Archived: Moorleigh Nursing Home

We last inspected Moorleigh Nursing Home in July 2016 when the home was rated 'Requires Improvement' overall. We identified four breaches of regulations. We found medication systems were not robust to ensure safety, known risks identified in the property were not mitigated to prevent harm to people and risk assessments did not cover all known risks and where they were completed guidance from assessment was not always followed. As a result we served a warning notice for Regulation 12 (Safe care and treatment). We also found assessments of people's capacity and records of decisions made in people's best interests were not completed where required. This was a breach of Regulation 11 (Need for consent). Quality assurance systems were not robust enough to ensure quality and safety. This was a breach of Regulation 17 (Good governance). We also saw that staff training was not up to date. Clinical training and competencies for nursing staff were not in place for all areas of clinical practice. This was a breach of Regulation 18 (Staffing).

Following our July 2016 inspection, the registered provider sent us an action plan detailing the changes and improvements they intended to make to improve the quality of service provided to people living at the home. We took this into account when planning this inspection to make sure we checked these actions had been completed. At this inspection, we found the provider had made all the required improvements and addressed all the concerns that had been highlighted last time we visited the home.

Moorleigh Nursing Home is a large property which consists of a Victorian main building with modern extensions. People have access to extensive gardens which are accessible to people with mobility difficulties. The service provides accommodation care and support for up to 36 older people who require personal care and nursing. The service is close to all local amenities.

There was a registered manager in place. 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.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager.

People's needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people's changing support needs.

There were policies and procedures in place to assist staff on how to keep people safe. There were sufficient numbers of staff on duty to meet people's needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with suitable amounts of food and drink and were happy with the meals they received. People's nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to any comments made.

Moorleigh Nursing Home is a large property which consists of a Victorian main building with modern extensions. People have access to extensive gardens which are accessible to people with mobility difficulties. The service provides care and support for up to 36 older people and is accommodation for people who require personal care and nursing. The service is close to all local amenities.

The home had a registered manager in place. 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.

The registered provider had not completed works to the property where risks to people and the property had been identified during safety checks carried out by appropriate specialists. The provider told us this work would be completed following the inspection. We saw not all known risks had systems in place to check for safety. For example, no checks were completed to check bed rails were safe to use.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. The documents did not always reflect accurately the risks to people, either because staff had incorrectly completed the document or records within the care plan had conflicting information.

Systems were in place for the management of medicines. The service did not record robustly the information needed to ensure people received ‘as and when required’ medicines and creams and lotions as prescribed. Medication discrepancies or errors were not fully investigated.

Staff understood the practicalities of using the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards to provide support for people in the least restrictive way. However, they did not formally assess people’s capacity or record best interest decisions made for people who lacked capacity.

Staff training was not up to date and this meant staff may not have the skills and knowledge to provide support to the people they cared for. We saw most staff had received supervision on a regular basis however; staff had not received an annual appraisal.

There were systems in place to monitor and improve the quality of the service provided. We saw the range of checks carried out both by the registered manager and registered provider did not cover all known risks or analyse robustly the patterns trends and root cause of issues identified. Actions identified were not always completed.

The registered provider had a system in place for responding to people’s concerns and complaints. People said they knew how to raise concerns. A system to capture day to day concerns raised was not in place.

People told us there were enough staff on duty to meet people’s needs. A tool was not in place to use information about people’s dependency to understand safe staffing levels. We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

We saw people’s care plans were person centred and written in a way to describe their care needs. We saw evidence to demonstrate people and their families were involved in all aspects of their care plans. At times information held in the care plan did not match information reflected in risk assessment records.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there was a good and varied range of activities which people told us they enjoyed. People told us they would like outings into the community as this did not happen.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found:

Is the service caring?

This was a follow up inspection concerning previous regulatory breaches against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a follow up inspection concerning previous regulatory breaches against the regulations and we did not look specifically at this area.

Is the service safe?

There were systems in place to ensure safety checks on fire, electrical and gas systems were undertaken on a regular basis.

Is the service effective?

This was a follow up inspection concerning previous regulatory breaches against the regulations and we did not look specifically at this area.

Is the service well led?

The Registered Manager and provider had put in place a range of systems to check the care provided at the home and the environment. We saw a range of audits were undertaken and that there were regular meetings with staff and people who used the service to ensure they had opportunities to raise concerns or express views.

Staff and people who used the service said they thought the home was well managed and that they had confidence in the Registered Manager and Provider.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

People were treated with respect and dignity by staff. One person said, 'I have no grumbles here, everyone is so nice, we are treated very well.'

Care plans and risk assessments were detailed and person centred and provided staff with clear guidance on how to meet people's health and social needs.

Staff were kind and supportive to people.

Overall, the service was clean and hygienic with systems in place to ensure people were not put at risk from infection.

Is the service effective?

Health care needs were assessed and people who used the service or their relatives were involved in developing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans when needed.

Staff described how they met and monitored people's health needs. Care records showed people had regular contact with health and other professionals.

Is the service caring?

People who used the service were asked about their care and able to make decisions. They were supported by kind and attentive staff.

People who used the service told us they were happy with the care and support received. They said the standards of care provided were high. Their comments included: 'I do like it here, all very nice, staff are lovely' and 'I have everything I need here, no grumbles at all.'

We saw care practices were good. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and it was clear that staff were well aware of the needs and wishes of the people who used the service.

Is the service responsive?

People who used the service told us they knew how to complain or raise concerns if they had any.

We saw people who used the service were responded to promptly when they asked for any support or assistance

People were supported to be involved in a good selection of activity of their choice within the home.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager and Provider were approachable. They said they had confidence that any issues brought to their attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

The Provider had systems in place to assess the quality and safety of the service provided, however, these were not always evaluated fully to ensure they were effective.

Relatives told us people's care needs were met. One relative said the home had provided 'good care' which had resulted in a weight gain and the healing of a long standing wound.

Some choices, such as times for getting up and going to bed were limited and care was not always centred on people who received a service. One person who used the service talked about routines and told us they were assisted to bed too early. They said, 'After tea about 6 o'clock we go to bed. I would like to stay up and watch the soaps.'

People were comfortable in their environment and could choose to spend time in communal areas or time in their room. Everyone was protected against the risks of unsafe premises.

We spoke with nine members of staff. They said people who used the service were supported by suitably skilled and experienced staff.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.