Moss Cottage Nursing Home

Moss Cottage is a care home providing personal and nursing care to 30 older adults and people with physical disabilities at the time of the inspection. The service can support up to 34 people. The home has communal areas, including lounge and dining area and communal bathrooms. There are individual bedrooms across two floors, some of which have en-suite facilities.

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

People were being supported to take their medicines and there were detailed records and secure storage of people’s medicines. The home was clean and tidy and the current guidance to manage the risks associated with Covid-19 were being followed. People felt safe, individual and environmental risks were assessed, action taken to reduce risks as much as possible, and learn lessons when things went wrong. Suitable recruitment processes were being followed to ensure there were enough staff to meet people’s needs, although some people did comment that they would like more activities to do.

People enjoyed their food and staff knew how to meet the needs of people who required a specific type of diet. People’s needs were being assessed and staff worked closely with other healthcare professions to meet these needs. Staff felt suitably trained and well supported in their roles.

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.

People were supported by a stable team of staff, and a registered manager who was committed to improving the service. The registered manager completed a variety of checks to enable any risks or shortfalls to be quickly addressed and understood the requirements of their roles. People felt able to raise concerns and feedback their views, and feedback was taken onboard.

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 2020) and there were two 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 between 03/03/2020 and 20/03/2020. Breaches of legal requirements were found.

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, Effective 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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 Moss Cottage Nursing Home 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.

Moss Cottage is a care home providing personal and nursing care to 23 older adults and people with physical disabilities at the time of the inspection. The service can support up to 34 people. The home has communal areas including lounge and dining area and communal bathrooms. There are individual bedrooms across two floors, some of which have en-suite facilities.

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

The service was not always safe. We found that medicines were not always securely stored, and information was not always accurately recorded within people’s records. Checks of the environment did not always ensure that concerns were quickly addressed. The service was clean and tidy, but good infection control processes were not always being followed. We received mixed feedback about whether there were enough staff and have made recommendations about staffing and use of agency staff.

Kitchens staff understood people’s dietary requirements and how these were to be met. However, other records, such as care plans and handover records, did not always contain the right information. There was a programme of redecoration and we have made recommendations about the decor of the premises and meal time experiences. People told us the food was generally good. A programme of ongoing training, checks of competency and supervision was in place and staff told us they felt equipped for their role. People were supported to access healthcare services. 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.

People told us that staff were generally kind and caring and we observed positive interactions between people and staff during the majority of the inspection. We noted some issues with how staff considered people’s dignity but were reassured by people, relatives and staff that this was not the normal behaviour of staff. Staff appeared to know people well.

An electronic system for care plans had recently been implemented. Care records contained enough details to ensure staff knew how to meet people’s needs, but this information was not always accurately reflected in other records used by staff. Improvements to make care plans more detailed and person centred were needed. An activity coordinator was in place, offering a range of activities, but some people stated they would like more stimulation. Processes were in place to support people with end of life care and staff worked with healthcare professionals when supporting people at end of life.

Systems for auditing and checking the quality of the service were not always effective in identifying issues and ensuring effective action was taken in response to concerns identified. There were a range of meetings held for people, relatives and staff where information was shared, and views and ideas were sought. The management team had an action plan in place to drive improvement and was working closely with local stakeholders who told us they could see that things had improved within the service.

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 22 June 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of people with swallowing difficulties who require a modified diet. This inspection examined those risks

The inspection was also prompted in part due to concerns received about allegations of abuse and poor moving and handling practice. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment as medicines were not always being safely managed and robust infection control processes were not always being followed in the laundry during this inspection. We also identified breaches of good governance as the provider failed to have systems to ensure lessons were learnt and systems for checks and audits were robust enough to identify and action the areas for improvement.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Moss Cottage Nursing home is a care home. It is registered to provide accommodation and personal and nursing care for up to 34 people. At the time of the inspection 28 people were living at Moss Cottage.

People’s experience of using this service:

The registered manager and deputy manager were new to post. They had identified a number of areas for improvement within the home and had quickly taken action to begin to address these. We saw significant progress had been made with the action plan but some work in relation to infection control and the management of people’s medicines was ongoing. There was no evidence that people had not had their care needs met as a consequence. The service has been rated as Requires Improvement in the well-led domain as we need to see evidence that improvements and oversight is maintained following changes in the management team.

The service had a programme to update the décor and had started by improve the lighting within the communal areas. The registered manager was aware of good practice in relation to infection control and supporting people with dementia and intended to incorporate this into the programme of redecorating.

Staff were fully trained and felt well supported to do their job. They told us they enjoyed their work and we saw that they worked well together as a team.

We saw staff were kind and caring. People and relatives spoke highly of the caring nature of the staff team.

Care records were up to date and included the details necessary to guide staff on how best to support people. Information about people’s life history was included and staff knew people’s preferences and care needs well.

The registered manager had introduced a number of opportunities to gain feedback from people. This included a suggestion box, compliment book, dignity tree and carer of the month award. Surveys were sent to people, relatives and professionals annually and the most recent feedback was in the process of being analysed to drive improvement.

People felt the service was well organised and felt able to raise concerns with the registered manager. The registered manager told us they operated an open-door policy and welcomed feedback.

People told us they had plenty to eat and drink. We saw snacks and drinks were offered throughout the day. Clear information about people’s dietary needs was readily available to staff, and people with modified diets, such as those with swallowing difficulties, had their needs met.

People’s health care needs were being met and the service would make referrals to other agencies and seek advice and support as required.

Rating at last inspection:

At the last inspection the service was rated Good (30 November 2016).

Why we inspected:

This was a planned inspection based up the rating of the service at the last inspection.

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for services of this rating.

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

We previously inspected Moss Cottage Nursing Home on 29 August 2013, at which time the service was compliant with all regulatory standards inspected.

Moss Cottage Nursing Home is a nursing home in Ashton Under Lyne, providing accommodation, personal care and nursing care for up to 34 older people with physical disabilities and dementia. There were 32 people using the service at the time of our inspection.

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 directors, 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 service excelled in caring for people at the end of their lives in a sensitive, dignified and inclusive fashion. Staff valued the relationships they made with people who used the service, demonstrating this through their dedication to meeting people’s needs and respecting people’s preferences up to, including and after death.

Person-centred care plans were in place and staff had ensured information about each person was readily accessible. We saw regular reviews took place with the involvement of people and their family members and found the care delivered was done so in an inclusive way that focussed on each person’s needs and preferences.

The atmosphere at the home was relaxed, welcoming, respectful and calm. People who used the service, relatives and external stakeholders were consistent in their praise of staff who behaved extremely patiently and in a dedicated manner. We observed staff interacting with people in this way and gathered a range of superlative feedback regarding the caring attitudes of all levels of staff. The notion of treating people who used the service as staff would their own relatives was well evidenced through our observations and conversations and was indicative of an extremely caring service.

There were sufficient numbers of staff on duty in order to safely meet the needs of people who used the service, with the registered manager regularly assessing people’s dependency and ensuring their needs could be met.

All areas of the building were clean and well maintained, including external areas.

Staff were trained in safeguarding and demonstrated a good knowledge of safeguarding principles and what they would do should they have any concerns, whilst people who used the service confirmed they felt safe.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service (DBS) checks, references and identity checks.

The storage, administration and disposal of medicines was safe, in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE) and supported by clear lines of accountability.

Risk assessments identified individual needs and staff displayed a good knowledge of the risks people faced and how to reduce these risks.

People received the treatment they needed from onsite nursing staff or prompt and regular liaison with GPs, nurses and specialists.

Mandatory staff training was regularly updated to ensure staff had a good working knowledge of people’s needs, whilst an effective training matrix ensured staff refreshed their knowledge regularly. Staff had received training in Fire training, Pressure Sores, Moving and Handling, Deprivation of Liberty Safeguards/Mental Capacity Act, Continence Care, Equality and Diversity, Infection Control, Control of Substances Hazardous to Health (COSHH), Health and Safety, Dementia Care, and Safeguarding.

Staff received regular supervision and appraisal processes as well as regular team meetings.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We checked whether the service was working within the principles of the MCA. Staff displayed a good understanding of capacity and consent and we found the provider had followed the requirements in the DoLS.

Group activities took place regularly, such as in-house entertainment. Likewise, one-to-one time was offered to people by the activities co-ordinator. There was an opportunity to improve the way activities were planned and documented, which the registered manager and clinical manager agreed to pursue. Relatives and people who were able to communicate their preferences confirmed they enjoyed the group activities.

People who used the service, relatives and external professionals we spoke with were complimentary about the registered manager and the team as a whole. We found morale to be high and a strong team ethic in place, with a culture consistently focussed on ensuring people received a high quality of dignified care in place they considered home.

People told us that they liked living in the home. One person told us "if I need anything I only have to ask, .' Another person said " the staff are great" and they liked living there.

We saw that records were well-organised and detailed individual needs. We saw evidence that the provider regularly audited and monitored the service provided.