu boards had also been removed during redecoration and had not yet been put back.
“However, we noted not all staff consistently offered people a choice of the two hot meals available at lunchtime.” from the report
Some dementia interactions needed more confidence
minorMost staff interacted well with people living with dementia, but some were more focused on completing tasks than on the quality of their interaction. Inspectors asked management to consider further training.
“Some staff we observed, however, were slightly more reserved or not as confident tending to focus on the task in hand rather than the quality of their interactions with the person.” from the report
Nursing cover had recently been under pressure
needs fixingNurses said they had been asked to cover many additional shifts. The home had recruited a new night nurse to increase nursing capacity and reduce this pressure.
“Nurses told us they had been asked to cover a lot of additional shifts lately” from the report
- 01How do you now make sure every person is offered all available meal choices?
- 02Have the visual menu boards been replaced, and how do you support people who find written menus difficult to understand?
- 03What changes have been made to make care plans more personal and to improve daily recording?
- 04What further training or support have staff received when caring for people living with dementia?
- 05Has the recruitment of night nursing staff reduced the need for nurses to work additional shifts?
This was an unannounced inspection of the overall service, covering all five CQC questions; the report says the previous inspection in March 2017 rated the service Requires Improvement overall. This explanation was written from the published report of 5 May 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2017
Rated Requires Improvement; inspectors found good effective, caring and responsive care, but safety and management were not consistent.
This was an unannounced inspection on 20 and 21 March 2017. Inspectors spoke with people, relatives and staff. They observed care and checked care plans, staff records and management records.
People were generally treated kindly and received care suited to their needs. Staff supported people's health, food and drink needs, privacy, dignity and activities. The ratings for effective, caring and responsive care were Good.
Some safety practices were not followed consistently. Shared hoist slings did not meet good practice guidance, staff did not always apply wheelchair brakes during hoisting, and thickening powder was not stored safely. There were also gaps in the arrangements for medicines given when needed.
The overall rating was Requires Improvement. This means the home was providing some good care, but inspectors found important areas that needed improvement. The well-led rating was also Requires Improvement because monitoring systems had not yet reliably identified or fixed these problems.
Kind relationships
People generally described staff as caring. Inspectors saw staff greet people, check on their welfare and respond to their requests.
“People experienced caring relationships with the staff who looked after them.” from the report
Respect and choice
Staff usually involved people in decisions and protected their privacy and dignity during care.
“People were involved in decisions about their care.” from the report
Individual care
Care needs were assessed and reviewed. Staff had information about people's health, communication, mobility and personal interests.
“Staff were responsive to people's individual care needs.” from the report
Food and health support
People were offered choices and suitable amounts of food and drink. Staff worked with a range of health professionals when needed.
“People were offered a sufficient amount and variety of foods and drinks to meet their needs.” from the report
Activities and feedback
The home offered a programme of activities and used meetings and complaints to make some changes.
“Processes were in place to seek people's feedback and to act upon it.” from the report
Hoist slings
seriousPeople shared hoist slings, and they were washed less often than the guidance required. The provider bought individual slings after the inspection, but inspectors said the new practice still needed to become established.
“The provider was not following good practice guidance in relation to the provision of individual hoist slings for people” from the report
Hoisting safety
seriousStaff did not apply wheelchair brakes before using a hoist on five observed occasions on the first day. This continued on the second day even after staff had been reminded.
“Staff did not apply the brakes to people's wheelchairs prior to using the hoist, which placed people at potential risk of an accident.” from the report
As-required medicines
seriousRequired written protocols for medicines given when needed were not in place. The deputy manager acted immediately, but inspectors said staff practice still needed to become consistent.
“PRN protocols were not in place as required to ensure their safe use for people.” from the report
Thickening powder storage
seriousContainers of drink thickener, including an open tub, were left on an open shelf in a person's room. This did not follow the safety guidance intended to reduce the risk of choking.
“These tins were not stored safely in accordance with guidance to manage the danger of choking for people from the ingestion of thickener powder.” from the report
Management checks
needs fixingThe new audits and trackers had not yet become reliable. They failed to identify problems with slings and as-required medicines.
“The audit process had not identified or addressed the issues we identified at the inspection.” from the report
Communication
needs fixingPeople and relatives gave mixed views about how open communication was. One relative's concerns about nutrition had not been clearly explained, even though records showed the correct care was being provided.
“Most, but not everyone spoken with reported that they had experienced open communication with the service.” from the report
- 01What checks now confirm that each person has and uses their own hoist sling?
- 02How do you check that staff apply wheelchair brakes every time they use a hoist?
- 03What written protocols are now in place for medicines given as required, and how are they audited?
- 04How are thickening powders stored, and how do you check that staff follow this rule?
- 05How will you keep families informed about people's nutrition, care changes and any concerns?
This was an unannounced inspection covering all five quality areas, including observations, interviews and records; the report also says that two breaches found at the previous inspection had been met. This explanation was written from the published report of 25 April 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Orangery Care Home
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- May 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 4 March 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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