Archived: Moorfield House Nursing Home

People’s experience of using this service: We identified a number of concerns relating to fire safety which put people at risk of harm. Following our inspection, we contacted the fire service and they visited the service and issued an enforcement notice.

Systems were in place to monitor the quality of the service. However, these were not robust and had failed to identify the issues we found. Where audits identified areas for improvement we saw action was not always taken.

Issues relating to records were identified. Each person had a range of care plans which were detailed and included how they wished to be cared for. However, these differed between the two units and were not always completed and reviewed in a timely manner.

People told us that they were happy at the service. They gave examples of how staff supported them to remain as independent as they could be.

People and their relatives told us staff treated them well and with kindness and respect. Relatives said they were always made to feel welcome when visiting their family member.

Medicines were managed safely. Guidance was in place to ensure people received their as required medicines when they needed them.

Staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were shared with staff, to reduce the risk of further occurrences.

Staffing numbers were sufficient to keep people safe. The provider followed safe recruitment procedures to ensure staff employed were suitable for their role.

People's needs were assessed and care provided in line with their preferences. Staff completed an induction when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People received enough to eat and drink and were supported to use and access other health and social care professionals.

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.

People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt supported and received supervision and appraisals of their performance. The registered manager was aware of their responsibility to report events that occurred within the service to the Care Quality Commission and external agencies.

Rating at last inspection: At the last inspection the service was rated Requires improvement (report published 24 April 2018). This service has been rated requires improvement at the last three inspections.

Enforcement: We have identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the safety and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Moorfield House Nursing 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.

Moorfield House Nursing Home is a Grade 2 listed building located in a residential area north of Leeds. There is also a purpose-built extension to the main house. Moorfield House provides accommodation for 50 people on three floors with a passenger lift. There are single bedrooms and some have en-suite facilities. There are communal lounges and an activities room.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least a good rating. At this inspection we saw improvements had been made in all key questions.

The home had a registered 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.

At the last inspection in May 2017 we found the service required improvement. At this inspection we found the service had improved.

Policies and procedures were in place however, it was unclear how staff accessed these freely. The provider had systems in place to assess and monitor the quality of the service. However, actions from audits undertaken by the provider were not completed in a timely manner. We have made a recommendation around this.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people were able to speak to the registered manager or deputy at any time.

Staff were familiar with risks people faced and knew how to manage these. We saw that regular checks of maintenance and service records were conducted to make sure these were up to date.

There were sufficient numbers of qualified staff to care for and support people and to meet their needs.

We saw that the provider's staff recruitment process helped to ensure that staff were suitable to work with people using the service. However further security checks on staff during their employment had not been completed.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people's needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The provider had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. 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.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff who knew them well. Personal care was provided in the privacy of people's rooms. People were supported at the end of their lives and had their wishes respected.

People's needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people's concerns and complaints. People told us they felt happy to speak up when necessary. From our discussions with the registered manager and deputy, it was clear they had an understanding of their management role and responsibilities and the provider's legal obligations with regard to CQC.

Moorfield House Nursing Home is registered to provide accommodation and nursing care for 57 people. At this inspection there were 30 older people in the main house who required nursing care, some of whom were living with dementia and/or had a physical disability. In the extension to the main house there were 14 adults under 65 who had a physical disability and required nursing care.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Medicines were not managed safely. Records of people’s medications were not all accurate which meant it was unclear if some people had received their medications as prescribed. This put people’s health at risk. 'As and when necessary' medication and creams were not always administered as prescribed. Medication audits had not identified the concerns found during our inspection.

Staffing levels had not been properly assessed to make sure the needs of people who used the service could be met. The registered provider had not followed the actions which they had agreed to do at our last inspection.

The systems and procedures in place to protect people from the risk of harm did not fully take account of environmental risks and hazards, which meant people were not always kept safe. The registered provider had not made reasonable adjustments to the environment in order to support people's independence and keep them safe. Staff were aware of the different types of abuse and what action to take in order to protect people. Recruitment was managed safely.

Staff knew to offer people choice and what to do in the event they refused care. The registered manager and staff we spoke with had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005.

Overall, care and support was provided by appropriately trained staff. Training records showed staff had completed a range of training; however some training required renewal. Staff said they received support and supervision to help them in their roles, although the registered manager had not yet carried out yearly appraisals.

We observed staff support people in a kind and caring manner. However, there were occasions where we heard language used between staff that did not fully respect people who used the service.

People who used the service and their relatives were involved in planning the care and support received. Care plans contained sufficient information for staff to follow and provide the care people wanted. Regular reviews were taking place to make sure people’s current needs were responded to.

There were procedures in place for responding to people’s concerns and complaints. The registered manager responded to any concerns with a proper investigation and response.

The systems in place to monitor and improve the quality of the service provided had not been not effective at identifying the concerns found during this inspection. There was a lack of involvement by the registered provider and concerns found at the last inspection had not been rectified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see some of the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Moorfield House is a Grade 2 listed building located in a residential area north of Leeds. There is also a purpose-built extension to the main house. Moorfield House provides accommodation for 50 people on three floors with a passenger lift. There are single bedrooms and some have en-suite facilities. There are communal lounges and an activities room. The home is located close to local amenities and public transport routes. There is parking to the front of the home.

There was a registered manager in post in the home on the day of our inspection. 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.

We saw medicines were not always managed safely. We found records of applications of creams and ointments were not always complete, instructions for the management of covert medicines were incomplete and found loose medicines had been left in a person’s room. The registered manager carried out an investigation into this after our inspection.

Medicines that required refrigeration were appropriately stored and controlled drugs records were in order. We observed good practice on the medication round including checking whether people needed pain relief.

We looked at staffing levels and noted staff did not always have time to sit and chat with people who used the service. We found the dependency levels were only assessed on an individual basis and were not reviewed to establish a level of dependency of the service overall. We made observations, spoke with staff, people who used the service and visitors, reviewed rotas and spoke with the registered manager. We concluded there were not enough staff to meet people’s care and support needs safely, which was a breach of Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who used the service lived in a clean, well maintained home. The provider ensured that equipment and fittings were regularly checked and serviced.

Care plans contained mental capacity assessments; however we found that best interest’s decisions were not always adequately documented in people’s care plans. A range of consents had been documented and signed for in people’s care plans. Staff could tell us about people’s mental capacity and how the Mental Capacity Act impacted on their work.

People told us they enjoyed the food and we observed that people who needed assistance with their meals received caring support, although on some occasions staff needed to break off from assisting one person to attend to the needs of another. We saw people had been provided with adapted cutlery and crockery to help maintain their independence in eating. Records relating to nutrition and hydration were not always correctly completed.

Staff told us they received regular training and we saw records that evidenced this was kept up to date. Staff were further supported with annual appraisals and regular supervisions, though some records of supervision were not up to date.

Formal handovers were undertaken before the start of each shift, and we found these were meaningful discussions where staff spoke respectfully about people.

People told us they found the staff to be caring, and we observed good practice throughout the inspection. People who used the service looked well cared for and staff told us a number of ways in which they were mindful of people’s privacy and dignity when receiving care and support.

The care plans contained information as to each person’s aims in respect to each care and support need, but we found the records to be generic and lacking in detail as to how the aim would be achieved.

On the day of inspection we found a lack of meaningful activity which people who used the service could join in with. People spent long periods in lounges with no staff member present. We saw there was a plan of activities for each day of the week, but people who used the service told us there was a lack of things to do.

The provider had systems in place to ensure complaints and concerns were logged and acted on appropriately. We saw evidence that complaints were discussed in staff meetings. People who used the service said they would feel able to speak to the registered manager if they had any concerns. We saw a range of compliments from relatives of people who had used or were using the service.

There was a rolling programme of audits in place, however it was not always clear how some areas had been checked and some action plans contained insufficient detail to show how improvements would be made, by whom or when.

Staff and people who used the service expressed a high level of confidence in the registered manager. People told us they found her approachable and staff said they felt they were well supported and received honest and constructive feedback. Staff had regular meetings which they told us they found useful and said they felt able to speak openly. In addition the staff had completed a survey and we saw the registered manager had responded to areas of concern with an action plan, though it was not always clear how effective action was going to be taken.

We found the provider was in breach of Regulation 12 Safe Care and Treatment of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, their relatives and the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

There were sufficient care staff to respond to people's health and welfare needs.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care, wherever possible. From speaking with staff they were able to demonstrate a good understanding of people's care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. We saw that there was some good humoured banter between several people living at the home and staff. One person said 'The care staff are good.' People looked well cared for and we observed staff knocking on people's door before they entered. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

Relatives we spoke with told us they felt the home was a 'Really nice place, the staff are really friendly.' They felt staff understood the needs of their relative, they told us 'The care staff know her well and know what she wants and needs.'

Is the service responsive?

People's needs were assessed and records we looked at showed they received specialist equipment or aids that they needed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People we spoke with knew how to make a complaint if they were unhappy.

We saw the staff team acted in a professional manner and responded appropriately to people's care needs. We saw them explain to people what they were going to do and asked permission before they carried out any support or care.

The service carried out an annual satisfaction survey. Results were collated and analysed and action plans in response were agreed and actioned.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and responsive.

Effective management systems were in place to promote and safeguard people's safety and welfare. For example, health and safety records and peoples care records were up to date and had been reviewed regularly.

Relatives we spoke with told us they thought management of the home was very good. They told us 'The manager and deputy are both approachable and I feel they listen to me.'

People had thorough, detailed care plans relating to all aspects of their care needs. They contained a good level of information setting out exactly how each person should be supported to ensure that their needs were met. We spoke with seven people and they told us they were happy with the care, support and treatment they received. One person told us, 'I am very happy here, so far so good. It is like a big family.'

We observed people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. However, one bathroom was in need of refurbishment. The people we spoke with told us they had no concerns with the cleanliness of the home.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work. This included carrying out a Criminal Records Bureau check and obtaining references.

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided a good overview of the quality of the services provided.

One person told us, 'I have choice and can make my own decisions.' Another person said, 'Staff understand what I need.'

We spoke with three relatives during our inspection who told us they had been fully involved in the development of their relative's care and care plan. They also told us they were able to make changes and contribute to their relative's care if they wished. One person told us, 'I have been through the care plan with the nurse and nothing happens without me knowing.'

People who used the service told us they were happy living at the home and they were well looked after. However, they said if they had any concerns or complaints they would discuss them with members of staff or the manager.

Comments included

'It's fine living here.'

'Staff look after me well.'

'There is always someone to come and help me.'

'There is not always enough staff, sometimes I wait a few minutes for the call bell to be answered.'

'I like it, nice people.'

'It's alright sometimes and there is enough staff in this area.'

People we spoke with said that the staff gave them their medication and that they received it on time and when they needed it. One person told us, 'I get my medication when I need it.'