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Lake and Orchard Residential and Nursing Home Requires improvement

We are carrying out a review of quality at Lake and Orchard Residential and Nursing Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary

Overall summary & rating

Requires improvement

Updated 14 March 2020

About the service

Lake and Orchard Residential and Nursing Home is a care home providing personal and nursing care to 64 people aged 65 and over at the time of the inspection, including those living with dementia. The service can support up to 90 people.

The care home accommodates people across two separate wings, each has separate adapted facilities. One of the wings specialises in providing nursing care.

People’s experience of using this service and what we found

People did not receive good quality care. The provider had failed to make improvements and act on recommendations made by professionals following the last inspection. We met with the provider during this inspection to outline the improvements required and to seek assurances of their commitment to making improvements at this service.

We found no evidence people had been harmed but they were at risk of avoidable harm due to the ineffective governance arrangements in place. For example, risks, accidents and incidents were not always managed and monitored effectively to keep people safe and prevent reoccurrences. Medicines were not managed safely due to shortfalls in administration arrangements and records. The environment had not always been properly cleaned and maintained to keep people safe and prevent infection. Care records did not always show checks, including pressure area checks, had been completed to evidence people’s care needs were being met. Improvements were needed to records kept about people’s care and support.

People’s needs were not always met in a timely, responsive way because the provider had not ensured sufficient staff were on shift. Staffing arrangements did not support the delivery of high-quality, dignified care. Feedback from relatives and observations showed us there were times when people had to wait extended periods for support. For example; people did not always receive timely or effective support to eat and drink. The provider reviewed their staffing levels following our inspection and agreed to increase staffing levels.

People were not always offered choices about their care. Family members were not always involved in the care of their relatives. People were therefore not supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were not always suitably trained or supported to meet people’s needs. For example; staff needed more knowledge in end of life care. All of the staff we met were motivated to provide the best care possible for people and felt frustrated that they were not able to deliver the care and support in a more person-centred way because of the poor staffing levels. The provider’s responsiveness following inspection and commitment to increase staffing levels should enable staff to work in a more person-centred way.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at

Rating at last inspection

The last rating for this service was requires improvement (report published 8 February 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last seven consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.


We have identified breaches in relation to person-centred care, safe care and treatment, premises and equipment, good governance and staffing. Please see the action we have told the provider to take at the end of this report.

The provider had also failed to ensure statutory notifications were submitted to the CQC. This is a breach of regulation Full information about CQC's regulatory response to this is added to reports after our process outside of inspection has been concluded.

Follow up

We wrote to the provider to request an improvement plan to address the shortfalls we fou

Inspection areas


Requires improvement

Updated 14 March 2020

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 14 March 2020

The service was not always effective.

Details are in our effective findings below.


Requires improvement

Updated 14 March 2020

The service was not always caring.

Details are in our caring findings below.


Requires improvement

Updated 14 March 2020

The service was not always responsive.

Details are in our responsive findings below.



Updated 14 March 2020

The service was not well-led.

Details are in our well-led findings below.