Moorhead Rest Home

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to the area this home was located were commonly known as 'Tier Four Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

We noted good practices in all of the areas we considered including the use of and disposal of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.

Processes when visitors entered the home were reasonably robust. Most visitors had to answer a short health and safety questionnaire but this was not raised with visiting health care professionals. This was corrected at inspection and will help to prevent people bringing infection into the home.

There were comprehensive measures to prevent any infections spreading within the home. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Where appropriate, and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in 'Tier Four Rules' , these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

We noted the provider and registered manager had developed a visiting area in a suitable location within the home. This incorporated shielding and isolation processes to ensure visitors and residents were protected. Importantly, visitors did not have to enter the home to use the facility. The registered manager said staff were in the process of preparing to use this facility as the guidance and rules had recently been relaxed.

Visiting rules and process were communicated effectively to people using the service and their relatives. People were also supported in contacting their friends and relatives by the use of social media and video messaging services. This assisted in promoting people's mental wellbeing.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home.

The registered manager insisted people were tested before admission and consistent with guidance, new residents were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

Staff had comprehensive knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

We noted an area of the home could be segregated in the event of widespread infection so as to assist with appropriate isolation of people. The registered manager said separate staff members could be used to help in this situation.

The home was clean and hygienic. The service had designated cleaners who were working during the inspection. The registered manager said that they had doubled the amount of cleaning as a result of the pandemic and all areas were 'deep cleaned' at least every month. This should help prevent any infection spreading in the home.

All staff had received Covid-19 related supervision and the registered manager was proactive around ensuring staff and management had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Moorhead Rest Home is a care home providing personal care and accommodation for 27 Older people. It is an extended and adapted detached three storey house with accessible gardens. At the time if the inspection, 26 people were using the service.

At our last inspection we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People using the service told us they felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people's safety, and balanced these against people's rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Effective infection control measures were in place to protect people.

Any accidents/incidents or errors had been used as a learning opportunity.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

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

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that they received additional healthcare to meet their needs.

Policies had recently been amended to ensure staff gained consent before supporting people.

The building had been adapted to meet the needs of the people who lived there. A passenger lift and a stair lift ensured people had access to all parts of the home.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People's privacy and dignity was maintained at all times. Care plans were written in a person centred way and were responsive to people's needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. There had been no recent complaints.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

The service was last inspected in September 2013 and was found compliant in all areas inspected.

At the time of this inspection there was a registered manager employed. 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.

Throughout this inspection we received positive feedback from people who used the service, visitors and community professionals. People expressed satisfaction with the service provided and spoke very highly of the staff that supported them. Comments included, “I would put my name down for here” and “It’s absolutely wonderful here”.

We saw the service had robust processes and procedures in place to maintain a safe environment for people using the service, staff and visitors. Detailed and up to date health and safety checks were in place covering areas such as hazardous substances, external and internal equipment and the kitchen environment. Audits on equipment and furnishings were done on a monthly basis. We saw the service had a robust fire procedure and each person living at the service had a personal evacuation plan.

People told us they felt safe living at the home. They referred to the home as a safe place. Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training.

At the time of inspection we found the service had adequate staffing levels and noted very little staff sickness. People told us their needs were met promptly and efficiently. Staff told us they did not feel rushed with their daily routine and this enabled them to spend time conversing with people. We observed regular staff interaction to support this.

We found an overall good recruitment system in place and a thorough induction process for all new staff.

Processes were in place for the appropriate administration of medication. Staff were adequately trained in medication administration. We noted the service had a ‘homely remedy’ policy and we saw assessments in each person’s file to support the policy.

We saw the service had created detailed individual risk assessments for all people using the service. These risk assessments included diet and nutrition, pressure relief and mobility.

We saw detailed care plans, which gave clear information about the people’s needs, wishes, feelings and health conditions. These were reviewed monthly and more often when needed by the registered manager.

We saw evidence of detailed training programmes for staff. We noted some staff had “care certificate” training. All carers had a Level 2 or above NVQ (National Vocational Qualification) or were working towards a Diploma in Health and Social Care. All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. The manager also demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who uses the service in their best interests. At the time of inspection we found that no person using the service was subject to DoLS.

We saw that people’s nutritional requirements were being met and choice was offered at every meal time. We saw the food was freshly prepared and served at a suitable temperature. Dining tables were well presented and adapted cutlery was provided to some people to promote independence. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

We saw positive staff interaction and engagement with people used the service. Staff addressed people in a respectful and caring manner. The service had calm and warm atmosphere. We observed people laughing and conversing.

We had positive feedback from people using the service, relatives and staff about the registered manager. People told us they were happy to approach management with any concerns or questions. We saw evidence that an open door policy was followed.

People told us that the staff were excellent and that they received care and support when they wanted it. One person said, "The staff are great, we get the best care here. They are all lovely.' Another person told us, 'I wouldn't want to be anywhere else. I am glad I am here.'

We also spoke with a small number of relatives. They said the staff were caring and supportive. One relative told us, 'The staff are superb. I would recommend here to anyone.' Another relative told us, 'The staff are fantastic. They have made all the difference to Mum.'

People told us that the meals were very good at Moorhead rest home. Staff were knowledgeable about the foods and drinks people liked and disliked. Mealtimes were relaxed and unhurried.

Systems were in place for monitoring the quality of the service people received. People living in the home and relatives told us that they were well supported by the manager and staff team. Equipment was serviced regularly to make sure that it was safe for people to use.

People told us there were opportunities for involvement in suitable activities either for small groups of people or on a one to one basis. One person said, "There is plenty going on in the afternoon; it makes the day more interesting".

During our visit we found all areas of the home to be bright, clean, safe and comfortable. The home was furnished to a high standard and one person said, "It's like a hotel". People were happy with their rooms and had brought in personal items to make them more homely.

People were very happy about the staff team. Comments from people living in the home included, "Staff are lovely; nothing is too much trouble" and "Staff are very kind and friendly".