CQC report explained · a residential care home
What the CQC found at Orchard House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks were assessed, medicines were recorded correctly, safeguarding concerns were reported and there were enough staff. Infection prevention arrangements were also judged satisfactory.
- Effective?
- Good
- People's health and nutritional needs were assessed, staff had suitable training and people were referred to healthcare professionals when needed. The home supported people with capacity and best-interest decisions in line with the law.
- Caring?
- Good
- This key question was not inspected during this focused visit.
- Responsive?
- Good
- Care plans included people's choices, preferences and independence needs. People were supported with communication, family relationships, activities, complaints and end-of-life wishes.
- Well-led?
- Good
- Audits and action plans were being used to find and correct problems. The home had an open culture, but there was no registered manager in post when inspectors visited.
What inspectors found, June 2022
Rated Good; inspectors found safe, kind and personalised care, with improvements since the previous inspection.
This was an unannounced focused inspection. One inspector visited on 25 April 2022 and reviewed records, medicines, staff recruitment and quality checks. They spoke with three people, two relatives, six staff and a healthcare professional.
The home provided personal care for up to 15 people, mainly people living with Huntington's disease. Inspectors found better risk assessments, medicines records, safeguarding systems, care plans and audits. People and relatives said they were happy, safe and well cared for.
The overall rating was Good. Safe, Effective, Responsive and Well-led were rated Good. Caring was not inspected during this visit. The overall rating improved from Requires Improvement after the previous inspection in 2019.
Safer risk management
The home had improved its assessments and guidance for moving people, health conditions, skin care and equipment. Fire and environmental checks were recorded.
“At this inspection improvements had been made and there were now risk assessments in place.” from the report
Medicines records
Inspectors found that medicines were given and recorded properly. Open dates had been added to liquid medicines and creams, and records matched the medicines available.
“Records were now completed accurately.” from the report
Personalised support
Care plans described people's preferences, hygiene choices and independence. Staff supported people with activities, communication and contact with relatives.
“People's care plans contained information about their choices and preferences, including how they liked to be supported with their hygiene needs.” from the report
Food and health support
Staff understood that people living with Huntington's disease may need high-calorie food. They monitored eating and drinking and involved dieticians and other health professionals when needed.
“People were supported to have a balanced diet and were supported to eat their meals safely.” from the report
No registered manager
minorThere was no registered manager in post during the inspection. A manager from another service was managing the home and had started an application.
“At the time of our inspection there was not a registered manager in post.” from the report
Some areas looked tired
minorThe main communal lounge had been updated, but inspectors said other parts of the building needed further decoration and new carpeting.
“Other areas of the house were worn and tired.” from the report
- 01Who is currently managing the home, and has the application for a registered manager been completed?
- 02How do you now check that medicines records remain accurate and that liquid medicines and creams are dated when opened?
- 03How often are care plans, falls, maintenance and night-time care audited, and what happens when a problem is found?
- 04What is the timetable for updating the worn and tired areas of the building?
- 05How are staffing gaps covered, and how do you make sure agency staff know people's needs?
This was a focused inspection of Safe, Effective, Responsive and Well-led to check improvements after the 2019 inspection; Caring was not inspected and the other ratings used in the overall rating carried over from the previous inspection. This explanation was written from the published report of 2 June 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, October 2019
Rated Requires Improvement; inspectors found kind, supportive care but important safety, medicines, care planning and management problems.
This was an unannounced inspection on 5 and 6 September 2019. The inspector met everyone living at the home, spoke with people, a relative, staff and a visiting physical therapist, observed care and checked care, medicines, recruitment and management records.
People generally felt safe and were treated with dignity and respect. Staff knew people's preferences, supported their independence and helped them keep in touch with family and take part in activities. Staff were trained, recruitment checks were completed and the home was clean.
However, risks were not always assessed or clearly explained to staff. Medicines were not always managed safely, care records did not always match the care being given, and incidents were not properly analysed or referred as possible safeguarding concerns. The home was rated Requires Improvement overall, with Good for Caring and Requires Improvement for Safe, Effective, Responsive and Well-led.
The previous rating was Good, published in March 2017. The CQC asked for an action plan and said it would work with the provider and local authority to monitor progress and return for another inspection.
Kind and respectful staff
Staff knew people's preferences, reassured them when needed and supported privacy and independence. Inspectors observed warm interactions between people and staff.
“People responded well to staff and we observed them laughing with them and calling them friends.” from the report
Food and nutrition support
People were offered high-calorie food, fortified meals and snacks. They could choose alternatives when they did not want the menu choice.
“People were offered snacks throughout the day. These were designed to have as many calories as possible.” from the report
Staff training and recruitment
Recruitment checks were completed before staff started work. Staff received training, induction, supervision and support relevant to people's needs.
“Recruitment checks had been completed before staff started work to make sure they were of good character to work with people.” from the report
Family contact and activities
People were supported to keep in touch with relatives, enjoy activities and go on trips and holidays.
“People had been supported to go on day trips such as wildlife parks.” from the report
Incomplete risk assessments
seriousRisk assessments did not consistently explain how staff should use moving equipment, respond to behaviour risks or prevent skin damage. Environmental checks also identified water temperature problems without recorded action.
“Potential risks to people's health, welfare and safety had not always been assessed and there was limited guidance for staff to mitigate risks.” from the report
Unsafe medicines practice
seriousSome medicines requiring two staff signatures did not have a second signature. Medicine records were not always signed, and out-of-date creams had not always been destroyed.
“Medicines were not always managed safely. Some medicines had specific storage and administration requirements, these had not been followed by staff.” from the report
Possible safeguarding concerns not acted on
seriousIncidents involving physical and verbal aggression had not been discussed with the local safeguarding authority or used to reduce the risk of repetition.
“Incidents of behaviour that may challenge had been recorded including incidents of physical and verbal aggression.” from the report
Care plans not up to date
seriousCare plans did not always match people's current needs or the care staff were giving. Some lacked detail about personal hygiene, continence and daily routines.
“Care plans did not consistently reflect the care being given.” from the report
Weak quality checks
seriousAudits had not identified the problems found by inspectors. Records did not always show what action followed people's or staff's suggestions.
“These had not been robust and effective in identifying the shortfalls found at this inspection.” from the report
- 01What has changed since the inspection to make sure risk assessments give staff clear instructions about hoists, slings, skin care and behaviour risks?
- 02How do you now ensure that medicines requiring two staff are administered and signed for correctly every time?
- 03How are incidents, including physical or verbal aggression, reviewed and referred to safeguarding when necessary?
- 04How are care plans kept accurate and updated when people's needs change?
- 05What action has been taken in response to the CQC's breaches and what evidence can you show of improvement?
This was an unannounced planned inspection covering all five CQC questions, including the premises and care provided; the report says the previous rating was Good. This explanation was written from the published report of 22 October 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
4 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- June 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 16 December 2010.
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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39 live-in carers within about an hour of Kent
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 33 can care for a couple. 12 years' experience on average.
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