Moorland House offers accommodation for up to 20 people who require personal care, including those who are living with dementia. We carried out an unannounced inspection on 5, 6 and 12 December 2016 and found breaches of legal requirements. The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timescale.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
At our previous inspection in October 2015 we identified the provider was not meeting seven regulations. Systems and processes were not established and operated effectively to prevent abuse. Staff failed to recognise restrictive practice and to assess less restrictive options for people’s support. Risk assessments were not always completed and regularly reviewed and actions were not taken to mitigate risks. Staff training, and procedures regarding the administration of medicines were inconsistent and did not ensure the proper and safe management of medicines. Staff recruitment procedures were not established and operated effectively to ensure safe recruitment decisions. Consent to care was not always sought In line with current legislation and guidance. Staff were not familiar with and able to apply the principles and codes of conduct associated with the Mental Capacity Act 2005. The provider had not acted at all times in accordance with the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. People were deprived of their liberty for the purpose of receiving care without lawful authority. Systems in place to assess, monitor and improve the quality and safety of the service were not operated effectively, in particular in regard to people’s health and welfare. Records in respect of service users, persons employed and the management of the regulated activity were not accurately maintained.
Following the inspection, the provider sent us an action plan telling us the steps they were taking to make the improvements required. In July 2016 they sent us an updated action plan which informed us they had completed their actions or they were in hand. At this inspection, we found some improvements had been made. For example, staff training, supervision and appraisals had been completed. Staff recruitment procedures had been improved and all appropriate checks had been completed. Some improvements had been made to the safety of the environment.
However, on-going concerns remained in all other areas of the management of the home and in the care of people who lived there.
There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.
We found the registered manager did not fully understand their responsibilities in relation to meeting the Health and Social Care Act 2008 regulations. They had failed to notify the commission of events required by law. They had not understood the seriousness of the concerns we highlighted during our inspection.
Systems to monitor and assess the quality and safety within the home were not effective. Audits had not identified short falls in the management of the home and people’s care that we identified during our inspection. The provider’s action plan had not been adequately monitored for progress and to identify areas that still required improvement.
The registered manager and provider had failed to display their ratings in the home and on the website which we discussed with the registered manager on the second day of inspection. On the third day of inspection we noted the rating was displayed in the lobby but not conspicuously as required by law. The registered manager had not acted sooner on an action from an audit in November 2016 to do this. The website was updated by the provider following the inspection to display the rating as required.
Whilst people and relatives told us they felt the home was safe, we found on-going concerns. Staff had received safeguarding training, demonstrated an understanding of key types of abuse and explained the action they would take if they identified any concerns. However, whilst some incidents had been reported, other incidents, such as verbal abuse and intimidation between people, had not been identified as safeguarding concerns and had not been reported to the local authority safeguarding agency or to the Care Quality Commission as required by law.
Individual and environmental risks relating to people’s health and welfare were not always identified and assessed to reduce those risks. This was an on-going concern. Risk assessments were not always in place to provide detailed guidance to staff in how to protect people from harm. Incidents and accidents were not analysed effectively to learn lessons and reduce the likelihood of them happening again.
Systems in place to ensure the storage and administration of medicines, including controlled drugs, were not safe. Medicines records were incomplete and inconsistent. Staff were assessed for competency to administer medicines, however not all staff had received regular training to do so. This was an on-going concern.
Staff did not always follow legislation designed to protect people’s rights and ensure decisions were made in their best interests. The registered manager did not fully understand the Mental Capacity Act 2005 and allowed relatives, who did not have the legal right to do so, to make decisions about their family member’s care. This was an on-going concern. Whilst improvements had been made in relation to restraint, the registered manager had not ensured they supported a person to meet the conditions within a Deprivation of Liberty Safeguards authorisation.
There were insufficient staff deployed to meet people’s needs at all times. People were left unsupervised for long periods of time in communal areas during the mornings when staff were busy getting other people up. People’s emotional and social support needs were not always met as staff did not have time to sit and engage with them until later in the afternoons when other tasks had been completed. Some activities were planned throughout each week, however, it was noted there were no activities planned at weekends when there were less staff and more pressure on their time.
Most people were supported to maintain their health and well-being and had access to healthcare services when they needed them. However, we noted other examples of people not receiving the care they required in a timely way. Staff did not always act in line with the home’s ‘falls protocol’ or take appropriate action to request medical advice for people sustaining a head wound following a fall.
Staff treated people with dignity and respect and ensured their privacy was maintained most of the time. However, we observed some interactions and use of language, which was not meant unkindly, but that did not promote dignity and respect.
Initial assessments were carried out before people moved into Moorland House to ensure their needs could be met. Information was used to develop plans of care for people most of the time. However, this was not always the case and changes to people’s care needs were not always reflected accurately in their care plans. People’s care records were not always accurate or up to date.
People were supported by staff who had received an induction into the home and appropriate training, professional development, supervision and appraisal to enable them to meet people’s individual needs. Staff meetings took place and staff said these were helpful and enabled issues to be discussed. Staff felt supported by the management team and were confident to raise any issues or concerns with them.
People were supported to have enough to eat and drink and that met their specific dietary needs. People received individual physical assistance to eat when required and were provided with specialist equipment to enable them to maintain their independence to eat where possible.
The service was responsive to people’s needs and staff listened to what people said. People and, when appropriate, their families or other representatives were involved in decisions about their care planning.
Staff were caring and sensitive when people became anxious or upset, providing re-assurance and appropri