CQC report explained · a residential care home
What the CQC found at Orchard House Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Inspectors found safer medicines management, well-managed risks, enough staff, robust recruitment and effective infection control.
- Effective?
- Good
- This key question was not covered by this focused inspection, so its previous rating was carried forward.
- Caring?
- Good
- This key question was not covered by this focused inspection, so its previous rating was carried forward.
- Responsive?
- Good
- This key question was not covered by this focused inspection, so its previous rating was carried forward.
- Well-led?
- Requires improvement
- A new manager had introduced improved governance systems and promoted an open culture. However, several checks and systems were still being implemented and needed to become embedded in staff practice.
What inspectors found, March 2023
Rated Good overall; inspectors found safe care and improved medicines management, but well-led was Requires Improvement while new systems were embedded.
This was an unannounced focused inspection on 21 February and 3 March 2023. Inspectors checked whether earlier improvements had been made in Safe and Well-led. They spoke with people, relatives and staff, observed care and reviewed care, medicines, recruitment and management records.
The home was rated Good for Safe. Medicines were being managed more safely, staff had received further training and medicines records had no unexplained gaps. Inspectors also found suitable staffing, safe recruitment, good risk assessments and effective infection control.
Well-led remained Requires Improvement. A new manager and consultant had introduced better checks and meetings, but many systems were new and not yet fully embedded. The provider was no longer in breach of regulations.
The overall rating changed from Requires Improvement to Good. The ratings for areas not inspected during this focused visit were carried forward from the previous comprehensive inspection.
Safer medicines
Medicines records were complete and staff had received training. The report also found that controlled medicines, patches and medicines given as needed were managed safely.
“Medicines including controlled medicines (medicines requiring additional controls due to their potential for misuse) were safely managed.” from the report
Enough suitable staff
Inspectors found enough staff to meet people's needs in a timely way. Recruitment checks and references were completed before new staff started.
“There were sufficient numbers of staff who were safely recruited to meet people's needs.” from the report
Risks were assessed
Care plans and risk assessments reflected people's needs and were updated when risks changed. Staff understood how to support people safely.
“People had detailed risk assessments in place which guided staff on how to keep people safe.” from the report
Improving leadership
The new manager was supported by a consultant and had introduced better audits, meetings and ways to involve people and relatives.
“The manager promoted an open and learning culture where staff were encouraged to share their views, work together as a team and seek ways to continually improve” from the report
New oversight systems
needs fixingSome management checks were still being introduced. The inspectors could not yet be sure that all the new systems were working consistently in everyday practice.
“However, systems developed by the provider to ensure effective oversight needed to be fully implemented and embedded into staff practice.” from the report
Incident monitoring not yet tested
minorThe new system for recording and analysing accidents and incidents had only recently started. Inspectors could not assess how effective it was at the time of the visit.
“This had been implemented at the end of January 2023, so we were unable to assess how effective it was at the time of our inspection.” from the report
- 01Which of the new quality checks are now fully in use, and what problems have they identified since the inspection?
- 02How are you checking that the new medicines checklist, PRN guidance and updated care plans are being followed consistently?
- 03What have your accident and incident records shown since the new system was introduced at the end of January 2023?
- 04Has the manager completed the registration process with the CQC?
- 05How are relatives and people using the service now involved in meetings and decisions about the home?
This was a focused inspection of Safe and Well-led only; the other key-question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 17 March 2023 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 2022
Rated Requires Improvement; inspectors found serious medicines and management problems, although people said they felt safe and staff were caring.
This was an unannounced focused inspection after concerns about medicines. Inspectors visited on 6 September and 21 September 2022. They spoke with people, staff and the manager, observed care, and checked care plans, medicine records and management checks.
The home was not always safe. Medicines were not consistently given as prescribed. Inspectors found missing guidance, out-of-date eye drops, medicines that had not been ordered in time, inaccurate measuring of liquid medicines and poor recording of administration times.
The home was also not well-led. Audits and the provider's action plan had not found or fixed important problems. The provider was unable to show effective oversight of medicines and safe, person-centred care.
The overall rating remained Requires Improvement, as it had at the previous inspection. This was the second consecutive inspection with that rating. The other three key question ratings were carried forward because they were not inspected this time.
People felt safe
People told inspectors they felt safe. Staff knew how to recognise and report possible abuse.
“People felt safe living at Orchard House. Staff were trained in safeguarding and understood their responsibilities to protect people from harm.” from the report
Enough staff
Inspectors found there were enough staff to meet people's needs promptly. Staff also had time to spend with people individually.
“We found staff had time to spend with people on an individual basis.” from the report
Infection control
Inspectors were assured that infection prevention measures, including PPE and arrangements for visits during an outbreak, were being used effectively.
“We were assured that the provider was using PPE effectively and safely.” from the report
People's views used
Resident meetings and surveys were used to gather views. Inspectors saw that menu changes had been made after people's feedback.
“Changes had been made to the menu following feedback from people.” from the report
Medicines were not safe
seriousPeople did not always receive medicines as prescribed. Inspectors found unsafe processes, including out-of-date eye drops, missing guidance and poor recording.
“People did not receive their medicines safely or as prescribed because the provider had failed to ensure proper and safe management of medicines.” from the report
Poor management checks
seriousAudits and checks had failed to identify repeated medicine problems and other risks. This meant the provider did not have effective oversight.
“We found no evidence that people had been harmed however, oversight of the service was not effectively managed by the provider to ensure people received safe and person-centred care at all times.” from the report
Records were not always accessible
needs fixingSome records could not be found by the provider or senior staff during the inspection. They had to wait for the manager to return and send them by email.
“The provider or senior staff were not able to locate some records we asked for during the inspection.” from the report
Low staff morale
needs fixingSome staff said morale was low and that they did not feel valued. The report also said the manager had insufficient support and too much responsibility.
“Staff morale is low at the moment. I think it's because of a mixture of things, such as new staff and new roles.” from the report
- 01What changes have you made to ensure medicines are given at the correct time and recorded accurately?
- 02How do you now check that PRN medicines have clear guidance for staff, especially when a person cannot communicate verbally?
- 03How are liquid medicines measured, and what training have staff completed for this?
- 04How do you make sure medicines are ordered on time and that opened medicines are dated and not used after expiry?
- 05What independent checks now show that the Warning Notices and governance concerns have been fully addressed?
This was a focused inspection of Safe and Well-led only; the Effective, Caring and Responsive ratings were carried forward from the previous inspection. This explanation was written from the published report of 15 November 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.
Every inspection of Orchard House Residential Care Home
8 rated inspections over 7 years: the service has held its Good rating throughout.
- March 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Orchard House Residential Care Home →
- November 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at Orchard House Residential Care Home →
- March 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- June 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- December 2020Goodstayed GoodSafe: GoodWell-led: Good
- November 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- November 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 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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