Tyne House

Moor View is a residential care home providing personal care to up to 13 people. The service provides support to people with learning or physical disabilities or autistic spectrum disorder. At the time of our inspection there were 12 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

People were supported to make choices in their daily lives and were supported to do things they enjoyed. People were engaged in varied activities of their interest, including activities to enhance their skills and learning.

People were supported to maintain family links and helped to grow friendships. People were encouraged to be part of the community. Staff had a good understanding of people’s individual needs and encouraged them to reach their goals.

There were enough staff to support people in a person-centred way. Each person had a key worker dedicated to their care and support. The national shortage in suitable applicants to fill vacant posts had impacted on the services ability to fill shifts. However, agency staff had been used to do this in the interim as they continued to recruit.

Risk was monitored and assessed. People received medicines safely and staff ensured this continued when away from the home. The provider updated records during inspection to further enhance procedures. The provider followed infection control guidance, including when visitors attended the home. A small number of staff needed to be reminded about mask wearing procedures.

Right care:

Personalised support plans were in place to help staff support people’s needs in the way they chose. Personal care was provided in a thoughtful and dignified manner. After feedback some records were enhanced.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right culture:

The service operated with openness. When something went wrong, they worked with other professionals and families to put things right. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

The needs and safety of people form the basis of the culture at the service. Staff understand their role in making sure that people are always put first. Staff talked positively about the role they undertook and consistently strived to deliver person centred care. People were empowered to live their best lives possible and were valued as individuals.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 April 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve quality assurance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

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.

For the key question of Effective, Caring and Responsive which were not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Moor View on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Moor View is a residential care home which provides accommodation and personal care to up to 13 people with learning disabilities or autistic spectrum disorder or physical disabilities. At the time of the inspection 10 people were living at the service.

The service incorporates three homes, Moor View, Tyne House and West Cottage across the same site. These homes form the registration of Moor View. The environment had been adapted to meet the needs of people.

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

The service was not always well led. Effective systems were not fully in place to monitor quality across the service. Audits had not been effective in identifying recording issues. This affected the ability of the service to deliver service improvements.

Systems were in place to safeguard people from the risk of abuse. We found one incident had not been reported to the local authority safeguarding team. The home manager responded to our feedback and ensured this incident was reported to the appropriate authorities.

Medicines records were not always accurately completed. Accident and incidents were reviewed to determine whether any action could be taken to reduce these and improve outcomes for people.

There were enough staff deployed to meet the needs of people. However, there was a reliance on the use of agency staff to support the service. The provider was actively trying to recruit staff and were considering ways they could attract staff to work at the organisation. The staff recruitment process occasionally did not follow expected requirements.

Risks people were exposed to had been assessed and measures had been implemented to mitigate any known risks. In addition, environmental checks had been undertaken to monitor the safety of the building.

Systems to mitigate risks in relation to COVID-19 had been considered.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Evidence was available to show how people were involved in decisions about their care and support and staff empowered people to communicate what they wanted. Staff had a good understanding of how to promote and maintain people’s dignity and human rights. Staff were clearly considerate of people’s needs and their behaviour and attitudes enabled people to live fulfilling lives.

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

Rating at last inspection

The last rating for this service was good (published 23 August 2018).

Why we inspected

We undertook this targeted inspection as part of CQC’s response to care homes with outbreaks of coronavirus. 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.

We inspected and found there were some record issues with infection prevention and control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Enforcement

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the overall governance at the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Moor View has three locations across the same site. The largest Tyne House service, and two smaller services of Moor View and West Cottage that have all been adapted to meet the needs of the people living there. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. 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 service is run. The registered manager had an office at Tyne House but was a regular presence at all three services on site.

Moor View was last inspected by CQC in February 2016 when the service was rated as Good. At this inspection we found the service remained Good and met all the fundamental standards we inspected against.

We saw that medicines were not being stored according to NICE and Royal Pharmaceutical Society guidelines. Guidance stated that medicines stored at room temperature should be at 25 degrees or below to maximise their effectiveness. On the last three weeks of recording prior to our visit, the temperature had exceeded 25 degrees each day and on one day had been 33 degrees. The registered manager had already raised this as an issue with the provider via her quality checks.

We discussed that risk assessments should ensure that any restrictions put in place such as straps for wheelchairs should be fully documented with the risk identified and measures to reduce the impact. Other risk assessments around the environment were in place.

We saw people’s medicines were administered to them in a safe and timely way by competent staff.

Family members told us they felt their relatives were safe and there were sufficient staff to meet people's needs. Following recruitment, there was now a stable staff team and we saw that people were supported consistently.

Checks were made to ensure the environment and equipment was well maintained and safe.

The records we viewed and interviews with staff showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: wheelchair services and other specialist healthcare professionals.

Staff told us they felt well supported in their role; they received an induction and training. Staff members spoke of good team work.

People had choice and control of their lives and staff supported them in the least restrictive way; the policies and systems in the service supported this practice.

Staff were aware of the importance of supporting people with good nutrition and hydration. Relatives we spoke with told us people with specialist diets were well supported. We saw that people were encouraged to shop for and prepare their own meals with staff support where they were able.

People had access to healthcare services, in order to promote their physical and mental health. We saw that people were supported to have annual health checks and to attend health screening appointments.

The premises were homely and suitable for people's needs. People were involved in decisions about the decoration and the provider had taken steps to make the environment more accessible in response to changes in people's needs.

There were detailed care plans in place, so that staff had information on how to support people with their routines. We discussed with the registered manager to ensure the detailed monthly reviews were linked to outcomes within the care plans to show how the service supported people to achieve their goals and aspirations.

People were able to take part in a range of activities of their choosing and which were meaningful to them. People were supported to play an active role in their local community, which encouraged their independence.

There was a complaints procedure in place, should anyone wish to raise a complaint. There were opportunities for people to raise concerns through meetings and discussions with the staff team. Staff knew how to access advocacy services’ if they needed them.

There was a quality assurance system, which enabled the provider to monitor the quality of the service provided.

We received positive feedback about the registered manager, staff and the service as a whole. Comments from relatives, staff and other professionals indicated there was a positive, person centred culture within the service.

Moor View had recently extended to add an additional unit and new people had moved into the service. Since, August 2015 Moor View has comprised of three care homes located on the site of the Percy Hedley College and School grounds. The service provides care for up to 13 people with physical disabilities, who may also have learning disabilities. One home is an adapted and extended two storey house; one home is a semi-detached house: and the other is a flat, which is located in the school building.

The registered manager has been in post since January 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.

At the time of the inspection 11 people lived in the service and we met nine of the people who used the service. People had limited verbal communication but were able to let us know that they were very happy with the service and found it met their needs.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle. Staff readily identified triggers that would lead people to become distressed or indicate that their health was deteriorating.

Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities.

The staff we spoke with understood the requirements of the Mental Capacity Act 2005 and were ensuring that where appropriate this legislation was used.

Staff shared with us a range of information about how they as a team worked very closely with people to make sure the service enabled each person to reach their potential.

People and the staff we spoke with told us that there were enough staff on duty. We found there were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints. We found that people felt confident that staff would respond and take action to support them.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, and relevant infection control procedures were followed by the staff at the home. We found that action was taken to minimise known risks.

The registered manager had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service.

People had their needs assessed and this information was used to develop personalised care plans. One person we spoke with said, 'It is good living here.' One family member commented that the service was, 'Very friendly and welcoming.'

The provider had developed procedures to ensure people received their medication in a timely manner. Medication was only administered by staff who had completed relevant training.

The provider had systems in place to ensure staff were suitable to work with vulnerable people.

We found systems in place to audit care records were not effective in identifying issues and ensuring appropriate action was taken to address these issues.

People were given information about how to complain. Staff told us people knew how to complain and would let them know if they were unhappy.

people were given appropriate information and were involved in making decisions about their care and treatment.

Comments included:

"I'm happy here."

"Everybody is kind to me."

'The food is good."

"There's plenty to do."

We found staff received professional development and they were well trained to help them understand the care and support needs of the people they worked with. People who used the service told us staff were very kind and caring.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.