Archived: Morriss House

Morriss House is a ‘care home’ for older people, most of whom are living with dementia. People in care homes receive accommodation and 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.

The service is registered to accommodate a maximum of 25 people. The provider had reviewed the number of bedrooms provided at the home and had reduced the number of bedrooms to 19. At the time of our inspection there were 13 people living in the home. Most of the people using the service had been living at the home for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

The registered manager had recently left the home and we were informed that an advert had been sent out for a new manager. 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 systems used to identify, mitigate and monitor risks lacked detail. Although staff knew people well and knew how to keep them safe, this information was not always recorded.

Care planning and the assessments of people’s needs did not always reflect current evidence-based guidance, standards and best practice. Care plans were basic and lacked sufficient detail to ensure new staff would understand the holistic needs of everyone.

Records required for the running of the service were not always available for inspection. Systems used to monitor and audit quality and safety at the home were inconsistent and ineffective.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the manager and deputy manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always supported this practice.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and associated Deprivation of Liberty Safeguards (DoLS). Staff knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs people had.

All parts of the home, including the kitchen, was clean and no malodours were detected.

People had access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care. Records of past complaints were not available which made learning from past mistakes difficult.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, meeting nutritional and hydration needs and good governance. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there were 25 adults living at the service, one of whom was living there on a temporary basis. The service was located in a large semi-detached house, on three floors with access to a back garden. We previously inspected the service on 19 November 2013 and the service was found to be meeting the regulations inspected.

Morriss House had a registered manager at the service. 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.

During the inspection people were calm and there was a relaxed atmosphere at the service. People using the service informed us that they were happy with the care and services provided. We saw staff were caring, kind and compassionate and treated people with dignity and respect.

Staff were aware of people’s needs as their needs were carefully documented within detailed care plans. Staff responded quickly to people’s change in needs if they were physically or mentally unwell.

Care records were individualised, contained people’s personal histories and reflected their choices, likes and dislikes, and arrangements were in place to ensure that these were responded to. Care plans provided detailed information on people’s health needs which were closely monitored. Risk assessments had been carried out and updated regularly. These contained guidance for staff on protecting people.

People were supported to maintain good health through regular access to healthcare professionals, such as GPs and the local community mental health team. People spoke highly of the food and people’s cultural and religious needs were facilitated by staff.

People had their medicines managed safely and received their medicines as prescribed. Storage and management of medicines was safe with clear processes in place.

Staff had been provided with training to enable them to care effectively for people and this was confirmed by people who lived at the service. Staff felt supported and there was evidence of supervision taking place although this was not taking place as regularly as stipulated in the supervision policy. Plans were in place for more frequent supervision. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

There were enough staff to meet people's needs, and we could see that staffing had been recently increased to meet the needs of people living at the service. The service was committed to offering a good service to people at the end of their life.

Although the management of people’s money was safe there were plans to change the system to ensure it was more personalised.

People told us the management was a visible presence within the home. Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate.

There was a stair lift to access upstairs and a lift to access all floors. There were accessible bathing facilities at the service and an accessible shower room for people with mobility problems.

We found the premises were clean and tidy, and measures were in place for infection control. The decor was dated but there were plans to decorate the communal areas in 2016/17. There was a record of essential services being checked. There was clear documentation relating to complaints and incidents. Audits were taking place to ensure the service maintained standards of care for people living there. Checks of essential services such as gas, electricity and fire equipment had taken place to ensure the building was safe.

Although most staff had been carefully recruited we found one member of staff had only one appropriate reference.

We have made a recommendation in relation to staff recruitment.

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People told us they felt safe and had no concerns about the service. A relative said that the front door was always opened by a member of staff, rather than just being buzzed in, 'We are pleased about this as it means that everyone who comes into the home is seen and our relative is not put at risk by unknown people coming into the home without staff being aware of them.'

We found that there were arrangements in place to manage and provide medicines to people in a safe manner.

The building and environment had been maintained to a standard that meant people could feel safe and secure.

We found that there were enough staff on duty each part of the day to ensure that people's care and support needs could be met.

The provider monitored the quality of the standards of care and the overall service in order to ensure that people were satisfied and had their needs met.