CQC report explained · a residential care home
What the CQC found at The Orchards Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks, safeguarding and medicines were generally managed safely. Inspectors found that some risk assessments lacked accurate or detailed guidance, and afternoon staffing levels needed review.
- Effective?
- Good
- Staff had relevant training and people had access to food, drink and healthcare. Records did not always show snacks being provided to people who needed extra calories, and some mental capacity and best interests paperwork was missing where DoLS applications had been made.
- Caring?
- Good
- People were treated with kindness, dignity and respect. People and relatives were involved in care planning and said they felt listened to.
- Responsive?
- Good
- Care plans covered people's needs, interests and communication needs, and activities were provided. Some care plans contained inaccurate or contradictory information, and some final-hours wishes had not been recorded.
- Well-led?
- Requires improvement
- There were quality audits and a positive atmosphere, but audits had not identified several problems in care records and other documentation. More regular monitoring was needed so managers could be sure people's needs were being met.
What inspectors found, April 2020
Rated Good overall; inspectors found kind, safe care, but the home was not always well-led because records and quality checks needed improvement.
This was an unannounced inspection on 11 March 2020. The inspector spoke with people living there, relatives, staff and health professionals. They also checked care records, medicines records, staff files and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found that medicines were managed safely, staff were kind and respectful, people had access to healthcare, and activities and complaints arrangements met people's needs.
The Well-led rating was Requires Improvement. Some care records were inaccurate or contradictory, and quality checks had not found problems with dietary records, mental capacity paperwork and care planning. Staffing levels were also reviewed during the inspection, and the registered manager said staffing would be increased across the day.
Medicines managed safely
Staff were trained and checked as competent to administer medicines. Records showed that people received their medicines regularly and audits were completed.
“Medicines were managed to ensure people received them safely and in accordance with their health needs and the prescriber's instructions.” from the report
Kind and respectful care
Inspectors saw friendly interactions. People were supported to keep their dignity, privacy and independence.
“We observed friendly and respectful interactions between people and staff.” from the report
Trained and supported staff
Staff had relevant training, induction and supervision. New staff shadowed experienced workers before working alone.
“People received effective care and treatment from staff who had received relevant training.” from the report
Good access to health support
People could access GPs, nurses, dietitians, dentists and other health professionals. The home followed professional recommendations.
“People had access to healthcare services and professionals according to their needs.” from the report
Care records were not always accurate
needs fixingSome care plans contained inaccurate or contradictory information. The manager said the records would be reviewed and corrected.
“However, some care plans contained inaccurate or contradictory information.” from the report
Quality checks missed problems
needs fixingAudits did not identify issues with dietary records, mental capacity paperwork and care records. More frequent checking was needed.
“The inspection process highlighted some issues which audit systems had failed to identify, such as the recording of dietary intake, MCA documentation, and inaccurate information within some care records.” from the report
Afternoon staffing needed review
needs fixingInspectors were concerned that two staff in the afternoon might not be enough for people's changing needs. Staffing was increased across the day after the inspection.
“due to changes in people's physical and emotional needs we had concerns that staffing may not be sufficient during the afternoon when staffing levels dropped to two staff.” from the report
Some legal decision records were missing
needs fixingFor some DoLS applications, records did not show the required mental capacity assessments and best interests decisions.
“Where DoLS applications had been made, we did not always see that capacity assessments and associated best interests decisions were in place” from the report
Dietary intake was not always recorded
needs fixingRecords did not always show whether people who needed snacks between meals received the extra calories intended to help them gain weight.
“we did not always see that this was recorded in care records to evidence if people were having additional calories to increase their weight.” from the report
- 01How often are care records now checked for inaccurate or contradictory information, and what happens when an error is found?
- 02How do you record snacks and extra calories for people who need to gain weight?
- 03Are mental capacity assessments and best interests decisions now recorded for every person with a DoLS application?
- 04What are the current staffing levels in the afternoon and at night, and can a trained medicines administrator always be contacted at night?
- 05How are people's final-hours wishes recorded and kept up to date?
This was a planned but unannounced comprehensive inspection covering all five key questions, the premises and the care provided. This explanation was written from the published report of 4 April 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, March 2019
Rated Requires Improvement; inspectors found kind care and good support, but care records, some safety checks and service oversight were not reliable enough.
This was an unannounced inspection on 30 January 2019. One inspector and an expert by experience spoke with people living there, relatives, staff and a healthcare professional. They observed care and checked care records, staff files, medicines, recruitment and management records.
People told inspectors they felt safe and well cared for. Staff were kind, knew people well and responded when help was needed. Inspectors rated the home Good for effective, caring and responsive care. Medicines, staffing, food and access to healthcare were also found to be managed well.
The home was not always safe or well-led. Some care plans and risk assessments were inaccurate or lacked important detail, including information about choking and diabetes. Environmental checks had missed exposed hot pipes and an unsecured boiler-room door, although these risks were dealt with during the inspection.
The overall rating was Requires Improvement, as were Safe and Well-led. The rating had not changed since the previous inspection, although the report says the quality of the service had improved and the home was no longer in breach of Regulation 17.
Kind and respectful staff
People described staff positively, and inspectors saw warm relationships and respectful support throughout the day.
“Staff were observed to be kind and caring in their interactions with people, and this was evident throughout the day.” from the report
Enough staff
Staff were available when people needed help, and recruitment checks were in place.
“We observed that staff were readily available to assist and support people when needed throughout our inspection visit.” from the report
Safe medicines practice
Staff were trained and assessed as competent to give medicines. Medicines were stored and disposed of correctly.
“People received their medicines safely by staff who were trained to do so.” from the report
Falls improvements
The manager had introduced extra falls audits and used best-practice guidance after the previous inspection.
“Following our last inspection, the registered manager had taken steps to improve the way they managed falls in the service.” from the report
Safety checks missed hazards
seriousInspectors found exposed hot pipes and an unsecured door to the main boiler. The provider acted immediately, but the environmental audit had not identified these risks.
“These risks had not been identified on the environmental risk audit which was completed in October 2018.” from the report
Care records were not consistently accurate
needs fixingSome records contained information that was no longer relevant or did not match people's current needs. Falls guidance was held separately rather than being included in the main care plan.
“Further improvements are needed to ensure that documentation held in care plans and risk assessments are accurate and sufficiently detailed.” from the report
End of life plans lacked personal detail
needs fixingEnd of life care plans were basic and sometimes generic. They did not always clearly record whether someone had declined to discuss their wishes or had not stated a preference.
“Further information is needed to ensure these were person centred and not generic in nature.” from the report
Limited activities outside the home
needs fixingPeople had activities inside the home, but there were no organised activities outside it. The report said this could increase the risk of social isolation and loneliness.
“There were no organised activities outside of the service that people could take part in.” from the report
- 01What has changed in the care plans and risk assessments for choking, diabetes and other individual risks since this inspection?
- 02How do you now check for hazards such as hot pipes, boiler-room doors and other environmental risks?
- 03How are end of life wishes recorded, including when someone does not want to discuss them or has not expressed a preference?
- 04What improvements were made under the refurbishment plan, particularly to the crowded lounge and the smaller lounge?
- 05What opportunities are now available for people to take part in activities outside the home?
This was an unannounced inspection covering all five key questions, including the premises, care, records, staffing, medicines and management systems. This explanation was written from the published report of 14 March 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 Orchards Residential Care Home
4 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- April 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at The Orchards Residential Care Home →
- March 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at The Orchards Residential Care Home →
- December 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 17 January 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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