Moorhead Rest Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified breaches of legal regulations. People’s consent was not always sought and paperwork relating to DoLS was not always up to date. Initial assessments were not always fully completed and not all care plans were robust enough to guide staff. Although we saw some evidence of referrals being made, not everyone had been referred to the appropriate healthcare professional in a timely manner.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always feel they had their care needs assessed prior to their admission to the service. One person said, “I don’t recall an assessment. I was in hospital following a fall and then I came here. I’m not aware of a care plan, it hasn’t been discussed with me.” Relatives also told us they weren’t aware of a care plan. One relative said, “I had a letter last time I visited saying they were going to do a care plan review. I can’t say I have ever seen a care plan.”

Staff told us the senior care assistants, or the deputy manager write the care plans. Staff appeared knowledgeable of people’s care needs and said they had time to read care plans.

Although we saw evidence that people’s needs had been assessed prior to their admission to the service, these records were not always fully completed. Not everyone had an in-depth care plan in place and one person had very limited information despite being at this service for some time. Not all care plans were signed by the person or their relative and some care plans held conflicting information. This meant they were not robust enough to guide staff.

People told us their experience of meals was not always positive. One person said, “There is no choice at lunchtime. If you don’t like it, that’s it, but I don’t want to make it awkward.” Another person told us, “We have to have what is on the menu, if you don’t like it, there is probably something else.” One relative praised the staff for encouraging their loved one to eat well. People were being weighed regularly; however, it was not clear what action had been taken when people were losing weight. One person’s nutritional risk assessment was calculated incorrectly showing they were low risk of malnutrition when it should have been a higher risk. This meant this person may not have been receiving the appropriate level of care and treatment due to this miscalculation.

Staff were aware of people’s dietary needs. Staff told us there was no choice for the lunchtime meal. However, if a person didn’t like what was served, the chef would make an alternative option.

There was no evidence that people were actively involved in their meal choices. The menu for the day was not always the meal people were given and observations of the lunch time meal showed people were not offered a choice of what they would like to eat. Staff gave meals to people with no explanation of what the meal was and there was a lack of staff presence in the dining room to encourage people to eat and drink well. Food and fluid charts were not always being filled in and thickener charts evidenced a lack of fluids being given. Monthly weight records evidenced a number of people who had lost weight, but it was unclear from the records what action had been taken including referrals to other healthcare professionals.

People told us they had access to various healthcare professionals. One person said, “I have a podiatrist visit me and the district nurse when needed.” Relatives also felt their loved ones would be seen by a district nurse should they need to. While people we spoke to had no concerns in this area, our assessment found elements of care did not meet the expected standards as documentation showed a lack of information sharing amongst the staff team.

Staff told us they had regular handovers where they were allocated tasks for the day. One staff member said, “We are given a beeper, they try to do it fairly, it changes every day.”

Partners felt they could access the service should they need. However, partners raised concerns that not all feedback had been taken on board and despite having actions plans in place, they were not always followed.

We saw evidence of handover records and allocation sheets; however, information was limited, and important incidents had not always been shared amongst the staff team. One person had a fall which resulted in a bang to their head, handover records evidenced this has not been shared with the next staff team on duty and no observations of the person had taken place. The manager worked alongside other service. However, not all feedback was taken on board and actions plans were not always being followed.

People felt they had not seen their GP recently. One person said, “I have not seen a GP since moving into the service four years ago.” Relatives felt staff would ensure people were seen by appropriate healthcare professionals should they need to; however, they were not always informed of this.

Staff knew what steps to take should someone become unwell. One staff member said, “We would tell the management or let the seniors know.” One staff member spoke about how they incorporated exercise into activities. They said, “We do group activities which include arm movements and the rower for legs.”

Not everyone had been referred to the relevant healthcare professionals when they needed to. Following on from an accident or an incident, some records indicated referrals to other professionals were necessary. However, other records showed this was not always the case as one person who had a significant fall had not been referred appropriately. Care records had limited information on which healthcare professionals were involved in people’s care. However, some records did show intervention from the Speech and Language Therapy Team. People were being weighed but no action was taken when a person had lost weight and there was little evidence to show what action had been taken to ensure they received a balanced, nutritious diet.

While people we spoke to had no concerns in this area, our assessment found elements of care did not meet the expected standards as tools for monitoring outcomes were not robust.

Staff spoke about how they encouraged people to eat and drink well. Staff also told us they had training on how to support people experiencing distress.

Tools for monitoring outcomes were not robust. Audits of accidents and incidents and hospital admissions were not detailed enough to analyse trends and themes. This meant there was no way of identifying patterns of when a person fell or became unwell. Behaviour charts were not being reviewed which meant there was no identifying of patterns or whether re-assurance techniques had been successful. There was little interaction between staff and people during mealtimes which meant meaningful encouragement could not be given.

People told us they had not signed any paperwork relating to consent. Relatives said they had not been informed of best interest decisions and when asked whether they had attended a meeting regarding best interests and capacity, one relative said, “If there has been one, it hasn’t been with me.” People in shared bedrooms had not formally consented to this arrangement and despite their mental capacity declining, there was no evidence of a best interest decision or consultation of their relatives to see if this was in their best interests.

Staff told us they always sought consent from people before any care interventions and they knew what steps to take should someone refuse any care intervention. One staff member said, “If they refuse, we ask again later, maybe with a different staff member.” The staff we spoke to did not have a good understanding of DoLS and what this meant in practice and the manager admitted records relating to DoLS were not up to date and always reflective of people’s current needs.

People’s consent was not always formally sought. Several care plans evidenced people had not consented to their care and treatment or consented to staff administering their medicines. Capacity assessments were not always being made for important decisions to check whether the person was able to make this decision themselves or required a best interests process. DoLS paperwork was outdated and not reflective of people’s current needs. Several people did not have a DoLS application for their current circumstances.