Archived: Moorlands Care Home

At the inspection in February 2017 we judged the service to be ‘Requires Improvement’ overall, and in the key questions of Responsive and Well-led, and ‘Good’ in all other areas. There was no breach of regulation at this time.

Moorlands Care 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.

Moorlands care home accommodates up to 67 people across two separate areas. One unit provides nursing care whilst the other unit specialises in nursing care for people living with dementia. During our inspection there were 37 people living at the home.

The home is required to have a registered manager in post. At the time of our inspection the service did not have a registered manager. The registered manager had left the home at the end of December 2017, having completed a four week handover with a new manager. However, the new manager had left the organisation. The previous registered manager had returned to the role of manager with the intention to re-apply to register with the Care Quality Commission. 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.

At this inspection we found that there were breaches of three of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care and the governance of the service.

People told us they felt safe. However, we identified some concerns in respect of safe care and treatment. Risks to people had not been adequately assessed or mitigated which meant people were at risk of potential harm. These related to health care needs such as the risk management of epilepsy and diabetes.

Infection control measures were poor. We saw some communal areas, people’s bedrooms and equipment which was not clean.

People were not provided with care which consistently met their needs. Care records contained gaps which meant it was difficult to establish whether people had received the support they needed. Care plans did not always provide staff with the guidance they required to meet people’s needs. The registered provider had identified this as an area which required improvement and had an action plan to address this.

Quality assurance systems had identified some but not all of the issues we saw during the inspection and some of the issues known to the provider had not been rectified in a timely manner.

Staff understood how to safeguard people and overall safeguarding referrals had been appropriately made to the local safeguarding authority.

Medicines were safely managed. Essential safety checks had taken place such as gas and fire safety.

Staff had been safely recruited. There was a high use of agency staff but measures were in place to mitigate risks associated with this and the provider had a plan to try and recruit more permanent staff.

Staff described feeling supported by the manager and they had access to a range of training and supervision. Annual appraisals had not taken place and the manager agreed to rectify this.

We saw a variation in the quality of support provided to people who required assistance to eat. Overall, the lunchtime experience was positive and people had access to a variety of nutritious meals.

Staff understood the principles of the Mental Capacity Act and sought consent before they provided support. However, records associated with this required further improvement.

People had access to a range of health care professionals to support them to maintain their health.

There was a variation in the quality of activities on offer to people living at the home. People living on the general nursing unit had access to more meaningful stimulation and we saw the activities co-ordinator spent the majority of their time on this unit. However, the manager explained they hoped to recruit an additional member of staff who would concentrate on meaningful activities for people living with dementia.

People and their relatives knew how to make complaints. The home had received two complaints in the last year which had been appropriately investigated and responded to.

We were provided with positive feedback from relatives about the manager and they were pleased to see them back in post. People, relatives and staff had the opportunity to give feedback on the service via regular meetings with the manager.

The service is divided into two units. The Jasmine Unit provides nursing care, whilst the Lavender Unit provides nursing care for people who may also be living with dementia. All accommodation is on the ground floor and people living on both units have access to a small courtyard. There is a large car park at the front of the service.

We last inspected the service in June 2016 when we identified breaches of Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). At the time of that inspection, the service was in ‘special measures’ and due to our on-going concerns the service was rated Inadequate and remained in ‘special measures’. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months.

This inspection was planned to check whether the registered provider had taken the necessary steps to address our concerns. This inspection took place on 1 February 2016. The inspection was unannounced. This meant the registered provider and staff did not know we would be visiting. There were 24 people using the service at the time of our inspection.

At this inspection, we found that the registered provider and registered manager had addressed our concerns and the service was now compliant with the fundamental standards of quality and safety. For this reason the service is no longer in 'special measures'.

We found that improvements had been made to the range of activities and level of meaningful stimulation available to people who used the service. We saw staff made genuine efforts to engage people in conversation. A range of activities were on offer within the service and staff tried hard to encourage participation. Staff listened to people, explained what they were doing, sought consent and respected people’s decisions. This demonstrated that improvements had been made to the level of person-centred care provided.

Improvements had been made to the way consent to care was recorded. Mental capacity assessments were completed and work was on-going to establish who was responsible for making best interest decisions. Applications to deprive people of their liberty were now submitted, where necessary, in a timely manner.

Improvements had been made to the way medicines were managed within the service. Systems were now in place to ensure people received their prescribed medicines safely. Improvements had been made to the way accidents and incidents were recorded and analysed and we observed there had been an overall reduction in the number of accidents and incidents occurring. This demonstrated that the preventative measures put in place by the registered manager were effective in reducing risks to keep people who used the service safe.

Improvements had been made to the management of the service. We received positive feedback about the registered manager. People told us there was stability within the service now that a permanent registered manager had been appointed and we could see that systems, processes and routines were being developed which supported staff to provide good care. The service was now compliant with the fundamental standards of quality and safety.

Whilst improvements had been made, we have not revised the rating for this service to 'Good', because we require evidence of consistent good practice and the improvements made need to be sustained to demonstrate this. We will re-inspect the service to ensure that the positive progress made is sustained.

During our inspection, we received positive feedback about staffing levels and saw that sufficient staff were deployed to meet people’s needs.

Health and safety checks of the service and any equipment used were completed. Risks were identified and assessed. Risk assessments were used to guide staff on how to provide safe care and support. Care plans were person centred and reviewed and updated regularly. We were concerned that some staff told us they did not read people’s care plans. However, we found that staff were knowledgeable about people’s needs and the risks associated with meeting those needs.

Systems were in place to ensure staff received regular training, supervisions and an annual appraisal of their practice.

We received positive feedback about the food provided at Moorlands Care Home and saw that people were supported and encouraged to ensure they ate and drank enough. People’s food and fluid intake and weights were monitored to minimise the risk of dehydration or malnutrition.

We received positive feedback about the staff and relatives of people who used the service told us they felt staff genuinely cared for people who used the service. Staff provided support in a way that maintained people’s privacy and dignity. People were supported to make decisions and staff respected people’s choices.

There was a system in place to gather and respond to feedback about the service provided including handling complaints or concerns.

The registered provider is required to have a registered manager as a condition of registration. 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. At the time of our inspection, the service had a registered manager and as such the registered provider was compliant with this condition of their registration.

The registered manager and registered provider completed a range of audits to monitor the quality of the service provided. We saw evidence of a clear commitment to improve the quality of the service.

We received positive feedback about the registered manager and the changes they had made.

The home is divided into two units; the Jasmine Unit provides nursing care, whilst the Lavender Unit provides nursing care for people who may also be living with dementia. All accommodation is on the ground floor and people living on both units have access to a small courtyard. There is a large car park at the front of the home.

The inspection took place on 15 and 22 June 2016. The inspection was unannounced. We previously inspected the service on the 18 January 2016 and identified three breaches of regulation. These included breaches in regulations governing the safe management of medication, meeting nutritional and hydration needs and good governance. Due to the severity of our concerns we rated the home as ‘Inadequate’ and the home was placed in ‘special measures’. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months.

This inspection was planned to check whether the registered provider had taken the necessary steps to address our concerns.

There were 28 people using the service at the time of our inspection with 13 people in the Jasmine Unit and 15 people in the Lavender Unit.

During our inspection we found that, although some improvements had been made, there had been insufficient progress and there were still outstanding concerns about the care and support provided at Moorlands Care Home. Because of this, Moorlands Care Home remains in ‘special measures’ and we will report on any enforcement action we have taken in response to these concerns at a later date.

The system used to ensure medication was managed and administered safely was not robust enough.

This was a breach of Regulation 12 (2) (c) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not robust systems in place to respond to accident and incidents or manage safeguarding concerns. This placed people using the service at increased risk of harm and showed us that the registered provider had not taken all reasonable steps to manage risks.

This was a breach of Regulation 12 (2) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Consent to care and treatment was not always sought in line with relevant legislation and guidance. The Deprivation of Liberty Safeguards (DoLS) had not been used in a timely manner to prevent possible unlawful deprivations of liberty.

This was a breach of Regulation 11 (1) (3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care and support provided was not person centred and we were concerned about the lack of meaningful stimulation and interaction for people using the service. Staff were not always responsive to people’s needs.

This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were on-going issues and concerns regarding the quality of the care and support provided at Moorlands Care Home. The registered provider had failed in their responsibility to ensure compliance with the regulations and there had been multiple breaches in regulations for three consecutive inspections of the home. This showed us the home was not well-led.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are currently reviewing what enforcement action to take in response to these breaches in regulation.

The registered provider is required to have a registered manager as a condition of registration. 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. At the time of our inspection the home did not have a registered manager in post. A new manager had been recruited and started working at the home in March 2016. The Care Quality Commission had received an application for this manager to become the home’s registered manager in June 2016 and this application was being processed at the time of our inspection.

During the inspection we found that there were sufficient staff to meet people’s needs.

People received effective support to ensure they ate and drank enough. We received largely positive feedback about the new chef and the quality of the food provided.

The manager was in the process of ensuring staff training and supervisions were up to date and we have made a recommendation about this in our report.

We found that people were not always supported or encouraged to make decisions and have made a recommendation about this in our report.

We found that a more robust system was needed to record compliments, complaints, comments and concerns and have made a recommendation about this in our report.

We received generally positive feedback about the new manager and the changes they had made in the three months that they had been working at the home.

The home is divided into two units; the Jasmine Unit which provides nursing care and the Lavender Unit which provides nursing care for people who may also have dementia. All accommodation is on the ground floor and people living on both units have access to a small courtyard. The home has a large car parking area.

The inspection took place on the 18 January 2016. The inspection was unannounced. We previously inspected the service on the 3 and 5 August 2015 and identified five breaches in regulation. These included breaches in regulations governing person centred care, meeting nutritional and hydration needs, premises and equipment, good governance and staffing. Due to the severity of our concerns, we issued two warning notices telling the provider that significant improvements were required. This was a follow up visit to check whether the required improvements had been made.

There were 35 people living at the home when we carried out our inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. 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 registered provider is required to have a registered manager as a condition of registration. 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. At the time of our inspection the service did not have a registered manager in post. We were told a new manager had been recruited and, once in post, they would be applying to become the homes registered manager. In the interim, the home was being managed by three managers, with the regional operations manager in charge on the day of our inspection.

During the inspection we found that staffing levels had improved and the registered provider was consistently using agency staff to ensure staffing levels were maintained at a safe level. However, there was no system to proactively review and reassess staffing levels and skill mix. This is important to ensure that there are enough staff to meet people’s needs as the number of people using the service changes. We have made a recommendation about monitoring staffing levels in our report.

The system used to manage medication was not safe and this increased the risk of medication errors occurring.

This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014.

People did not receive appropriate support to ensure they drank enough. We received a significant amount of negative feedback about the quality of the food provided and a number of complaints that food was served cold. We identified concerns that staff did not have the appropriate skills and knowledge to meet people’s specific dietary requirements.

This was a breach of Regulation 14 (4) (a) of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014.

We found that appropriate support was not given to ensure that a person using the service received appropriate healthcare treatment in a timely manner.

This was a breach of Regulation 12 (2) (f) of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014.

The home did not have a registered manager in place and was managed by three different managers at the time of our inspection. The management of the service was disjointed and the lack of a registered manager had created uncertainty for staff and people using the service.

Quality assurance processes and the management of the home was ineffective. There had not been an appropriate management response to address knows risks and areas of concern. This placed people using the service at on-going risk of receiving poor care and support.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are still considering our enforcement powers in relation to these breaches and we will report on this in future inspections of the service.

We found that there were systems in place to identify and respond to safeguarding concerns and care plans and risk assessments had been updated since our last inspection.

Staff did not always appropriately record that they had sought consent to care and treatment in line with relevant legislation. We have made a recommendation about this in our report.

We could see that parts of the home had been refurbished; however, further work was needed to maintain a dementia friendly environment. We have made a recommendation about this in our report.

There was a system in place to respond to complaints; however, the registered provider had not taken appropriate action in response to complaints and concerns they had received about the quality of the food provided. We have made a recommendation about this in our report.

People told us their privacy and dignity were respected and we observed staff treating people using the service in a kind, caring and respectful way. However, we found that the high number of agency staff used within the home impacted on people’s ability to develop meaningful caring relationships with the staff that were supporting them. We likewise found that the high number of agency staff impacted on the level of person centred care provided to people using the service.