Moorlands Care Home

Moorlands Care Home accommodates up to 40 people in one adapted building. At the time of the inspection there were 26 older people, some people were living with dementia or had nursing needs.

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

People, relatives and staff told us there was not enough staff to complete tasks and have quality time with people. Opportunities for continuous learning and improvement had not always been implemented.

Risks were assessed and managed to ensure people were kept safe. Medicines were administered in a safe way. The service learned lessons when things went wrong. There was a named infection control lead and the service was following infection control guidelines.

The registered manager was passionate about the service and wanted to achieve good outcomes for people.

Care plans reflected people’s current needs and it was clear how people were involved in reviewing these. Policies and procedures were in place to help ensure the quality and safety of the service provided. Working in partnership with others had been effective.

The provider understood and demonstrated a duty of candour in their approach to complaints management. Checks on equipment and premises were in place.

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 requires improvement (published 28 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations

Why we inspected

We undertook this focused inspection to check whether the provider had followed their action plan and to confirm they now met legal requirements regarding Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities).

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led 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 not changed. This is based on the findings at this inspection.

Follow up

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

Moorlands Care Home, is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Moorlands Care Home accommodates up to 40 people in one adapted building. At the time of the inspection there were 27 older people, some people were living with dementia or had nursing needs.

People’s experience of using this service:

There were insufficient staff to meet people’s needs. Staff had not undertaken sufficient or appropriate training to enable them to meet the needs of people living with dementia and those who had behaviour that challenges. This meant there was potential for people’s safety, health and welfare to be at risk. Staff underwent a robust recruitment process. People were kept safe by staff who understood how to safeguard people from abuse and the actions they needed to take to protect people from the risk of harm. People’s medicines were managed safely.

People’s views about how they were treated, and the approachability and availability of staff was linked to staffing levels. People told us they sometimes felt rushed and that staff didn’t have time to sit and speak with them. People and family members stated staff were kind and caring and we saw examples of positive interactions between people and staff. People told us they were consulted about their care and that they were encouraged to make decisions. The service had received many thank you cards praising staff for the quality of care provided.

Staff had requested additional training in specific topics and had asked for a different method and style of training to be provided. People were supported to have sufficient amounts to eat and drink and were provided with the appropriate specialist diet where required. Staff supported people to maintain their health and well-being, which included liaising and working with a range of health care professionals, which had positive outcomes for people. 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.

There were opportunities for family members to be involved in their relative’s care, which included end of life care. Activities were provided, however not everyone chose to join in and some people said there were limited opportunities to go outside. Accessibility of information and communication styles were considered to support people in understanding key information. People were confident to speak with staff about any issues of concern to them.

The registered manager had requested additional resources to provide classroom-based training and training in key areas to drive improvement. The provider had systems in place to monitor the quality of the service with audits were undertaken on a range of topics. Information agreed to be forwarded to the Care Quality Commission following the site visit was not received. People, family members and staff were given the opportunity to comment upon the service. The registered manager and staff liaised and worked with partner agencies to support people in the best way possible.

Rating at last inspection:

Good. The last report for Moorlands Care Home was published on 5 October 2016.

Why we inspected:

This was a planned comprehensive inspection.

Enforcement:

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to staffing. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services

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

Moorlands Care Home provides accommodation and nursing for up to 40 people who have nursing or dementia care needs. There were 34 people living in the home at the time of our inspection.

On the day of our inspection there was not 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.

People felt safe and trusted the staff who cared for them. Staff knew how to keep people safe from harm. People had access to information on how to keep them safe. Individual risks were identified and managed. Risks to people’s health and welfare were assessed and action was taken to minimise any risk. Sufficient staff were on duty at the time of our visit. Safe recruitment had taken place to ensure staff were suitable to care for people. People received their medicine in a safe and timely manner and as prescribed.

People needs were met by skilled and knowledgeable staff. Staff had opportunities to improve and develop their skills and knowledge. People were involved in decisions about their care and welfare. Staff had received training about the Mental capacity Act (MCA) and the MCA was adhered to. People received sufficient to eat and drink. Where supported appropriately to receive a balanced diet. People were supported and had access to other healthcare professionals to ensure they maintained their health and wellbeing.

People were encouraged to form and develop caring relationships, but people felt staff needed to spend a little more time with them. People were supported to express their views and were actively involved with decisions about their care and support. People were involved with their care planning and had access to advocacy services if needed. People were treated with dignity and respect.

People felt their needs were responded to appropriately and in a timely manner. People were encouraged to make choices and have their preferences adhered to. People were supported to participate in activities that were meaningful and of interest to them. There was a complaint procedure available and accessible for people should they wish to raise a concern. People were aware how to make a complaint in line with the provider’s policy and producers.

The service had been without a registered manager since August 2015. The manager had not submitted an application to CQC at the time of our inspection. People felt there had been some improvement to the home since the new manager was appointed. Effective systems were in place to monitor and assess the quality of the service.

We found that people's privacy, dignity and independence were respected and that care and treatment was planned and delivered to ensure people's safety and welfare.

Another relative told us the standards of care had noticeably improved recently. They told us that "the home was not plush but that they were more interested in the quality of care and kindness". Another relative told us the family had looked at a number of homes and had chosen this one because "staff seemed to be kind to everyone". They told us their relative had recently moved to the home and they were happy with the care so far. They told us had minor issues but accepted that living in a care home was different to living in your own home.

We found that people who used the service were protected from the risk of abuse and the risk of inadequate nutrition and dehydration. The provider had a safe system in place for managing the administration of medicines.

We spoke with one person who uses services. They said, “I’ve been looked after all right. I get everything I need.” They also said, “The home is clean and well looked after.” They said, “There are enough staff at the moment." They also said, “I’ve talked about my care plans and I’ve completed surveys. I go straight to the office if I’ve got any problems.” They told us they hadn’t seen any issues of concern and were happy with how other people who use services were cared for by staff.

We found that people who use services experienced care, treatment and support that met their needs. They were protected from the risk of infection and were also protected against the risks of unsafe or unsuitable premises.

We also found that there were enough qualified, skilled and experienced staff to meet people’s needs. People were cared for by staff who were supported to deliver care and treatment safely and the provider had an effective system to regularly monitor the quality of service that people receive.