CQC report explained · a nursing home
What the CQC found at Orchard House Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, May 2019
Orchard House Residential Care Home was rated Good overall, but inspectors found that quality checks and some care records needed improvement.
Inspectors visited without notice on 30 April and 2 May 2019. They spoke with people living at the home, relatives, staff and healthcare professionals. They also reviewed care records, medicines, recruitment files, complaints, accidents, audits and maintenance records.
People were found to be safe and well cared for. Medicines, risk assessments, staffing, infection control and staff training had improved since the previous inspection. People were treated kindly, supported to remain independent and offered activities, food choices and healthcare support.
The main weakness was how the home checked the quality of its own care. Some care plans had not been updated when people's health or continence needs changed. Inspectors also found weaknesses in the way some pureed meals were served and supported.
The overall rating improved from Requires Improvement to Good. Safe, Effective, Caring and Responsive were rated Good. Well-led remained Requires Improvement because improvements to quality checks were not yet fully established.
Improved safety
Risk assessments and medicines management had improved since the last inspection. Staff recorded incidents and used them to review risks and prevent further problems.
“This inspection found that the managements of medicines had improved.” from the report
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw respectful care and support for people's independence and choices.
“Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.” from the report
Skilled staff
Staff received relevant training, supervision and induction. Records showed training in areas including dementia, moving and handling, safeguarding and infection control.
“Staff had regular training to ensure they had the right knowledge and skills to carry out their roles.” from the report
Personalised activities and choices
People were supported to choose how they spent their time, including through activities, outings, food choices and contact with their faith communities.
“There was a wide range of activities organised and these included, flower arranging, visits from pets, quiz sessions and arts and crafts.” from the report
Some care plans were out of date
needs fixingThe home's checks had not identified that some care plans failed to reflect recent changes in people's health and continence needs. This could make it harder for staff to follow the right care instructions.
“the care plan audits had not identified that some care plans had not been updated to reflect changes to people's health needs.” from the report
Meal support needed closer oversight
needs fixingInspectors found that pureed food was sometimes mixed together, making it harder to distinguish different foods and tastes. They also saw one staff member assisting two people at once when another staff member withdrew.
“pureed food was served in a bowl and when staff assisted people with their meal, staff automatically mixed all the food together.” from the report
Quality checks were not fully established
needs fixingNew audits and checks had been introduced, but they had missed important shortfalls. The report says these improvements needed to be further developed and embedded.
“these improvements were still not fully sustained or embedded.” from the report
- 01How quickly are care plans updated when a person's health, continence or other needs change?
- 02How do senior staff supervise mealtimes for people who need help eating?
- 03How are pureed meals presented so that people can distinguish different foods and tastes?
- 04How do you review staff deployment during busy morning periods?
- 05What action has been taken to make sure the new quality audits identify problems that were previously missed?
This was a planned inspection of all five key questions; Safe, Effective, Caring and Responsive were rated Good, while Well-led was rated Requires Improvement. This explanation was written from the published report of 22 May 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.
What inspectors found, May 2018
Orchard House is rated Requires Improvement; inspectors found kind and personalised care, but unsafe medicines practice, incomplete records and weak oversight.
This was an unannounced inspection on 5, 8 and 12 March 2018. Inspectors spoke with 20 people, 12 staff and visiting health and social care professionals. They reviewed care plans, risk assessments, medicines records, staff files, training records, complaints and quality checks.
Some improvements had been made since January 2017, including staff deployment and the home environment. However, people did not always receive safe care. Insulin was given by staff without the required training or competency checks. Medicines records had gaps, some medicines were late, and risk assessments were not always updated.
Care was rated Good for caring and responsive. Safe, effective and well-led were rated Requires Improvement. This was the second consecutive overall Requires Improvement rating. The home had no registered manager at the inspection, although a new manager had recently started.
Kind, personal care
Staff knew people well and supported them in a person-centred way. People told inspectors that staff were very kind and looked after them well.
“Staff were caring and kind. They knew people well and this enabled them to support them in a person centred way.” from the report
Respect and dignity
People's privacy, dignity, equality and personal choices were respected. They could choose how to spend their time and visitors were made welcome.
“Peoples' dignity was promoted. We saw people were dressed appropriately in suitable clothing of their choice.” from the report
Detailed care planning
Care plans included information about people's routines, interests and support needs. Staff received updates during handovers and could describe people's needs.
“Care records were detailed and evidenced that staff knew people well.” from the report
Unsafe insulin practice
seriousStaff giving insulin had not received the necessary training or competency checks. Inspectors found that insulin guidance had not been followed for some people. The provider stopped staff giving insulin until training and checks were completed.
“Staff had not received training or competency checks for doing this.” from the report
Medicines records and timings
seriousMedicines were sometimes prepared without using the medication record, some morning medicines were up to three hours late, and there were unexplained gaps in records.
“During our inspection morning medicines prescribed to be given at 8am took up to three hours to be dispensed.” from the report
Out-of-date risk information
seriousSome risk assessments and care plans did not reflect changes in people's health or treatment. Inspectors also found incorrectly set pressure-relieving mattresses and unsafe footwear that had not been checked.
“Peoples' risk assessments were not all accurate and some lacked sufficient guidance to keep people safe.” from the report
Weak quality checks
seriousAudits had not identified important problems with medicines, care records, staff training, supervision or falls. Falls had not been analysed to identify patterns or prevent them happening again.
“Some audits were carried out; however these were not effective in bringing about improvements.” from the report
New management arrangements
needs fixingThe registered manager had left shortly before the inspection. A new manager had only recently started, so the new arrangements were not yet established.
“The registered manager left the service the week before the inspection.” from the report
Activities were limited
minorSome people and visitors thought activities could be better, particularly after the activity worker left. Other people preferred spending time in their rooms or choosing their own activities.
“Not many activities on offer since the activity person was poorly and left, but, we are happy with our lives here.” from the report
- 01Who currently gives insulin, and what training and competency checks have they completed?
- 02How do you check that medicines are given at the right time and that every dose is recorded correctly?
- 03How are care plans and risk assessments updated when a person's health, medicines or mobility changes?
- 04What action has been taken to analyse falls and reduce the risk of them happening again?
- 05How often are staff supervised and how do you check that all required training is up to date?
This unannounced inspection covered all five key questions and followed up concerns from January 2017; caring and responsive remained Good, while safe, effective and well-led remained Requires Improvement. This explanation was written from the published report of 1 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.
Every inspection of Orchard House Nursing Home
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- May 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 10 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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