CQC report explained · a residential care home
What the CQC found at The Orchard
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, assessed risks, safe medicines support and suitable infection-control arrangements. The home was clean and people said they felt safe.
- Effective?
- Good
- People's needs were assessed and reviewed, and staff received training and support. People were helped with eating, drinking, healthcare and decisions about their care.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People and relatives were encouraged to share their views and be involved in decisions.
- Responsive?
- Good
- Care plans reflected people's backgrounds, preferences and needs. People had access to activities, support with communication and a complaints process.
- Well-led?
- Good
- Inspectors found an open and inclusive culture, supportive management and systems for checking care quality and safety. Staff worked with health and social care professionals.
What inspectors found, February 2020
The Orchard is rated Good; inspectors found safe, kind and personalised care after improvements since the last inspection.
The inspection took place on 17 and 21 January 2020. The first visit was unannounced. One inspector spoke with people living at the home, relatives, staff and health and social care professionals. Records about care, medicines, complaints, staffing, incidents and safety were also checked.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines support, clean premises, individual care plans and kind, respectful care. People were supported with food, activities, healthcare and making choices.
The previous inspection, published on 24 January 2019, rated the service Requires improvement and found two regulation breaches. The provider made improvements, and this inspection found it was no longer in breach of those regulations.
Safe staffing
Inspectors found enough staff with the right skills to respond to people's needs. People, relatives and staff said staffing arrangements were safe and suitable.
“We saw there were enough staff on duty to monitor people's wellbeing and respond to their individual needs and requests.” from the report
Kind and respectful care
Staff were observed treating people warmly and respectfully. They supported privacy, dignity, independence and involvement in decisions.
“We saw many caring interactions between staff and the people they supported.” from the report
Personalised support
Care plans included people's backgrounds, preferences and interests. Staff said they read and followed the plans.
“People's care plans were individual to them and included information about their personal backgrounds, preferences and interests to promote a person-centred approach.” from the report
Positive leadership
People, relatives, staff and professionals described communication with management as open and supportive. The provider had audits to monitor important areas of care.
“The provider had an audit schedule in place to enable them to monitor the quality and safety of key aspects of people's care.” from the report
Fluid monitoring plan
needs fixingAfter the inspection, the manager met a GP to develop clearer plans for monitoring one person's fluid intake. Inspectors said they would check this at the next inspection.
“Following our inspection, the registered manager met with one person's GP to develop clearer plans for monitoring their fluid intake.” from the report
Induction arrangements
needs fixingThe provider was reviewing induction procedures to make sure they fully included the Care Certificate requirements. Inspectors said they would follow this up.
“The provider was reviewing their induction procedures to ensure these fully incorporated the requirements of the Care Certificate.” from the report
More regular resident meetings
minorManagement intended to organise meetings with people living at the home more regularly. Inspectors planned to follow this up.
“The registered manager discussed their intention to organise meetings with the people who lived at the home on a more regular basis.” from the report
- 01What clearer arrangements are now in place to monitor people's fluid intake?
- 02Have induction procedures been updated to fully include the Care Certificate requirements?
- 03How often are meetings now held with people living at the home, and how are their views acted on?
- 04How are care plans reviewed when a person's needs or risks change?
- 05How do you check that medicines records remain accurate and up to date?
This was a planned inspection covering all five CQC questions, including the care provided and the care home's premises. This explanation was written from the published report of 12 February 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, January 2019
The Orchard was rated Requires Improvement; inspectors found kind, personalised care but important safety, training and management weaknesses.
Inspectors visited on 6 and 11 December 2018. The first visit was unannounced. They spoke with people living at the home, relatives, staff and community professionals. They reviewed care records, medicines records, staff files, complaints and quality checks.
The home was caring and responsive. Staff were kind, treated people with dignity and adapted care to individual needs. People had choices about food and drink, support with activities and access to health professionals.
However, medicines records and guidance were not always accurate or clear. Risk assessments did not give staff enough information to keep some people safe. Staff training and supervision had lapsed, one Deprivation of Liberty Safeguards authorisation had expired, and quality checks had failed to identify these problems.
The overall rating was Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement, while Caring and Responsive were rated Good. This was worse than the previous inspection, when all five areas were rated Good.
Kind and respectful staff
Inspectors saw staff supporting people gently and patiently. People were treated with dignity and their privacy and independence were respected.
“Staff treated people in a kind and caring manner.” from the report
Personalised care
Care plans included people's needs, preferences, histories and choices. Staff adapted their support and communication to the individual.
“They [staff and management] seem to understand the person as an individual and their individual needs.” from the report
Food and health support
People had choices about food and drink, help to eat and drink safely, and access to healthcare professionals when needed.
“We saw mealtimes were relaxed, flexible events during which people had encouragement and any physical assistance needed to eat and drink safely and in comfort.” from the report
Activities and involvement
People were supported to take part in activities based on their interests. Relatives and people were involved in care decisions and knew how to complain.
“People had support to pursue their interests and participate in recreational and social activities at the home.” from the report
Staffing levels
Inspectors found enough staff on duty to respond to people's needs without unreasonable delay.
“During our inspection, we saw there were enough staff on duty to respond to people's needs and requests without unreasonable delay.” from the report
Medicines records and guidance
seriousElectronic medicines records were not always up to date. Guidance for medicines given when needed was unclear, and applications of topical medicines were not consistently recorded.
“Inaccurate medicines records are a potential cause of preventable drug errors.” from the report
Risk plans were not detailed enough
seriousPlans for self-harm, suicide risk and pressure sores did not clearly tell staff how to keep people safe. Checks and repositioning support were not consistently recorded.
“The content of these risk assessments was limited and lacked key information about how staff were to support them to stay safe.” from the report
Training and supervision had lapsed
needs fixingNot all staff had completed mandatory or refresher training. Not all staff had received regular supervision during the previous six months.
“Not all staff had completed the provider's mandatory training or attended their annual refresher courses.” from the report
Mental capacity and DoLS records
seriousSome mental capacity assessments and best-interest decisions were not specific enough. One DoLS authorisation had expired and the renewal application had not been made at the time of inspection.
“We found one person's DoLS authorisation had expired in November 2018 and that the required application to renew this had not been made.” from the report
Quality checks did not work well enough
seriousThe provider had audits, but they failed to identify and address several important care and safety problems.
“They had not enabled the provider to identify and address the significant shortfalls in the quality and safety of people's care we identified during our inspection.” from the report
- 01Have all medicines records been checked and kept accurate, including records for discontinued medicines?
- 02How are PRN medicines and topical medicines now explained to staff and recorded?
- 03Have the risk assessments for self-harm, suicide risk and pressure sores been rewritten with clear instructions and monitoring records?
- 04Are all staff now up to date with mandatory training, refresher training and regular supervision?
- 05How does the home now check that quality audits identify and resolve safety, recruitment and training problems?
This was a comprehensive inspection of the home, covering all five CQC questions; the previous December 2017 rating was Good in each area. This explanation was written from the published report of 24 January 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 Orchard
3 rated inspections over 2 years: the service has held its Good rating throughout.
- February 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2018GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016
Registered with the Care Quality Commission on 27 October 2016.
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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11 live-in carers within about an hour of Herefordshire, County of
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Most charge £960 to £1,410 a week. 10 can care for a couple. 8 years' experience on average.
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
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.