CQC report explained · a nursing home
What the CQC found at Orchard House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments, safeguarding arrangements, medicines management and infection control had improved. However, staffing levels put people at risk of not receiving care safely or when they needed it.
- Effective?
- Requires improvement
- This area was not covered by this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Requires improvement
- This area was not covered by this focused inspection. Inspectors reported that people were happy with the care and staff.
- Responsive?
- Requires improvement
- This area was not covered by this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Requires improvement
- Management checks and action plans had improved, and the registered manager had provided more stability. However, changes in senior management and unresolved staffing problems meant leadership and oversight were still inconsistent.
What inspectors found, December 2020
Rated Requires Improvement; inspectors found caring staff and better risk checks, but staffing levels put people at risk.
This was an unannounced focused inspection. Inspectors visited on 25 August and 16 September 2020. They spoke with people, a relative and staff, observed care, and checked care, medicine, recruitment and management records.
The home had improved its risk assessments, safeguarding arrangements and management checks since the previous inspection. People said they felt safe and were happy with the home. Medicines were generally managed properly, and infection control arrangements were judged suitable.
However, there were not always enough staff, especially on the ground floor. Some people were washed and partly dressed very early, and two people waited almost half an hour for lunch. This was a breach of Regulation 18 on staffing.
The overall rating remained Requires Improvement. Safe was Requires Improvement. Well-led improved from Inadequate to Requires Improvement. The other three areas were not inspected during this visit, so their previous ratings were used.
Improved risk management
Staff assessed risks such as falls, moving and handling, pressure ulcers and behaviour that could challenge others. They followed guidance and reviewed assessments.
“Staff assessed risks to people's health and welfare such as moving and handling, falling, the risk of developing pressure ulcers and for behaviour that challenges.” from the report
People felt safe
People told inspectors they felt safe. Staff understood how to recognise and report possible abuse.
“People felt safe. One person told us, "I feel safe anywhere here.” from the report
Medicine arrangements
Staff had medicine training, medicines were stored securely and most records were completed accurately.
“Staff had received training in how to safely give medicines, they maintained records to show this.” from the report
Better management oversight
The manager had put the previous action plan into practice. Audits and analysis of incidents were used to identify and address problems.
“The registered manager completed an action plan following our previous inspection.” from the report
Not enough staff
seriousStaffing was not always sufficient, particularly on the ground floor and at night. People were sometimes washed and partly dressed before 6am, and some waited for meals.
“Not having enough staff put people at risk of not receiving appropriate care or not receiving care safely.” from the report
One medicine record was incomplete
needs fixingThe time an as-required medicine was given had not been recorded for one person. Inspectors said this could increase the risk of the medicine being given more often than prescribed.
“However, one person's medicine administration record showed the time 'as required' medicine was given had not been entered.” from the report
Changes in senior management
needs fixingInspectors remained concerned about provider oversight because some senior management staff had changed again. This had also been a concern at the previous inspection.
“We continued to have concerns about provider oversight of this service as there had again been a change of some senior management staff at organisational level prior to this visit.” from the report
- 01How many staff are scheduled on the ground floor during the day and overnight, and how many are actually working now?
- 02How do you cover sickness and make sure there are enough staff when extra staffing has previously not been provided?
- 03What has changed to prevent people being washed and partly dressed very early in the morning?
- 04How do you make sure people receive meals promptly when staff are also providing personal care?
- 05What checks now ensure that the time an as-required medicine is given is recorded every time?
This was a focused inspection of Safe and Well-led only; the other three ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 4 December 2020 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, November 2019
Rated Requires Improvement, with unsafe risk management, poor oversight and repeated breaches, although staff were often kind and there were enough staff on duty.
This was an unannounced inspection on 10 and 12 September 2019. Inspectors spoke with people living at the home, visitors, staff and a health professional. They reviewed care records, medicine records, complaints and quality checks.
The home was not always safe. Risks linked to behaviour, medicines, safeguarding and door locks were not always assessed or acted on. Some care plans were missing or out of date, and people had too little to do at times.
Inspectors found that staff were usually kind, respected privacy and supported people with food, drinks and health appointments. There were enough staff on duty, and complaints were investigated. However, the systems for checking the quality and safety of the home were not effective.
The overall rating was Requires Improvement. Safe, effective, caring and responsive were all rated Requires Improvement. Well-led was rated Inadequate. The home had received Requires Improvement at the previous inspection and had not made enough improvement.
Enough staff
Inspectors found enough staff on duty to meet people's care needs. Call bells were answered quickly.
“There were enough staff on duty to support people safely.” from the report
Kind and respectful care
People generally liked the staff. Staff supported people's choices and protected their privacy and dignity during personal care.
“People said that staff were kind and caring and they commented positively about staff members.” from the report
Food and drink support
People were offered choices and were supported to eat and drink when they could not do this independently. Staff monitored food and drink where needed.
“Staff provided support to people who were not able to eat and drink independently.” from the report
Health professional involvement
Staff contacted health professionals when needed and followed their advice. Information was also sent with people when they attended other care services.
“People were referred to health care professionals for advice and treatment, for example to community nurses, dieticians or community mental health teams.” from the report
Risks were not managed
seriousRisks linked to challenging behaviour, self-administered medicines and door locks were not always assessed or reduced. This left people and staff at risk of harm or injury.
“Risks to people were not always assessed, monitored or mitigated effectively to ensure people were safe.” from the report
Safeguarding concerns were missed
seriousSome possible safeguarding incidents were not passed to senior managers or the local authority. Staff did not all understand how to apply safeguarding procedures.
“The lack of assessment of risks meant that appropriate actions had not been identified and therefore people and staff remained at risk of harm or injury.” from the report
Care plans were incomplete
seriousSome people did not have care plans for changing health needs or behaviour. This included a person at risk of choking whose care plan had not been updated.
“The lack of care plan information meant that staff did not have sufficient guidance or an effective strategy to meet people's needs.” from the report
Too little to do
needs fixingPeople said there was not much entertainment, and inspectors saw people left unoccupied between planned events. The report recommended developing activities for people with dementia.
“People told us they had little to occupy their time during the day.” from the report
Weak provider oversight
seriousThe home had recurring problems and frequent management changes. Audits did not consistently identify responsibility, deadlines or follow-up action.
“The ongoing lack of consistent home management and provider oversight meant that risks to people were not identified and learning through identifying the cause of issues did not take place.” from the report
Recruitment records incomplete
needs fixingMost recruitment checks were completed, but some references and employment history checks were incomplete. The provider could not guarantee that all staff were safe to work with people.
“This meant that the provider could not guarantee all staff were safe to work with people.” from the report
- 01What has changed since the inspection to make sure risks from challenging behaviour, choking and self-administered medicines are assessed and recorded?
- 02How are safeguarding incidents now reported to senior managers and the local authority?
- 03How do you make sure care plans are updated quickly when a person's health or behaviour changes?
- 04What activities are now available, especially for people living with dementia, during the periods between planned events?
- 05How does the provider check that problems found in audits are given to a named person and followed up until they are fixed?
This was a planned, unannounced inspection covering all five key questions, including both the care provided and the care home's premises. This explanation was written from the published report of 19 November 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 Home
6 rated inspections over 5 years: the service has improved, from Inadequate to Requires improvement.
- December 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- October 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2016Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- August 2014
Report published without a new overall rating.
- June 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 31 January 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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Most charge £1,020 to £1,200 a week. 14 can care for a couple. 12 years' experience on average.
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