CQC report explained · a nursing home
What the CQC found at The Orangery
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured that infection risks were being managed. They found safe visiting and admission arrangements, effective use of protective equipment, testing, hygiene and infection outbreak plans.
- Effective?
- Requires improvement
- Does the care work? Training, consent, food and drink, working with GPs and nurses.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Good
- Is the home run well? The manager, the culture, how problems get found and fixed.
What inspectors found, September 2020
Inspected but not rated; inspectors found good infection prevention and control at The Orangery.
This was an announced, targeted inspection on 18 August 2020. It looked at infection prevention and control during the coronavirus pandemic, rather than the home's overall quality.
Inspectors were assured that people were protected from infection. They found well-planned visits, safe arrangements for new admissions, effective use of protective equipment, testing, social distancing and cleaning.
Staff had extra training and competency checks. Daily audits were used to check infection control and make changes when needed. The home was inspected but not rated.
Carefully planned visits
Visits were arranged to reduce infection risk. Visitors received information beforehand, clear guidance and protective equipment.
“Visits were well planned to reduce risk and avoid the potential spread of infection.” from the report
Trained staff
Staff received extra infection control training and had competency checks to show they understood the required procedures.
“Staff received additional training and completed competency assessments to show that they understood and followed guidance about infection control procedures such as hand washing and using PPE.” from the report
Regular checks
The home carried out daily audits covering infection prevention, staff understanding and safe practice. Managers checked whether procedures were being followed.
“Audits were carried out daily and included general infection prevention and control checks, compliance with guidance and staff understanding of procedures and safe practice.” from the report
Inspectors raised no specific concerns in this report.
- 01How are visits currently arranged, and have the planned dedicated visitor areas been developed?
- 02How are new admissions isolated while still being given some freedom and independence?
- 03How often are staff trained and checked as competent in hand washing and using protective equipment?
- 04What do the daily infection control audits check, and how are any problems put right?
- 05How are people using the service and staff currently accessed for testing?
This was a targeted inspection of infection prevention and control during the coronavirus pandemic; the service was inspected but not rated and the report does not assess its other care quality areas. This explanation was written from the published report of 9 September 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.
What inspectors found, December 2019
Rated Good overall; inspectors found kind, safe care, but effectiveness required improvement because oral health and fluid monitoring were not always adequate.
The inspection took place over two days, with the first day unannounced and the second announced. Inspectors spoke with people living in the home, relatives and staff. They also reviewed care plans, medicines records, staff files and quality checks.
People said they felt safe and were treated with kindness, dignity and respect. The home was clean, medicines were managed safely, care was personalised and relatives felt able to raise concerns. Staff worked with healthcare professionals and supported people's choices.
The main weaknesses were in oral healthcare and fluid monitoring. Oral health assessments did not always contain enough information, and people were not always supported to access routine dental care. Fluid records did not always show action when people had targets because they were at risk of dehydration, although inspectors found no evidence that people were dehydrated.
The home was rated Good overall. Safe, caring, responsive and well-led were Good. Effective was Requires Improvement, meaning care and support did not always achieve good outcomes or was inconsistent. The home had also been rated Good at the previous inspection, but the effective rating had fallen.
Safe care
Risk assessments gave staff useful guidance about protecting people from harm. The home also carried out daily safety checks.
“Risk assessments were in place and these included guidance for staff.” from the report
Kind and dignified support
People and relatives spoke positively about staff's kindness. Inspectors saw people being treated respectfully and privately.
“People told us they were supported by staff who were kind and caring.” from the report
Personalised care
People's preferences and communication needs were recorded. Families were involved when people could not communicate their choices themselves.
“People's preferences and choices were recorded in their care-plans.” from the report
Safe medicines management
Medicines were stored and managed safely, with relevant information available to staff.
“Information relevant to the administration of medicines was available to staff.” from the report
Positive leadership
Staff described a supportive team culture. The provider used feedback, audits and links with outside organisations to support improvement.
“Staff said they worked as a team to support people.” from the report
Oral healthcare
needs fixingOral health plans did not always include important information, such as dental history and the person's registered dentist. People were not always offered the opportunity to have routine dental check-ups.
“Oral health care-plans were not completed in line with published guidance about best practice and there was limited information available to staff about people's oral healthcare needs.” from the report
Fluid monitoring
needs fixingWhen people had fluid targets because they were at risk of dehydration, records did not always show that staff had taken action to improve their fluid intake or review the target.
“When people had fluid targets set because they were identified as being at risk of dehydration, the records did not always show actions had been taken to increase the person's fluid intake.” from the report
- 01What has changed in the way you assess each person's oral health since the inspection?
- 02How do you help residents arrange routine dental check-ups, including when they first move into the home?
- 03How do you record and respond when someone does not meet their fluid target?
- 04How do you decide whether a person's fluid target is realistic and needs to be reviewed?
- 05How do you make sure staffing is sufficient at busy times and weekends?
This inspection covered all five CQC questions, including the premises and care provided; the first day was unannounced and the second day was announced. This explanation was written from the published report of 5 December 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 Orangery
4 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- September 2020Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- December 2019Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- May 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- December 2011
Registered with the Care Quality Commission on 2 December 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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25 live-in carers within about an hour of Bath and North East Somerset
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,030 to £1,320 a week. 20 can care for a couple. 12 years' experience on average.
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Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.