CQC report explained · a residential care home
What the CQC found at Oriel 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
- Some staff had not taken part in emergency evacuation drills, and one did not know the assembly point. Staff did not always record why as-needed medicines were given or what effect they had.
- Effective?
- Requires improvement
- Not all staff had completed mandatory training on time. Some guidance for supporting people with dementia and mental health needs was limited, and two people had waited too long for DoLS applications.
- Caring?
- Good
- Inspectors saw respectful interactions and relatives spoke positively about staff. However, some language in care notes was not respectful or showed enough understanding of dementia.
- Responsive?
- Good
- Care plans included personalised information and relatives were involved in reviews. Views about activities were mixed, and some people needed more effective support when distressed or wanting to leave the home.
- Well-led?
- Requires improvement
- Quality checks had not identified several safety, medicines, training and legal-authorisation problems. The report says systems to monitor quality and reduce risks failed to identify some risks.
What inspectors found, April 2023
Oriel Care Home rated Requires Improvement; inspectors found kind care but gaps in safety, training, medicines and oversight.
Inspectors made an unannounced visit on 6 December 2022. They spoke with people, relatives, staff and health professionals. They reviewed care records, medicines records, staff files and management records, and observed care.
People said they felt safe and the home was clean and uncluttered. Inspectors saw kind interactions and found that care was personalised. However, some staff had not practised fire evacuation drills, some training was incomplete, medicines records were not always accurate, and incidents involving distress were not properly analysed.
The home was rated Good for Caring and Responsive. It was rated Requires Improvement for Safe, Effective and Well-led. The overall rating changed from Good at the previous inspection. CQC found a breach of Regulation 17 and served a warning notice.
Kind and respectful care
Inspectors saw respectful interactions, and relatives described staff positively. People were supported with privacy, dignity and independence.
“We saw staff knocking on people's doors before entering and they were able to describe ways in which they protected people's dignity and privacy.” from the report
Personalised care planning
Care plans included people's preferences and information about what they could do for themselves. People and relatives were involved in care assessments and reviews.
“Care plans were personalised, and people and their relatives took part in their reviews.” from the report
Partnership working
The home worked with several health professionals, including speech and language, occupational therapy and community mental health services.
“We saw evidence the staff team had been working alongside a number of other health professionals to ensure people received additional support.” from the report
Falls reduced
Inspectors found that analysis of falls had led to changes which successfully reduced the number of falls in the home.
“Changes to mitigate risk resulting from this had successfully reduced the number of falls.” from the report
Fire evacuation readiness
seriousSome staff had never practised an evacuation, and one did not know the assembly point. This created a risk of a confused response in an emergency.
“A failure to ensure staff had received the correct fire safety information meant there was a risk of a poor and confused response from staff in the event of an emergency.” from the report
Medicines records
seriousStaff did not always record why as-needed medicines were given or their effects. A pain relief patch was also not rotated as instructed.
“This left people at risk of inappropriate or ineffective use of medications.” from the report
Incidents involving distress
seriousIncidents involving distress were recorded separately, without looking for patterns or learning about better ways to support people.
“There was no evidence that incidents arising from people's distress were subject to analysis and learning.” from the report
Incomplete staff training
needs fixingSeveral staff had not completed mandatory training within the home's own deadlines, including falls, dementia awareness and health and safety training.
“This meant there was a risk of inappropriate or unsafe support from staff who may lack the necessary skills and training.” from the report
Delayed legal applications
seriousTwo people who lacked capacity to choose to live at the home had not had timely DoLS applications. Applications were made during the inspection.
“Two people living at Oriel Care Home who lacked capacity to choose to live there had not had DoLS applications made in a timely way.” from the report
Food variety
minorPeople gave mixed views about the food. Some found it monotonous, although portion sizes and the amount of food and drink were considered adequate.
“The food is not bad, it is eatable if you are not fussy, but it can be a bit monotonous.” from the report
- 01What evidence can you show that every staff member now understands the emergency evacuation procedure and has taken part in a drill?
- 02How do you record why as-needed medicines are given, their effects, and the information passed to the next staff team?
- 03How do you analyse incidents involving distress, dementia or mental health needs and use the findings to change care?
- 04Which staff training was incomplete at the inspection, and how do you now check that training remains up to date?
- 05How do you make sure DoLS applications are made promptly when people cannot consent to living at the home?
This was an unannounced inspection covering all five key questions, but it did not examine the circumstances of the death that prompted the inspection because that incident was subject to a separate CQC investigation. This explanation was written from the published report of 6 April 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, August 2021
Rated Good; inspectors found safe, effective and well-led care, with some records and staff training still being improved.
This was an unannounced focused inspection on 26 July 2021. Inspectors looked at Safe, Effective and Well-led after concerns about falls and the Mental Capacity Act. They spoke with people, relatives and staff, and checked care, medicines, recruitment and management records.
Inspectors found people were protected from abuse and avoidable harm. There were enough staff, falls risks were assessed, medicines were generally managed safely, and infection control arrangements were in place. People received healthcare support and their dietary needs were understood.
The home had improved its work around consent and legal safeguards. Some staff training was overdue, some care records lacked detail, and guidance for as-needed medicines needed more information. These improvements were already being worked on.
The overall rating was Good. Safe, Effective and Well-led were rated Good. Caring and Responsive were not inspected during this visit, so their previous ratings were carried forward.
Managing falls
The home assessed falls risks, used equipment where needed and made healthcare referrals. Inspectors found no evidence that the concern about falls had put people at risk of harm.
“They [staff] did everything they can to make it safe for [person] and they haven't fallen now for a while.” from the report
Staffing and safety
People and relatives said there were enough staff. Inspectors saw staff respond quickly when sensor alarms sounded.
“There seems to be enough staff, I usually always see someone around.” from the report
Improved legal safeguards
Staff had received further training about the Mental Capacity Act, and records showed the home was now working within its principles.
“However since then, we understand it more, so we are reviewing the applications we made previously.” from the report
Positive leadership
People, relatives and staff spoke positively about the management team. Feedback was collected and acted on, including through meetings during visiting restrictions.
“Absolutely chuffed to bits with them. They have been fantastic, they keep us informed, reassure us and [person] has come on leaps and bounds.” from the report
As-needed medicines guidance
needs fixingGuidance for medicines given when needed did not always contain enough information. Senior staff had identified this and were updating it.
“Although some of these documents required further information, this had already been identified by senior staff who were in the process of including updates to these.” from the report
Overdue staff training
needs fixingSome staff were overdue training updates. The manager said refresher courses had been booked because training had been affected by COVID-19 restrictions.
“Records held in relation to training showed that a number of staff were overdue updates to their training.” from the report
Care records lacked detail
needs fixingSome care records did not fully describe people's needs. Audits had identified this and work was under way, and inspectors found no indication that it had put people at risk.
“Care records had not always included detailed information about people's needs.” from the report
Limited outdoor independence
minorBecause the gardens were not secured, people often needed staff support to go outside. Plans were in place to secure the gardens.
“Due to the gardens not being secured, people would often require staff support to go outside.” from the report
Choice of meals
minorPeople gave mixed views about the food. Some wanted more variety in the choices, and the provider said it would discuss this with people.
“However other people commented that although they have a choice of meal they would like to see more variation in the choices available to them.” from the report
- 01Have all overdue staff training updates now been completed, and how do you check that staff remain competent?
- 02Have the care records been updated with enough detail about each person's needs?
- 03What information is now included in guidance for medicines given on an as-needed basis?
- 04Have the gardens been secured so people can go outside independently where appropriate?
- 05What changes were made after people asked for more variety in meal choices?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 21 August 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.
Every inspection of Oriel Care Home
4 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- April 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021GoodSafe: GoodEffective: GoodWell-led: Good
- December 2020Inspected but not ratedSafe: Inspected but not rated
- March 2020Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2019Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2018
Registered with the Care Quality Commission on 9 January 2018.
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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