Archived: Mornington Hall Care Home

Mornington Hall Care Home is a nursing home providing care to 47 people at the time of the inspection.

The service can support up to 120 people. The home is divided into four communities, two for people with

nursing needs and two for people without. At the time of the inspection a residential and a nursing community were unoccupied and closed. Many of the people living in the home experience dementia.

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

People’s relatives told us there had been lots of changes at the service and care had improved. There was a new registered manager, clinical lead and deputy manager in post since the last inspection who had a strong vision about increasing the quality of care and to make all staff responsible for high standards within the service. Some staff expressed that they did not feel listened to and the provider was working towards ensuring staff would feel heard during this improvement process.

The provider had systems to monitor the quality of the care provided including audits and internal inspections. We made a recommendation that the provider increase oversight during weekends and nights to check consistency of work.

People’s relatives and staff told us staff were stretched and very busy, particularly at weekends, but that staff did come quickly when people needed immediate support.

The provider had implemented a range of new activities led by an engaging team. Relatives told us they would like to see further activities embedded at the service.

Risks people faced were identified, assessed and reviewed. Risk assessments and care plan documentation for people with behaviour that challenged required further improvement such as schizophrenia documentation. Staff had a good understanding of how to mitigate risks people faced, including mobility, pressure sores and diabetes.

Medicines were well-managed. Improvements were needed to meet best practice including the implementation of pain scales and accurate recording of topical creams.

Relatives told us staff were caring and respected people’s dignity and privacy. Staff were safely recruited to ensure they were suitable to work in the caring profession. Relatives told us staff knew how to support their loved ones. Care records captured people’s likes and dislikes and were personalised.

The provider had implemented infection prevention and control measures to respond to the pandemic.

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.

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 inadequate (published 09 October 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

We carried out an unannounced comprehensive inspection of this service on 22 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to all the Key Questions which contain those requirements. 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 inadequate to requires improvement. 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 Mornington Hall Care 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.

Mornington Hall Care Home is a nursing home providing care to 107 people at the time of the inspection. The service can support up to 120 people. The home is divided into four communities, two for people with nursing needs and two for people without. Many of the people living in the home experience dementia.

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

People and relatives told us they thought individual care workers were kind and caring, but were too busy to provide personalised care. People told us there were not enough staff, and those that were on duty were rushed. Records confirmed not enough staff were deployed to meet people’s needs and we saw people’s dignity was not always upheld. We saw interactions between staff and people were not positive.

People were not always confident staff knew how to do their jobs and did not think staff morale was good. Records showed the provider had failed to address our concerns about staff training.

Staff were not confident about the steps to take in response to allegations of abuse. The provider had not identified that complaints submitted constituted allegations of abuse. It was not clear that lessons learned from incidents were shared with the staff team, or actions put in place to reduce the risk of incidents recurring.

People told us staff supported them to take their medicines. Records confirmed this but the provider had not updated care plans to ensure medicines information reflected best practice guidance. Likewise, risk assessments had not been updated and we found cases where people were at risk as staff supported them in a way that did not reflect the advice of healthcare professionals. Staff were not always following the risk assessments that were in place.

People gave us mixed feedback about the food. While some people said it was tasty, others complained about the lack of variety. The chef told us the menu was prepared centrally and people did not get to choose what went on the menu. We observed mealtimes and saw there was not a pleasant dining experience.

People were unable to tell us if they had care plans. While some care plans had been updated, most had not. Those had had been updated were not improved and this meant people were at risk of not receiving personalised care. Activities provision was poor and people had very limited opportunities for engagement. Review records did not demonstrate people were involved in a meaningful way in making decisions about their care. Relatives confirmed they were told about people’s healthcare appointments and records of healthcare professionals advise were maintained. However, their advice was not incorporated into care plans and risk assessments.

People were not always 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. There was no exploration of least restrictive options and records regarding people’s capacity to consent to care were confusing.

People and relatives told us they felt staff morale was low. Staff told us they did not feel supported by the management team. Despite our last inspection, local authority visits and their own audits identifying the issues found during this inspection, the provider had failed to take effective action to address the concerns. People and staff did not feel engaged in the development of 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 and update

The last rating for this service was requires improvement (report published 29 March 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We returned within six months as we had feedback from stakeholders that the provider was not making enough progress.

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding, premises and equipment, staffing and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special measures

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.

Mornington Hall Care Home is a large care home for people living with dementia some of whom also have nursing care needs. It is divided into four communities for 30 people each. Two of the communities are for people with nursing needs, and two are for people living with dementia. At the time of our inspection 108 people were living in the home.

People’s experience of using this service:

People living in the home had varied experiences of care. While some people told us they felt safe and well cared for, others told us they were bored and staff were slow to respond to their requests for support. During the inspection we saw people were not always treated with kindness and compassion.

Risks to people living in the home had not always been mitigated and care plans lacked details about people’s needs and preferences. Information within files was sometimes contradictory and this put people at risk of harm.

Information about people’s ability to made decisions and choices was not clear. It was not clear that staff were following the principles of the Mental Capacity Act 2005.

Staff were deployed according to people’s level of need, and had been recruited in a way that ensured they were suitable to work in a care setting.

The service had identified many of the issues we found with the quality and safety of the service. However, the actions in place to address these issues had not yet been effective.

There were lots of different ways for people to provide feedback about their experiences.

Some areas of the home had been redecorated to make them more suitable for people living with dementia. However, it seemed these resources were being under-used.

Rating at last inspection:

The service was rated Good overall and in each of the key questions when it was last inspected in July 2017.

Why we inspected:

This inspection was brought forward as we received information from local authorities and members of the public that indicated the quality and safety of care at Mornington Hall Care Home may have deteriorated.

Enforcement:

We identified breaches of six regulations. These related to person centred care, dignity and respect, need for consent, safe care and treatment, staffing and good governance.

Please see the end of the report for details of our regulatory response.

Follow up:

We will continue to monitor the service closely and liaise with commissioners to monitor progress. We will return to inspect the service in line with our public commitments.

The service 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 service was safe and had practices in place to protect people from harm. Staff had training in safeguarding and knew what to do if they had any concerns and how to report them. People who used the service told us they felt safe and protected from harm.

Risk assessments were personalised and detailed. Staff had the information they needed to mitigate risks.

Staffing levels were meeting the needs of people who used the service.

Recruitment practices were safe and records confirmed this.

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Newly recruited care staff received an induction and shadowed other members of staff on various shifts. Training for care staff was provided on a regular basis and updated regularly. Staff spoke positively about the training they received.

Care workers demonstrated a good understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was being recorded in people’s care plans.

The service was supporting people who were subject to Deprivation of Liberty Safeguards (DoLS) in an effective way.

People were supported with maintaining a balanced diet and the people who used the service had access to the kitchen without restriction.

There was mixed feedback about the food and some people told us they were unhappy with it. The service was actively engaging with people to obtain their feedback and act on their suggestions for improvement.

People were supported to have access to healthcare services and receive on-going support and records confirmed this. The service made referrals to healthcare professionals when necessary and advice from healthcare professionals was followed.

Staff demonstrated a caring and supportive approach towards people who used the service and we observed positive interactions and rapport between them.

The service promoted the independence of the people who used the service and people felt respected and treated with dignity.

Care plans were reviewed every month and any changes were documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service told us they knew how to make a complaint.

The registered manager had a good relationship with staff and the people who used the service. Staff spoke positively about the registered manager and their management style.

The service had robust quality assurance methods in place and carried out regular audits.

Feedback from people was mixed about how quickly staff attended to their needs. Some people who used the service told us it took a prolonged amount of time for staff to attend to them when they used their call bells. We have made a recommendation about this.