Orchard House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

We identified staffing levels needed to be improved and this was actioned immediately. There was evidence of learning from incidents and accidents. Staff were able to tell us how to keep people safe from harm and abuse. Staff had received relevant training in relation to their roles. We observed the home was clean and staff followed infection prevention and control practices. There were safe practices in relation to robust recruitment processes. People were given their medicine in a timely manner and administration of medicines was appropriately recorded. There were processes in place to support good medicines optimisation. We observed people’s individual risks were being managed and people had accessed external support to meet their individual needs.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

We received positive responses from family members about the initial transition for their loved ones into the service. One relative said, “It was a hard decision to look at care homes, but when we visited, we felt it was homely with a lovely atmosphere, it’s early days but we feel it was the right choice.” Another relative told us that they were kept informed of appointments and referrals to specialists. They said, “They are good at keeping us up to date, and if we can, we will go with our relative –but if we can’t, a staff member goes with them.”

Whilst we were told that people were assessed before a placement at the home was offered, the documentation to support this was not always completed in full. It lacked detail about peoples’ health status and the admission process had not always included a thorough physical assessment and risk assessments. This was acknowledged by the manager, and improvements had been made and were ongoing.

Staff worked alongside other ASC and health organisations to ensure people received appropriate care. There was regular contact with local authority, social workers, paramedics and doctors. Staff told us they knew the paramedics and health team well and told us of collaborated teamwork. "We have had recent meetings with the GP, and we are hoping for better communication going forward.”

We spoke with two health care professionals who told us staff sought advice, when needed, and picked up when people were unwell. One health professional said, "There has been some mixed communications, but things have improved, they are knowledgeable about their residents, they are open to advice.”

People were supported to maintain their health, attend appointments both inside and outside of the service. People's care records showed prompt referrals had been made to healthcare professionals where concerns had been identified. The management team worked hard to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, passports were used, these are currently being updated. These ensured that hospital staff have vital information about them and their health.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

We received positive responses from family members about the initial transition for their loved ones into the service. One relative said, “It was a hard decision to look at care homes, but when we visited, we felt it was homely with a lovely atmosphere, it’s early days but we feel it was the right choice.” Another relative told us that they were kept informed of appointments and referrals to specialists. They said, “They are good at keeping us up to date, and if we can, we will go with our relative –but if we can’t, a staff member goes with them.”

Whilst we were told that people were assessed before a placement at the home was offered, the documentation to support this was not always completed in full. It lacked detail about peoples’ health status and the admission process had not always included a thorough physical assessment and risk assessments. This was acknowledged by the manager, and improvements had been made and were ongoing.

Staff worked alongside other ASC and health organisations to ensure people received appropriate care. There was regular contact with local authority, social workers, paramedics and doctors. Staff told us they knew the paramedics and health team well and told us of collaborated teamwork. "We have had recent meetings with the GP, and we are hoping for better communication going forward.”

We spoke with two health care professionals who told us staff sought advice, when needed, and picked up when people were unwell. One health professional said, "There has been some mixed communications, but things have improved, they are knowledgeable about their residents, they are open to advice.”

People were supported to maintain their health, attend appointments both inside and outside of the service. People's care records showed prompt referrals had been made to healthcare professionals where concerns had been identified. The management team worked hard to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, passports were used, these are currently being updated. These ensured that hospital staff have vital information about them and their health.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Improvements were needed to the management of people’s individual risks. Care plans and risk assessments were specific to each person with guidance for staff of how to manage and monitor the risk. However, not all were up to date, person centred, and some lacked specific detail to manage risk. This had also been identified by the manager in December 2024, all care plans were being reviewed and updated to reflect peoples changing needs. We have received an action plan that evidenced their findings in December 2024 with time scales for improvement. We spoke to one person who expressed they had not been involved in a care plan and if they had, they would have asked about being helped to walk, and that they were bored. The manager confirmed that they will progress the persons’ wishes within a risk assessment framework. We have also asked for one persons’ care plan and risk assessments to be a priority due to their increased frailty.

Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Improvements were needed to the management of people’s individual risks. Care plans and risk assessments were specific to each person with guidance for staff of how to manage and monitor the risk. However, not all were up to date, person centred, and some lacked specific detail to manage risk. This had also been identified by the manager in December 2024, all care plans were being reviewed and updated to reflect peoples changing needs. We have received an action plan that evidenced their findings in December 2024 with time scales for improvement. We spoke to one person who expressed they had not been involved in a care plan and if they had, they would have asked about being helped to walk, and that they were bored. The manager confirmed that they will progress the persons’ wishes within a risk assessment framework. We have also asked for one persons’ care plan and risk assessments to be a priority due to their increased frailty.

Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Relatives told us that the environment was safe. One relative said, “I feel that the home is safe, the garden is secure as well.” Another relative told us, “I think the home is lovely, it looks nice, the furniture is good, the conservatory adds a nice area to see my relative.”

The provider had conducted checks and audits that ensured the environment was safe. However, the documentation evidenced that only 10% of hot water outlets were checked monthly. We have asked the provider to review this with the Health and Safety Executive.

Staff told us that they regularly checked the environment for hazards. One staff member said, “I feel it’s a safe place to work, we report any things not working and they do get done.”

The premises and garden were free of obstacles and hazards, and we observed people moving safely and independently without any staff assistance around the care home. Where staff were seen assisting people with equipment, they were doing so in a professional and safe way.

Staff completed fire evacuation drills and any learning from them had been taken forward. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property.

he provider did not always make sure there were enough qualified, skilled and experienced staff.

People, and relatives told us, "Staff are visible, no problems with staffing that I have noticed," and "Staff are rushed I think, more staff would help especially when we want to talk to someone." Staff told us, "We lose a staff member in the afternoon, it would really help us if we had the 6th one, as there are people in their rooms, the 6 staff in morning is fine," and "There aren’t enough staff at night, just 2 care staff and an RN (registered nurse). Now we have people with nursing needs, there are people who need 2 staff for care, so if we had an emergency, it would be really unsafe, and difficult to manage,”

We spoke with the provider who responded positively and staffing levels in the afternoon immediately increased. Night staffing levels were to be reviewed against the increased needs of people.

Our observations showed us that staff were busy assisting people but there was always a staff member in the lounge and available to support people’s requests for help, take the time to sit with people, and to assist them with food and drink, if necessary.

The staffing levels were based on peoples’ needs and regularly reviewed. We looked at 3 months of rotas and the staffing levels were consistent supported by relief staff to cover sickness and holidays. Staff numbers and the deployment of staff had ensured people’s needs were met in a way that met their preferences. Care delivery was supported by records that evidenced that people’s physical care needs were being met. People mostly received timely care; call bells were answered promptly. However, there were some people who were on 24-hour bedrest and very frail who spent time without positive interaction apart from tasks undertaken. This was fully discussed and was under review.

Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Visitors told us the home was always clean and well maintained. Comments included, “It looks very nice, its clean and smells nice,” and "Really lovely, homely environment, clean and comfortable."

Staff told us they are well resourced for cleaning and infection control. Staff member told us, “Personal protective equipment (PPE) is available, and there is plenty of cleaning products and equipment,” and “We have a good housekeeping team, they do a good job.”

Staff told us they had received training in infection control and had regular spot checks to ensure they are doing it properly.

The general environment was clean with no odours. We saw housekeeping staff undertaking cleaning in all parts of the home. Our observation of the environment raised no concerns about safety or cleanliness. People’s laundry was managed well, and the laundry room was clean and well organised and had recently been upgraded. Staff were seen using gloves and aprons appropriately. People’s rooms were cleaned regularly by housekeeping staff and people commented positively, with no-one reporting any problems with the standard of cleanliness of the environment and equipment

The housekeeping staff understood their role and followed appropriate procedures to keep the home clean. All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed by the infection control lead, to ensure compliance with the procedures and policies of the home.

Staff were trained in the use of personal protective equipment (PPE) and of the importance of good hygiene practice. The manager told us they ensured staff continued to follow Public Health England guidance to reduce the risk of COVID-19 reoccurring. People had received COVID-19 booster injections.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Not everyone could share their experiences regarding medication, but one person said, “I haven’t been here long, but I get all my medicines.” One family member we spoke with said, “Staff keep us informed of any changes, especially if the GP changes the medication, I have no concerns.”

Due to a large number of medicine errors, the organisation made a decision to change to an Electronic Medication Administration Record (eMAR). This has reduced the amount of medicine errors. At present only the registered nurses were medicine givers.

Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and that they were recorded accurately. Risk assessments were in place for certain medicines. All discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. Protocols for 'as required' (PRN) medicines such as pain relief medicines were in place however, they were very generic and lacked personalisation. This was being addressed by the clinical lead.

The clinical lead had made improvements regarding the management of medicines, especially regarding storage. Work was on-going at present in creating a second clinical room which will address the storage issues they presently have.