CQC report explained · a residential care home
What the CQC found at The Old Orchard 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
- There were not usually enough staff to meet people's one-to-one support needs. Medicines were sometimes given without being recorded, and staff records did not always contain all required information.
- Effective?
- Requires improvement
- Some care plans gave contradictory advice about modified diets for people at risk of choking. Records did not consistently show that people received enough drinks or required physiotherapy support.
- Caring?
- Good
- The report did not give a separate rating for Caring. Inspectors found that people received kind and compassionate care and that staff respected their privacy and dignity.
- Responsive?
- Requires improvement
- Staffing arrangements limited people's opportunities to follow their interests and take part in activities in the community. People were supported to keep in contact with their families and had individual care plans.
- Well-led?
- Requires improvement
- Quality checks had not identified several problems, including staffing, medicines records, mould and contradictory care plan information. The provider had an improvement plan and changed the management arrangements after the inspection.
What inspectors found, September 2023
Rated Requires Improvement; inspectors found kind care, but staffing, medicines records, care plans and quality checks were not reliable enough.
The unannounced inspection took place on 28 June 2023. One inspector observed care for all five people, spoke with staff, relatives and outside professionals, and checked care, medicines, staff and management records.
The home was clean and well maintained apart from black mould in a cleaning cupboard, which was removed quickly. Staff knew people well, treated them with kindness and protected their dignity. However, there were usually not enough staff to provide the one-to-one support people had been assessed as needing.
Inspectors found medicines had been given without always being recorded. Care plans did not always give safe and accurate advice about modified diets for people at risk of choking. Records of drinks and physiotherapy were also incomplete, partly because staff had not been properly trained to use the electronic records system.
The overall rating changed from Good at the previous inspection to Requires Improvement. This means the home was not consistently meeting people's needs and there was limited assurance about safety and quality.
Kind and respectful care
Staff knew people well, responded to their individual needs and protected their privacy and dignity.
“People received kind and compassionate care. Staff protected and respected people's privacy and dignity.” from the report
Safe environment
The home was described as safe, well equipped, well furnished and well maintained for the people living there. The black mould found in one cupboard was removed quickly.
“The service gave people care and support in a safe, well equipped, well-furnished and well-maintained environment” from the report
Safeguarding
Staff understood how to recognise and report abuse. The home worked with other agencies when safeguarding concerns arose.
“Staff had training on how to recognise and report abuse and they knew how to apply it.” from the report
Family and professional communication
Relatives and outside health professionals reported that the manager and staff communicated well and contacted health services when specialist support was needed.
“The team are approachable, very good at sharing information, very good at communication between services and updating us when needed.” from the report
Management changes
The provider decided to appoint a separate manager for the other care home, so the registered manager would only be responsible for this home.
“This meant the registered manager would now only be responsible for managing The Old Orchard.” from the report
Not enough one-to-one staffing
seriousThe home usually had enough staff for shared support, but not enough to meet people's assessed one-to-one needs. This limited safe care, personal support and community activities.
“There were not usually enough staff to meet people's one-to-one support needs.” from the report
Choking risk information
seriousSome care plans contradicted safe swallowing guidance, including suggesting foods that should be avoided. This increased the potential risk of harm.
“Some people's care plans contradicted aspects of the guidance.” from the report
Incomplete care records
needs fixingRecords did not consistently show when people were offered drinks, how much they drank or whether physiotherapy exercises took place. Staff also lacked effective training on the electronic records system.
“Staff had not consistently recorded when people had been offered drinks or how much they drank.” from the report
Limited activities
needs fixingStaffing levels meant people did not often receive individual activities or go out into the community as they wished.
“People's ability to follow their interests and take part in community leisure activities, which were socially and culturally relevant to them, was limited by the provider's staffing arrangements.” from the report
Weak quality checks
seriousThe provider's monitoring systems had not identified several important problems, including staffing, medicines practice, mould and inaccurate care plan information.
“The provider's quality monitoring processes had not identified staffing levels were consistently below the level people had been assessed as requiring” from the report
- 01How many staff will be on each shift, and how will you provide the one-to-one support set out in my relative's care plan?
- 02What checks now confirm that every medicine given, including medicine patches, is recorded correctly?
- 03Has a speech and language therapist reviewed my relative's modified diet and safe swallowing guidance?
- 04How do you record drinks offered and consumed, and physiotherapy exercises completed?
- 05What action has been taken in response to the three regulatory breaches, and can we see progress against the action plan?
This inspection covered the home and the care provided, including infection prevention and control; the report did not give a separate Caring rating, and the previous rating was Good in 2019. This explanation was written from the published report of 2 September 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, July 2019
The Old Orchard Care Home was rated Good overall; inspectors found safe, caring and personalised support, with some areas needing further work.
This was an unannounced inspection on 3 June 2019. One inspector observed care, spoke with staff and contacted a relative and an advocate. They also reviewed care and medicine records, staff training, recruitment and management records.
The home supported five people. Inspectors found that people were protected from abuse and avoidable harm. Medicines, staffing, risk assessments, cleanliness and infection control were managed safely. Staff were trained and people’s health and dietary needs were supported.
Inspectors saw respectful relationships and detailed, person-centred care plans. People were supported to communicate, make choices and take part in activities. The home had systems for complaints, audits and learning from incidents.
The overall rating and each of the five areas were Good. This was the same overall rating as the previous inspection, published in March 2016, although the provider had changed.
Safe care
Inspectors found that people were protected from abuse and avoidable harm. Risk assessments and emergency plans were in place.
“People were safe and protected from avoidable harm. Legal requirements were met.” from the report
Personalised plans
Care plans covered people’s needs, preferences, communication and emergency information in detail.
“Care plans were person centred and were comprehensively detailed about people's needs and wishes.” from the report
Respect and dignity
Staff knew people well and used their individual communication methods to offer choices and support decisions.
“Staff respected people and always ensured their dignity .” from the report
Health support
Staff monitored people’s health and worked with health professionals. Inspectors found that changes in people’s needs were responded to quickly.
“People's health care was monitored. Staff had a good knowledge of people's health conditions, and care plans contained clear personalised information.” from the report
Learning and improvement
The home used audits and incident reviews to identify actions and reduce the chance of problems happening again.
“This showed incidents were used to learn when things go wrong.” from the report
End-of-life planning
needs fixingCare plans did not always record people’s wishes for care at the end of their lives. The provider said more work was needed.
“Care plans were not always reflective of peoples wishes for care at the end of their lives.” from the report
Annual reviews
needs fixingSome relatives said they had not always received an annual review with commissioners and other professionals. Senior staff said they would look into this.
“Some relatives expressed a concern that they had not always received an annual review.” from the report
Information for families
minorSome relatives had concerns about information exchange. The provider agreed to improve communication links with families.
“Some relatives had expressed concerns about information exchange with the provider.” from the report
Manager recruitment
minorThe home was recruiting a manager who would then register with the CQC. Until registration, the provider was legally responsible for how the home was run.
“The service was in the process of recruiting a manager who will then register with the Care Quality Commission.” from the report
- 01Have all residents’ end-of-life wishes now been recorded in their care plans?
- 02How often are relatives and professionals invited to take part in care reviews?
- 03How will you keep families informed about changes in care, incidents and important decisions?
- 04Have the results of relatives’ feedback questionnaires been shared, and what actions followed?
- 05Who is the registered manager now, and how is management cover provided?
This was an unannounced inspection of the care, premises and overall management of the home, and all five CQC areas were rated. This explanation was written from the published report of 5 July 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 The Old Orchard Care Home
2 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- September 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2019GoodSafe: GoodEffective: GoodResponsive: GoodWell-led: Good
- April 2018
Registered with the Care Quality Commission on 30 April 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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