Archived: The Moat House

The Moat House is a residential care home providing the regulated activities personal and nursing care to up to a maximum of 72 people in one adapted building, over three floors. At the time of our inspection there were 24 people using the service.

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

People and their relatives told us the change in provider, and further changes in management had continued to make them feel unsettled, commenting on a lack of leadership. The previous registered manager resigned and cancelled their registration in November 2021. A new manager was appointed in December 2021 and was in the process of making an application to CQC to become the registered manager.

People and their relatives felt communication needed to improve. A continuing theme was the poor signal and bad reception which caused difficulties for people when contacting their family member and the service.

People did not always receive consistent, timely care and support from familiar staff who understand their needs. High turnover of staff and use of temporary agency staff has impacted on the services ability to meet people's needs, including those who received care in bed. People and their relatives spoke of loneliness and a lack of stimulation.

Risk management needed to improve. We found no evidence people had been harmed, however people were at risk of harm because systems were either not in place or robust enough to keep people safe and manage risks to their health and welfare effectively. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

We have made a recommendation about decision making in accordance with the Mental Capacity Act 2005.

Improvements were needed to ensure people received personalised care responsive to their needs. Poor recording, and a lack of measures in place to encourage people reluctant to drink, put people at risk of dehydration and developing pressure wounds. People were supported to access healthcare services, however a consistent theme related to people’s lack of oral healthcare and access to a dentist.

We have made a recommendation about managing people’s oral health care needs.

We were somewhat assured systems in place for preventing and managing the risk of spreading infections were being managed effectively. Medicines were managed safely.

People did not always receive good quality care, support and treatment because staff training was not embedded into practice. Staff had completed a range of training to deliver safe and effective care but had not always followed current evidence-based guidance, standards and best practice.

Relatives commended the service for the end of life care provided to their family members. However, further work was needed to ensure advanced decision-making plans for end of life care are developed for all people using the service. This will ensure they have a comfortable, dignified and pain-free death in accordance with their wishes.

The provider had systems in place to acknowledge and respond to complaints about the service.

The service was not consistently well-led. Whilst the provider has governance systems in place, these were not yet well-embedded into the running of the service or being used effectively to drive the required improvements. These were not always reliable and effective in identifying risks to people’s welfare and safety. There was a limited approach to obtaining the views of staff, people who use services, external partners and other stakeholders.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 30 July 2021 and this is the first inspection. The service was previously registered under HC-One No.3 Limited. The last rating for the service under the previous provider was rated inadequate published on 3 December 2019.

Why we inspected

The inspection was prompted in part due to concerns received about poor management of people’s weight and pressure wounds and incidents including falls and skin tears not being reported and investigated appropriately. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person centred care, staffing and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.