CQC report explained · a nursing home
What the CQC found at Orchard Lodge 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
- Risks, staffing and infection control were managed well, but medicine records and administration processes were not always safe. Inspectors said this created an increased risk, although they found no harm had occurred.
- Effective?
- Good
- Staff had suitable training, supervision and induction. People's care needs, nutrition, healthcare referrals and consent were generally assessed and managed appropriately.
- Caring?
- Good
- People were treated with kindness, dignity and respect. People and relatives were involved in care decisions, and inspectors saw personalised support.
- Responsive?
- Good
- Care plans were detailed and personalised, and staff responded when people's needs changed. Activities and communication support were adapted to people's interests and needs.
- Well-led?
- Requires improvement
- There was a positive culture and evidence of improvement, but oversight of medicine records and end of life procedures was not strong enough. Communication with relatives also needed to improve.
What inspectors found, June 2021
Rated Requires Improvement; inspectors found kind, effective care, but medicines and management oversight still needed improvement, and the home has left Special Measures.
This was an unannounced comprehensive inspection on 4 and 13 May 2021. Inspectors spoke with people, staff, the manager, the provider, relatives and health professionals. They also checked care plans, risk assessments, medicines records, training records and management documents.
The home had improved from Inadequate to Requires Improvement overall. Safe and Well-led were rated Requires Improvement. Effective, Caring and Responsive were rated Good. Inspectors found people were treated kindly, their needs were understood, and staff responded to changes in their health.
There were still problems with medicine records and procedures for end of life care. Relatives also said communication about inspection outcomes and planned updates was not always reliable. The home had been in Special Measures since December 2018, but inspectors found enough improvement for it to leave Special Measures.
Risk management
People's risks were identified and reviewed. Care plans explained how staff should reduce the risk of harm.
“Risks to people were identified, comprehensive assessments were in place and these were reviewed and updated regularly.” from the report
Staff training
Staff received induction, supervision and training that inspectors considered suitable for supporting people effectively.
“Staff had received training and support that was current, meaningful and worthwhile. This enabled staff to care for people effectively.” from the report
Kind and respectful care
Inspectors saw meaningful interactions and found that people were treated with dignity. Relatives also noticed improvements in care and staff kindness.
“Relatives told us they had not noted the past findings of inspections when considering the care of their family member.” from the report
Personalised support
Care plans included people's preferences and life histories. Staff supported individual interests and helped people maintain relationships.
“Detailed person-centred care plans had been developed which enabled staff to support people in a personalised way.” from the report
Medicine records
seriousMedicine administration records did not always follow the home's policy. Some handwritten changes were unsigned, and amounts carried forward were not always recorded.
“Staff practice surrounding medication administration records did not always comply with the providers policy, nor best practice requirements.” from the report
End of life guidance
needs fixingEnd of life plans and procedures needed more detail. Staff did not always have clear guidance about when some medicines could be given or when a delivery device might be needed.
“We found care plans had potential for further development and the manager agreed these would be reviewed.” from the report
Communication with relatives
needs fixingRelatives said updates about the home's inspection history and planned communication did not always continue or take place.
“Relatives also told us planned communication updates did not always take place.” from the report
- 01How are medicine administration records now checked for unsigned handwritten changes and amounts carried forward?
- 02What written guidance do staff now have for end of life medicines and the use of a medication delivery device?
- 03How will relatives receive regular updates about changes in care and the home's improvement work?
- 04Has the manager completed the application to become registered with CQC?
- 05How do audits show that the improvements found at this inspection are being maintained?
This was an unannounced comprehensive inspection covering all five key questions and following up improvements required after the previous Inadequate inspection. This explanation was written from the published report of 18 June 2021 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, August 2020
Still rated Inadequate and in special measures; improvements were found, but this targeted inspection did not change the rating.
Inspectors made an unannounced visit on 14 July 2020. They followed up problems from the previous inspection, including pressure care, food and drink, staff training, records and infection control.
They found clear improvements. People had enough food and drink, received support with pressure care, and had detailed care records. Staff had relevant training, the home was visibly clean, and correct protective equipment was being used.
There were still some concerns. Visitor infection control needed review, some staff did not always speak to people kindly during meals, and some staff did not feel comfortable raising concerns. The inspection looked only at specific parts of Safe and Well-led, so it did not change the previous rating.
The previous overall rating was Inadequate. The home remains Inadequate and in special measures while CQC continues to monitor it.
Pressure care
People received support based on advice from health professionals. Equipment was checked and staff followed repositioning plans.
“People were now receiving support from professionals such as occupational therapists and tissue viability nurses.” from the report
Food and drink
There was plenty of suitable food, including fresh fruit and vegetables. People were encouraged to eat and drink regularly, and records showed their intake.
“There was plenty of food at the service including fresh fruit and vegetables.” from the report
Training and records
Staff had received relevant training and competency checks had started. Care records, food and fluid charts and pressure-care records were detailed and correctly completed.
“We reviewed various documentation about people's care including daily notes, food and fluid charts and pressure care recordings.” from the report
Cleanliness and protective equipment
The home was visibly clean and staff were using the correct protective equipment during the COVID-19 pandemic.
“Staff and the management team were wearing the correct PPE and following government guidance regarding COVID-19 to promote people's safety and wellbeing.” from the report
Visitor infection control
needs fixingVisitor checks were in place, but inspectors said social distancing and taking temperatures immediately on entry needed improvement.
“However, some improvements could be made to this process with regards to social distancing and taking temperatures immediately when visitors enter the building.” from the report
Respectful communication
needs fixingMost staff were kind, but some did not speak to people in a person-centred way while helping them eat. The provider was asked to improve this.
“However, some staff did not speak to people in a person-centred manner when supporting them to eat their meals.” from the report
Staff raising concerns
needs fixingSome staff did not feel able to raise concerns with management because they feared their views would not be heard or would lead to negative feedback.
“Some staff told us that they did not feel comfortable raising concerns with the registered manager or provider.” from the report
Some care-plan detail
needs fixingSome records still needed more detail, including plans for medicines given when needed, short-term care needs and mental capacity decisions.
“However, we did find that further improvements could be made to some areas of people's care plans.” from the report
- 01What changes have you made to visitor checks, including social distancing and taking temperatures immediately on entry?
- 02How do you check that staff speak respectfully and in a person-centred way during meals?
- 03How can care staff raise concerns safely, and what happens when they do?
- 04What extra detail has been added to PRN medicine plans, short-term care plans and mental capacity decisions?
- 05What progress has been made since this inspection towards leaving special measures and improving the overall Inadequate rating?
This was a targeted inspection of specific parts of Safe and Well-led; it did not assess the whole of either question or the other three questions, so the previous ratings carried over. This explanation was written from the published report of 13 August 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.
Every inspection of Orchard Lodge Care Home
6 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- June 2021Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2020Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- April 2020Inadequatestayed InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- September 2019Inadequatestayed InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2019Inadequatestayed InadequateSafe: InadequateEffective: Requires improvementCaring: InadequateResponsive: InadequateWell-led: Inadequate
- April 2019Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 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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