Moundsley House

Moundsley House is a residential care home providing personal and nursing care to up to 60 people. The service provides support to adults living with dementia. At the time of our inspection there were 47 people using the service. Moundsley House is part of a purpose-built care village which currently has two other homes open and two which are dormant on the site.

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

People’s risk and needs were assessed and managed well by staff. Issues with the environment in some areas were resolved promptly and there had been no impact on the safety of people from this.

The registered managers had oversight of the home and had quality assurance systems in place however development of these would give greater oversight and support to the managers in identifying some of the issues CQC found relating to the environment.

Care plans were in place and reviewed regularly but would benefit from being more detailed to support new and agency staff to have a better understanding of the care they needed to provide.

Medicines and IPC were managed well. Staff received training and support to ensure medicines were managed safely.

Staff sought people’s consent before providing support. 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.

Staff, people and relatives were positive about the registered manager and the support they provided.

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 06 November 2020).

Why we inspected

We received concerns in relation to staffing levels, staff training and medicines management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

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

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. This included checking the provider was meeting COVID-19 vaccination requirements

Follow up

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

We found the following examples of good practice.

Moundsley Hall ensured current guidance in relation to COVID-19 and the use of infection prevention and control were being followed. The registered managers ensured staff had access to and were supported to understand and follow the latest guidance.

The registered managers both had good oversight of people’s and staff vaccination status, isolation periods and COVID-19 test results.

Moundsley House managed risk in relation to infection well. Where people were unable to social distance or self isolate plans and additional cleaning was in place to manage this. Staff had good access to personal protective equipment such as masks and aprons which were accessible in all areas of the home.

The provider had contingency plans in place for if there was an outbreak of COVID-19 and the home and staff had plans in place to reduce the risk of cross contamination.

Moundsley House is a nursing home providing personal and nursing care for older and younger adults who may have a physical disability and/or dementia.

Moundsley House is part of a purpose-built care village development. Moundsley House accommodates 65 people across three floors. There were 52 people living at home on the day of the inspection.

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

People told us they felt safe and supported by the staff who worked in the home. One person said, “I am happy here.” Staff recognised different types of abuse and how to report it. The registered manager understood their safeguarding responsibilities and how to protect people from abuse. Potential risks to people's health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care. There were sufficient staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

All people, relatives and staff felt the registered managers were approachable and had made positive improvements to the home and the way the service was run. The registered manager listened to people and staff's views about the way the service was run. The registered manager had put checks into place to monitor the quality of the service provision. However, the provider had not undertaken any of their own audits and checks due to the pandemic. There was an acknowledgement that better communication was required with external agencies about planned changes of people’s place of residence, however, we found this had not had a negative impact on people who lived in the home.

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 01 May 2019) and there were multiple 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

The inspection was prompted in part due to concerns received about safeguarding matters and lack of transparency with external agencies regarding planned changes to move people to different homes within the village. The service also had breaches of regulation from the last inspection and we needed to check they had followed their action plan to confirm they now met legal requirement. As a result, a decision was made for us to inspect and examine those risks, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement 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 Moundsley House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: Evidence was not fully available at the time of the inspection of all the premises checks and tests which had been carried out. New checks and tests on the electrical installations, gas and legionella were carried out following our inspection. Signage around the home was not always clear for those living with a dementia related condition. We have made a recommendation about this.

People and relatives spoke positively about the caring nature of staff. One relative told us, “I would describe this as a home from home, I feel like this is my second family now.” We observed positive interactions between people and staff.

Electronic care plans were not always accurate and some were more detailed than others. There was an activities programme in place. Several relatives told us that more activities would be appreciated. Musical entertainment and exercise were carried out on the days of our inspection.

Audits and checks were carried out to monitor the quality of the service. These were not always effective at ensuring that shortfalls were identified and timely action taken.

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

Rating at last inspection: Good (previous report 23 June 2016)

Why we inspected: This was a planned inspection in line with Care Quality Commission scheduling guidelines for adult social care services.

Action we told provider to take: You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit. If any concerning information is received we may inspect sooner.

Moundsley House is registered to provide accommodation for personal and nursing care for adults who may have a dementia related illness for a maximum of 65 people. There were 47 people living at home on the day of the inspection. The home is arranged over two units with communal living and dining areas in both units.

There was a registered manager in place who covered all five homes at this site. 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. Each home had a unit manager who reported to the registered manager.

People told us they felt safe and staff were available to support them. People were helped by staff to reduce the potential risk of harm and free from the risk of abuse. Medicines were given to people as prescribed or as they needed them. People felt they had staff that were always around and they did not have to wait for assistance. Staff at the home agreed they were able to look after people and meet their needs, without delay.

Assessments of people’s capacity to consent and records of decisions had not always been completed. The provider could not show where people had not been able to give their consent to care and treatment or that the relevant people had been consulted. People told us they liked the staff and felt they knew how to look after them. Staff also ensured they listened and responded to people’s day to day choices about their care and support.

Staff were provided with training that they told us helped them understand and know how to provide care. All staff were supported by the unit manager and provider and staff told us they were able to speak to them about advice and guidance when needed.

People enjoyed the choice of meals and had been supported where further assistance or particular diets were needed. People had accessed other health and social care professionals when needed to support their health. People were helped to contact and arrange appointments with services which were not available within the home. They had regular visits from one local GP surgery when needed.

Staff knew the care needs of people who felt involved in their care and treatment. Staff were clear about the levels and expected care needs of people at the home. People’s privacy and dignity were respected and staff were kind to them. People had been involved in the planning of their care and relatives were involved in supporting their family members care.

People were able to spend time doing the things they enjoyed and spent their time in an environment they liked. People and relatives both felt that staff were approachable and listen to their requests. Staff also felt confident to raise any concerns of behalf of people.

The care and nursing staff spent time with people and staff and people were positive about them. The registered manager and provider had kept their knowledge current, which had been shared across the five homes unit managers. The provider and manager had made regular checks to monitor the quality of the care that people received and look at where improvements may be needed.