CQC report explained · a nursing home
What the CQC found at The Orchards
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2018
Rated Good; inspectors found safe, effective, kind and responsive care, with improvements needed to make good practice consistent over time.
This was an unannounced, comprehensive inspection on 1 and 5 February 2018. Inspectors spoke with people living at the home, relatives, staff and managers. They reviewed care plans, risk assessments, medicines records, audits, complaints and incident records.
The home was rated Good overall, and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were safe, medicines were managed properly, staff understood people's needs, and care was respectful and personalised.
The home had improved since the previous inspection in November 2017, when it was rated Requires Improvement. Quality checks had been developed and activities had improved. However, a registered manager was not yet in post, and the provider still needed to show that good practice was consistent and lasting.
Safer medicines
Inspectors found that medicines were recorded, checked and given safely. This was an improvement from the previous inspection.
“At this inspection we found the service had made improvements with managing people's medicines.” from the report
Kind and respectful care
People were involved in their daily care and staff respected their privacy, dignity, routines and independence.
“During the inspection, the staff that were on duty showed compassion with meeting people's needs and demonstrated a caring attitude.” from the report
Improved activities
People had more opportunities for group and individual activities, hobbies, religious interests and social contact.
“At this inspection we found the service had made improvements with staff dedicated to improving people's choice and involvement in a range of things to do” from the report
Stronger quality checks
The manager had introduced audits and action plans to identify problems, monitor care and track improvements.
“Audits had been fully implemented to identify and record the required ongoing improvements.” from the report
Registered manager not yet in post
needs fixingThe manager had applied to register with CQC, but the application was still being processed. The provider also needed to show that good practice was consistent and sustainable over time.
“However, a registered manager will need to be in post and the provider to demonstrate consistent and sustainable good practice overtime.” from the report
Some people were unaware of meetings
minorThe home held meetings and collected feedback, but not everyone spoken to knew about the meetings.
“Not everyone we spoke with was aware of the meetings that took place.” from the report
- 01Has the manager's application to register with CQC now been completed?
- 02How are the new audits and action plans being used to make sure improvements remain consistent?
- 03How will the home make sure all residents and relatives know about meetings and can give feedback?
- 04How are medicines records checked when a person first arrives or when their medicines change?
- 05What individual activities are available for someone with particular hobbies, interests or religious needs?
This was an unannounced comprehensive inspection covering the premises and care provided, with ratings given for all five key questions. This explanation was written from the published report of 18 April 2018 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 2017
Rated Requires Improvement; inspectors found important progress in safety and leadership, but medicines and quality records still had gaps.
This was an unannounced focused inspection on 2 August 2017. Inspectors checked whether the home had acted on problems found at the previous comprehensive inspection, especially around safety and management. They spoke with people, relatives and staff, observed care, and checked care records, medicines records and quality checks.
There had been clear improvements. People said they received their medicines as prescribed, staff responded to call alarms more quickly, and staff understood safeguarding and emergency procedures. A new registered manager was in post, and people, relatives and staff spoke positively about the leadership.
However, the improvements were not yet reliable enough. Inspectors found a missed medicine, expired eye drops, incomplete medicines records and gaps in information about medicines. Care records and checks did not always identify or correct problems, including records about repositioning, diet and fluids.
The overall rating was Requires Improvement. Safe and well-led were both rated Requires Improvement. This was not a full inspection of all five areas, so the report does not give new ratings for Effective, Caring or Responsive.
Improved medicines practice
People said they received their medicines as prescribed. Inspectors saw medicines being given safely, with consent sought where possible and information provided about what medicines were for.
“People we spoke with told us they received their medicines as prescribed.” from the report
Better response to call alarms
People and relatives said staff were more available and responded more quickly to call alarms than at the previous inspection.
“People's needs were met in a timelier manner because improvements had been made to the way in which staff were deployed and organised within the home.” from the report
Emergency preparation
Staff took part in a practical fire drill and were observed responding appropriately and efficiently. Staff were also more confident about identifying when CPR should or should not be given.
“We saw staff responded appropriately and efficiently.” from the report
Approachable leadership
People, relatives and staff described the new registered manager and management team as approachable and responsive. Staff said the management style had led to positive changes.
“Everyone we spoke with were positive about the improved leadership within the home.” from the report
Safeguarding awareness
Staff knew the signs of possible abuse and understood how to report concerns. The report says safeguarding concerns had been reported and investigated appropriately.
“This meant that staff had the knowledge and the skills they required to identify the potential risk of abuse and knew what action to take.” from the report
Medicines were still not fully reliable
seriousOne person missed a medicine, one person's antibiotic doses were not evenly spaced, and another person ran out of an anxiety medicine for three days. Two eye drops were still being used after their 28-day expiry.
“We found two eye drop bottles had gone past their 28 day expiry and were still in use.” from the report
Incomplete medicines information
needs fixingSome handwritten medicines charts were not dated, some instructions for medicines given when needed included incorrect side effects, and information for medicines given through a PEG tube was not always updated.
“Three of the MAR charts we looked at were handwritten and checked by two staff; however they had not been dated with the month or year.” from the report
Quality checks did not find problems
seriousThe home's monitoring systems did not consistently identify inaccurate or missing records. Inspectors also found that records did not always show what action had been taken or whether it had improved care.
“The provider's quality assurance systems had failed to identify that records were not being maintained accurately and/or monitored in order to trigger any action to be taken.” from the report
Repositioning records were inconsistent
needs fixingSome people assessed as needing repositioning every two hours were recorded as waiting three to four hours. Staff said they did not always record when support had been provided.
“Some people who were assessed as requiring re-positioning every two hours to protect their skin integrity, were at times waiting up to 3 to 4 hours for this support.” from the report
- 01How are you checking that every medicine is available, in date, given at the right time and recorded correctly?
- 02What system now prevents missed medicines and ensures medicines given when needed have accurate instructions?
- 03How do you check that people who need repositioning every two hours receive it and that staff record this accurately?
- 04What monthly quality assurance information has been sent to the CQC since this inspection, and what problems has it identified?
- 05How are care plans updated when a person's diet, fluid needs, seizure history or repositioning needs change?
This was a focused inspection of Safe and Well-led only; the other three areas were not inspected and their ratings were not changed by this report. This explanation was written from the published report of 7 December 2017 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 Orchards
7 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- April 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2017Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- May 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2016Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- August 2015Inspected but not ratedSafe: Inspected but not rated
- March 2015Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2015Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 31 October 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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