CQC report explained · a nursing home
What the CQC found at Orchard House Care Centre
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
What inspectors found, July 2022
Orchard House Care Centre is rated Good; inspectors found safe, kind care and strong management, but staffing levels needed review.
This was an unannounced focused inspection. Inspectors visited on 28 June and 1 July 2022, and reviewed information up to 6 July. They spoke with people, relatives, staff and a social care professional. They also observed care and checked care, medicines, recruitment and management records.
The home was rated Good for Safe and Well-led. People and relatives said they felt safe and were happy with their care. Inspectors found detailed risk assessments, safe medicines systems, suitable recruitment checks, good infection control and effective checks on accidents and incidents.
Inspectors saw kind and person-centred interactions. The home involved people in decisions and gathered feedback. However, people gave mixed views about staffing, and some staff and relatives said there were times when more staff were needed. The registered manager agreed to review staffing levels.
This inspection only looked at Safe and Well-led. The overall Good rating remained in place, while the other three areas used ratings from the previous comprehensive inspection in 2019. Safe improved from Requires improvement at the last inspection to Good.
Detailed risk planning
Care plans and risk assessments were specific to people's needs and regularly updated. Records showed that risks such as choking, epilepsy, mobility and skin problems were monitored.
“Risk assessments contained clear and detailed information for staff on how to mitigate and manage risks to people.” from the report
Safe medicines
Inspectors found that medicines were obtained, given and recorded safely. Staff were trained and assessed as competent.
“Records of medicine administration confirmed people had received their medicines as prescribed.” from the report
Kind, person-centred care
Inspectors observed kind interactions, and people said staff cared about them. People were involved in decisions about their care and the service.
“We observed a person-centred culture within the service and staff spoke with people in a kind and caring way.” from the report
Good management checks
The home had audits covering care plans, medicines, infection control, the environment and incidents. These checks were used to identify and make improvements.
“There were robust quality assurance procedures in place, which included audits of care plans, infection control, medicines, the environment and accidents and incidents.” from the report
Staffing levels
needs fixingFeedback about staffing was mixed. Some staff and relatives said there were times when more staff were needed, including in the dementia wing. The registered manager agreed to review staffing levels.
“There are days when we are short staffed and would like to give people more time” from the report
- 01What changes have been made to staffing levels since the inspection, especially in the dementia wing?
- 02How do you use call bell audits to check that people receive help quickly?
- 03How are short-term staff absences covered, and how often are agency staff used?
- 04How will you show that the staffing review agreed during the inspection has improved people's care?
- 05When were the Caring, Effective and Responsive areas last fully reviewed, and what has changed since that inspection?
This was a focused inspection of Safe and Well-led only; the other ratings carried over from the previous comprehensive inspection published on 10 April 2019. This explanation was written from the published report of 20 July 2022 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 2019
Orchard House Care Centre was rated Good overall, but inspectors rated Safe as Requires Improvement because some risks were not managed or recorded properly.
This was a planned inspection carried out without notice over three visits in February 2019. Inspectors spoke with people, relatives, staff and health professionals. They also observed care and checked care records, medicines, incidents, complaints and quality checks.
People generally said they were happy and felt safe. Inspectors found kind and respectful care, enough staff in most situations, safe medicines systems, suitable training and good support from health professionals. Activities were varied and care was usually personalised.
The main concerns were about managing and recording risks. Inspectors found problems with equipment cleaning, emergency seizure medicine, records of food and drinks, repositioning and personal care. The home acted straight away on several issues, but the Safe rating was Requires Improvement. The other four areas were rated Good, giving an overall rating of Good.
Kind and respectful care
Inspectors saw staff treating people with patience, compassion and respect. People and relatives said staff were kind and their needs were met.
“They told us their needs were met by staff who were competent, kind and caring.” from the report
Medicines
Medicines were stored, given and recorded safely in most respects. Staff who administered medicines had training and regular competency checks.
“Records of medicine administration confirmed people had received their medicines as prescribed.” from the report
Activities and personal choices
People could choose how they spent their day, when they got up and where they ate. Activities included individual interests, outings and support for people who stayed in their rooms.
“Records showed there was a good variety of activities providing physical and mental stimulation for people with varying needs.” from the report
Management and improvement
Inspectors found clear leadership, regular quality checks and a willingness to act when problems were identified.
“The service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.” from the report
Equipment and emergency medicine risks
seriousRequired cleaning and replacement of equipment had not been completed for one person. For another person, emergency seizure medicine was not given within the stated time and staff did not know where it was kept.
“Emergency rescue medicines had not been administered within the stated time frame, placing the person at risk of a further deterioration in their health.” from the report
Incomplete care records
seriousRecords did not always show that people at risk of dehydration, pressure injuries or skin problems received the care set out in their plans. This made it difficult to confirm that risks were being safely managed.
“It was therefore not possible to confirm that their risk of dehydration was being safely managed.” from the report
High staff turnover
minorThe home reported that 56 staff had left during the previous year. Some people commented on frequent staff changes and said they preferred staff they knew.
“Prior to the inspection, the registered manager completed the Provider Information Return (PIR). This included information about staff turnover and stated that 56 staff had left the home's employment in the year prior to the inspection.” from the report
- 01How do you now check that emergency rescue medicines are available and given within the required time?
- 02How do you record drinks, snacks, repositioning and continence care for people whose care plans identify these as risks?
- 03What checks are now in place to make sure essential equipment filters, tubing and masks are cleaned or replaced on time?
- 04What changed to staffing arrangements after inspectors found gaps in cover during the evening-to-night shift changeover?
- 05What has been done to understand and reduce the high staff turnover reported at the inspection?
This was a planned inspection of the overall service, including all five key questions, the premises and care provided; inspectors spoke with 16 people, eight relatives and a range of staff and professionals. This explanation was written from the published report of 11 April 2019 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 Orchard House Care Centre
5 rated inspections over 7 years: the service has improved, from Inadequate to Good.
- July 2022Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2019Goodstayed GoodSafe: Requires improvementWell-led: Good
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- November 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 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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