Archived: Morningside Rest Home

Updated 20 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was unannounced and took place on the 13 February 2018 and was completed by two adult social care inspectors.

Prior to the inspection we contacted Healthwatch, an independent organisation with the power to enter care services and report on their findings. They had not recently visited the service, however they did raise concerns from their previous visit to the service. We also liaised with the local authority who raised concerns regarding the management of the service and staff morale. They also raised concerns around the standard of mental capacity assessments which were being completed.

During the inspection we looked at the care records for four people using the service. We spoke with seven people and four members of staff including the registered manager. We spoke with two people’s family members about their experiences of the service. We also reviewed information relating to the day-to-day management of the service, such as management audits and maintenance records.

Updated 20 February 2019

The inspection was unannounced and took place on the 13 February 2018. At the last inspection carried out in August 2017 we identified breaches of Regulations 9, 10, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection whilst we found that some improvements had been made we identified ongoing breaches of Regulations 9, 12 and 17.

Morningside Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 up to 31 people. It is situated in the town of Winsford in Cheshire and has parking to front and a garden to the rear. The service is situated across two floors and primarily supports older people and people living with dementia and physical disabilities.

The service is run by a manager who is registered with the CQC. 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.

There were leadership issues within the service. The registered provider had not appointed a nominated individual as required by law. A nominated individual is responsible for monitoring and managing the activities being carried out by the service. This showed poor leadership and placed the service at risk of deterioration.

During this inspection we identified that people were not always safe. There were portable heaters in people’s bedrooms which were unguarded and well in excess of safe temperature levels. The registered manager had completed a risk assessment around these, however this was poor and did not protect people from the risk of harm. We asked for these to be removed and for alternatives to be sourced.

The registered manager had failed to complete an audit of accidents and incidents for December 2017 and January 2018. This had been highlighted as an issue at the previous inspection in August 2017. This placed people at risk of potential harm and showed poor management of accidents and incidents.

Care was not always provided in a person-centred way. We found that adaptations had not been made to the environment in line with best practice to make it dementia friendly. In one example best practice guidance was not being used to implement positive behaviour plans to improve a people’s wellbeing. Action had not been taken to make changes to the meal time experience despite people requesting this. We raised these issues with the registered manager for them to address.

People’s confidentiality was not always protected, and personal information was not stored securely. We observed the registered manager leaving the door to their office open and unlocked, which meant people’s personal information was not secure. Mail marked as ‘private and confidential’ was also being stored at the entrance to the premises in pigeon holes which meant it was accessible to anyone entering the service.

People each had individual care plans in place, some of which contained a good level of detail. However we observed examples where care records did not always reflect the care that was being provided to people. In other examples the daily monitoring records did not contain relevant or all the necessary information. This meant that care records needed to be reviewed to ensure they contained correct information.

We spoke with the local authority who shared information from discussions they had had with staff. Some staff had reported feeling unsupported by the registered manager, and had commented that there was a negative culture within the service which was impacting on staff morale. The local authority had shared this with the registered provider for them to look into.

Quality monitoring processes had failed to identify issues which had been picked up by the inspection process. This showed that they needed to be made more robust. Where improvements had been made these had not been done so over a sustained period of time, so the registered provider could not yet demonstrate that this had been fully embedded into day-to-day practice.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and knew how to report their concerns to the local authority.

People were supported to take their medication as prescribed. Medication audits were carried out on a monthly basis by a pharmacist to help identify and address any issues. Medication records were being signed appropriately by staff and controlled drugs were being stored securely as required by law.

Staff had received the training they needed to carry out their role effectively. New staff were supported to gain the necessary skills and qualifications and shadowed experienced staff to gain knowledge of the role.

We observed positive interactions between people and staff using the service. People and their family members commented positively on staff and told us they felt at ease in their company and found them to be welcoming.

The overall rating for this service is ‘Requires improvement’. We are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.