Moors Park House

Moors Park House is a residential care home providing personal care and accommodation to up to 37 people. The service provides support to older people, the majority of whom are living with dementia. At the time of our inspection there were 34 people using the service. Accommodation is provided over two floors in an adapted and extended building. There were spacious communal areas for people to use including a lounge, conservatory, large dining room and library area.

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

Systems and processes were not operated effectively to protect people from the risk of abuse. The registered manager and provider consistently failed to share allegations of abuse and neglect with the local authority safeguarding team and failed to effectively investigate allegations of abuse, or act in line with their own safeguarding policy. Staff told us they did not feel confident safeguarding concerns were appropriately addressed.

Risks were not always safely monitored or managed, for example risks relating to bed rails, falls and eating and drinking. A lack of information and inconsistencies across people’s care plans meant people were at risk of harm. Medicines administrations systems were not well managed, and we identified a significant number of areas for improvement. Systems to ensure staff were recruited safely were not operated effectively and there were not always enough staff to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We found at least 14 people were living at Moors Park House without the capacity to consent to care and treatment. Capacity assessments had not been completed, and Deprivation of Liberty Safeguards applications had not been made. This meant people were being deprived of their liberty without legal authorisation.

Staff had not received sufficient training to meet people’s needs and there was a very low completion rate of core mandatory training including safeguarding and moving and handling. Staff had not completed sufficient training in meeting people’s specific individual needs such as dysphagia, diabetes and catheter care. Staff did not receive regular supervision.

People’s needs and choices were not always assessed. Some people’s care plans contained limited detail about their individual needs and choices, or how care should be provided in their best interest. People’s end of life care plans did not reflect their personal preferences. Some care plan's contained good information to help staff communicate with people, for example by reducing background noise and maintaining good eye contact.

People gave negative feedback about a minority of staff and often received support in line with staff routine and preference, rather than their own choice. Staff routinely used institutionalised language such as “singles” and “doubles” to describe the level of assistance people needed, and some concerns were raised about the way staff spoke with people. People and their relatives were not always involved in their care planning or their health monitoring.

Complaints were not recorded, and no regular reviews took place to ensure improvements were made following receipt of a complaint. Staff told us they had raised concerns, but they had not been addressed.

Quality assurance systems were not effective. Whilst some regular audits were being completed, they did not identify any of the concerns found at this inspection. No care plan audits were being completed. There were also no effective checks at provider level. Notifications were not made to CQC in line with legal requirements and there were no systems in place to ensure continuous learning.

We received mixed feedback about the culture of the service from staff and from people’s relatives. Staff told us they did not feel listened to, and this impacted upon the care people received because concerns were not addressed. Some people’s relatives told us they found communications received from the home hostile at times and concerns were not addressed. Other people’s relatives were more positive. One said, “The manager is very approachable. The culture is open and welcoming.”

Whilst some relatives had raised concerns with CQC, other’s felt confident their relative was safe. One relative said, “It’s comfortable and safe, I’m impressed.” Another relative said, “I think [relative] is safe. The staff are good, the manager is good, I’ve no concerns.” Some people’s care plans contained good information about how staff should use equipment to support them. Some staff were experienced in care and had completed training either some time ago at Moors Park House or in other care settings. This meant some staff did have enough knowledge to ensure people received safe care.

People were supported to eat and drink enough. One person told us, “The food is always good, I enjoy most of it.” Staff supported people to access healthcare services and people’s relatives felt confident staff sought input from other professionals in a timely way. One said, “I think staff would act on health needs promptly.”

Most people gave positive feedback about staff. One person told us, “The staff are all respectful”. Another person told us, “It’s pleasant here, the staff are all pleasant too.” We saw and heard kind, caring and supportive interactions between staff and people. People were supported to be active and to maintain relationships. On the second day of inspection, we saw an exercise session taking place in the lounge. We observed people were engaged with the activity and enjoyed taking part.

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 (15 March 2019)

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding people, the quality of care, communication, and the management of the service. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

The provider told us they were committed to addressing the concerns identified during this inspection. Prior to the end of this inspection, they had booked safeguarding and Mental Capacity Act training, and were taking action to update their policies and procedures.

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

Enforcement

We have identified breaches in relation to safeguarding people, safe care and treatment, person-centred care, consent, receiving and acting on complaints, staffing, fit and proper persons employed and good governance at this inspection. We issued 7 Warning Notices.

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 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Moors Park House provides personal care and accommodation for up to 37 older people who may also be living with dementia. Nursing care is not provided by the service. This service is provided by community nurses working for the National Health Service. At the time of this inspection, 33 people were living at the home. The provider company Crocus Care group has three services, with the provider living locally.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

There was a registered manager in post. 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 manager was on holiday but came to the inspection to support staff. They were very knowledgable about people and their needs and were clearly passionate about the work they do.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised electronic care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people's needs and any changes in the support they required.

People had access to a wide range of group and individual activities, and events they could choose to participate in, which were tailored to meet their specific social needs and interests. This enabled people to live an active and fulfilling life.

People who preferred or needed to stay in their bedroom were protected from social isolation. People regularly participated in outings and activities in the local community. The service also had strong links with local community groups and institutions.

When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded.

Staff were aware of people's communication methods. They provided them with any support they required to communicate to ensure their wishes were identified, enabling them to make informed decisions and choices about the care and support they received.

The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the managers.

People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. The registered manager took time to ensure they employed staff who were able to promote the Crocus Care ethos of ‘Caring for life with dignity’. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.

People's medicines were managed safely and the provider ensured that incidents and accidents were fully investigated. The home was well kept and hygienic. There was ongoing investment in the older style building. The home was dementia friendly and met the needs of the people living there. Staff demonstrated they knew people well, and people and their relatives were all positive about the care provided.

Staff were well supported through training, supervision and appraisal. They worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them.

People enjoyed the meals available to them and were appropriately supported with eating and drinking. People were 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 supported this practice.

People were treated with privacy and dignity and supported to be as independent as possible, whilst any differences or cultural needs were respected.

The service had a robust management structure in place, and quality assurance systems were effective in driving improvements across the home. Regular feedback was sought from people and their relatives to ensure they were involved in the development of the service.

Further information is in the detailed findings below.

The service was last inspected on 2 and 3 December 2014 when it was rated as ‘Requires Improvement’ overall. We found; there were not sufficient staff to meet the needs of people living at the service; staff said they did not receive sufficient training to support people; some people did not receive the support they needed at mealtimes; records did not provide staff with information about people’s changing healthcare needs; people’s needs and preferences about the support they received were not sufficiently understood by staff; people’s needs were not sufficiently understood by staff and quality assurance systems were not always effective. At this inspection in July 2016 we checked to see that improvements had been made and found that they had.

Prior to this inspection we had received some concerns about the quality of care provided to people. We had asked the provider to look into these matters and they provided us with a full response following a thorough investigation. At this inspection in July 2016 we also looked into the issues that had been raised. We found no evidence to support the concerns.

A registered manager was employed by the service. 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’s needs were met by ensuring there were sufficient staff on duty. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

Not everyone living at Moors Park House was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. Each time staff entered the lounge they spoke to people and tried to engage them in conversation.

People’s needs were met by kind and caring staff. One visitor told us that in the two years their relative had been at the service things had been “Absolutely brilliant, the care is excellent”. People’s privacy and dignity was respected and all personal care was provided in private.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals.

People and their relatives were supported to be involved in planning and reviewing their care. At each review of the care plan people were spoken with and asked for their views. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

The environment had been improved to make it more suitable for people living with dementia. Each person’s bedroom door was personalised with their name and a picture of an object that meant something to them. All corridors had been named using street signs. The registered manager said this helped people find their way around the service more easily.

There were regular activities available for people to participate in. These included singing, word games, crafts and gentle exercises as well as outside entertainers. A monthly newsletter was produced to tell people the activities on offer for the month and who would be celebrating a birthday. We saw people enjoying a ‘knitting and natter’ session and others taking part in a quiz.

The registered manager was very open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager. One told us “You can go to [registered manager] and she will put it right straight away”. Another said “[registered manager] is approachable, down to earth and you can discuss anything with her”. One social care professional told us that over the past year there had been an improvement in the way the service was managed.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. Monthly audits were undertaken including medicines, care plans and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. Records were well maintained.

Prior to our visit in February 2014 we received anonymous concerns about the care people received at the home. These concerns included, the way people were supervised in the lounge areas, that people were left in wheelchairs for long periods of time, that personal care routines were not followed particularly at night and that care workers did not ensure people drank fluids that were given to them. At our visit in February 2014 we found no evidence to support these concerns.

As part of our inspection in February 2014 we used our SOFI (Short Observational Framework for Inspection) tool to help us see people's experiences in the lounge area. We found that people were well supervised in the lounge areas.

We saw care plans were individualised and set out how care workers were to meet specific needs. Where possible, consent had been sought in relation to care and treatment provided and people's representatives had been involved in the care planning process.

There were 26 people living at Moors Park at the time of our inspection. We spoke with eight people who lived at the home, one visitor, four care workers,a senior care worker, the manager and their deputy.

People who lived at the home told us they were well looked after and were happy. One person said "I can't fault it, I can come and go as I please and all the staff are stars.'

People told us that they felt safe and knew what to do if they had concerns. One person said "If I was unhappy about anything I would speak to staff or the manager.' A visitor told us they would feel comfortable making a complaint if they needed to.

Care and treatment was delivered in a way that was intended to ensure people's safety and welfare. However, there was no evidence to confirm that people were asked for their consent or how the provider acted in accordance with their wishes before they received any care or treatment.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by suitably qualified, skilled and experienced staff.There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

There was an effective complaints system available.

People living at the home we spoke with told us they were looked after well. One said 'They are very good, I like it here.'

Many people who lived at this home had dementia. Staff had a good understanding of how to meet each person's individual and diverse physical and mental health needs.

We saw clear evidence of the involvement of external healthcare and community support services. We saw that people had opportunities to participate in some activities of their choosing. We saw that people were consulted about what they wanted to do, and about how they wanted their care to be delivered.

We saw that people were relaxed in the company of staff. They were kept safe from abuse because staff knew how to recognise abuse and how to report this. Staff training, supervision and annual appraisals were linked to ensure that staff had the skills to meet people's needs.

The home was clean and well maintained.

Records were up to date and securely stored.