Moreton Hill Care Centre

Moreton Hill Care Centre is a nursing home that can provide care for up to 67 older people and people living with dementia. At the time of our inspection 55 people were living at Moreton Hill Care Centre, three of which were supported with end of life care.

Moreton Hill Care Centre is a large adapted home with a number of areas, with two memory lane units, assisting people with dementia care. There was a range of communal areas people could use, including lounges, library, a large dining room and courtyard.

People’s experience of using this service and what we found

This was a targeted inspection that considered end of life care including the management of end of life medicines.

People at end of life received personalised care that took account of their wishes and preferences. Relatives spoke positively about the care and support their loved ones were receiving in the home at the end of their life.

Staff had received appropriate training and people received their end of life medicines promptly and as prescribed to ensure they would remain comfortable.

The management team responded to any concerns or complaints raised regarding people’s end of life care and medicines. Action plans were clearly documented, and lessons learnt shared showed that feedback was used to improve the service.

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

Rating at last inspection

The last rating for this service was good (published 07 February 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had in relation to end of life care. Prior to the inspection, we had received a formal reply from the provider in relation to the concerns raised and the provider advised us of the actions they were taking. A decision was made for us to inspect and examine the care people received at the end of their lives.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Moreton Hill Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the time of our inspection 47 people were living or receiving respite care at Moreton Hill Care Centre. Moreton Hill is a large adapted home with a number of areas, with two memory lane units, assisting people with dementia care.There was a range of communal areas people could use, including lounges, library, a large dining room and courtyard.

We found the following examples of good practice at Moreton Hill Care Centre.

¿ The registered manager and provider ensured staff had access to appropriate personal protective equipment (PPE). Arrangements had been made to ensure there was appropriate PPE to care for people who may have symptoms and require support to self-isolate.

¿ All of the staff solely worked at Moreton Hill Care Centre. The service did not use agency staff. Staff had received training support during the pandemic. The registered manager and resident’s ambassador spoke positively about the stability of staff.

¿ The registered manager worked proactively with healthcare professionals. They had weekly support from people's GP, including visits to the home and virtual consultations.

¿ The provider and registered manager ensured Covid-19 testing was carried out in accordance with best practice guidance. The service ensured appropriate action was taken in the event of a positive test result. Staff were supported to isolate away from the home if they had tested positive. Staff spoke positively about testing and measures to ensure people were protected from Covid-19.

¿ People were supported with a tailored activities programme, which included support to interact with their loved ones remotely. The home had a resident’s ambassador who discussed people’s views with the registered manager. The resident’s ambassador praised care staff, activities staff and the registered manager for the support people had received during the pandemic.

¿ The registered manager had worked with people's relatives to ensure socially distanced visits could take place whilst protecting people who were vulnerable. Visiting had been suspended, following guidance from local clinical commissioners and following national lockdown guidance. There were clear protocols in place to support relatives to visit their loved ones at the end of their lives.

¿ The registered manager had implemented robust systems to ensure there was clear oversight in relation to infection prevention and control. The registered manager, deputy manager and the provider’s operations managers ensured staff adhered to national guidance on PPE. There were comprehensive infection control audits and cleaning schedules in place to ensure the home remained clean and free from infection.

¿ The registered manager had ensured that all information and guidance, in relation to COVID19 was taken onboard. They spoke positively about summarising this information and providing staff with the key information they required. The provider provided regular updates for the registered manager and staff and had a dedicated work website staff could access in relation to Covid-19.

¿ The provider and registered manager had ensured support was in place for staff in relation to their own wellbeing. The provider had carried out a mental health campaign to assist those staff who were anxious. The work and dedication of all staff had been recognised and appreciated.

At the last inspection in June 2016, the service was rated Good. We carried out a comprehensive inspection on 10 and 11 January 2018. At this inspection we found the service remained Good.

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 2008 and associated Regulations about how the service is run.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was effectively monitored. Staff received supervision and training to ensure they could meet people’s needs.

People’s medicines were managed safely and audits and checks were completed. Actions were taken when errors were identified.

Staff demonstrated a good understanding of safeguarding and whistleblowing and knew how to report concerns.

Risk assessments and risk management plans were in place. We found improvements were needed to make all risks were fully considered and appropriate actions taken to keep people safe.

Incidents and accidents were recorded and the records showed that actions were taken to minimise future occurrences.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

A range of activities were offered and provided people with entertainment both in and out of the home.

Systems were in place for monitoring quality and safety and actions were taken where areas for improvement and shortfalls had been identified.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the home's staff and from looking at records. Please read the full report if you want to see the evidence supporting this summary.

Is the service safe?

Arrangements were being made to ensure that there were sufficient staff to support people safely. Risks were being assessed so that hazards to people were reduced when receiving care and when undertaking activities of their choice.

The environment and the facilities were being checked so that people benefited from a safe environment. When accidents and incidents occurred, the circumstances were analysed so that any improvements in safety would be identified.

Is the service effective?

People we met with were appreciative of the care they received and how staff went about their work. For example, people who used the service commented 'I can't fault the staff' and 'they often ask me how I'm feeling and they want to know I'm OK'. Relatives we met with felt that the needs of their family members were being met.

People's needs were being assessed in different areas of their lives. This meant that people at particular risk, for example because of poor nutrition or mobility, were being identified. Care plans helped to ensure that staff effectively supported each person with their needs.

Is the service caring?

People spoke positively about the way that staff treated them. A relative told us that they were kept well informed by staff about any changes in the health of their family member at the home.

The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff used gentle humour, body language and physical gestures to aid communication and to engage with people with dementia.

Is the service responsive?

People who used the service were consulted about the care and support that they wished to receive. They told us that their views were being respected. However, when people did not have capacity to make decisions there was a lack of documentary evidence to show that the appropriate procedures had always been followed.

Surveys were being used to gain the views of the people who used the service, their relatives and from staff. The feedback provided information about what was working well and how the service could be improved.

Complaints were being used as a means to identify what the service could do better. The manager gave us examples of improvements that had been made during the last year. These included changes in the d'cor and a better working relationship with the pharmacist.

Is the service well led?

The home was without a registered manager at the time of this inspection. However there was a temporary manager who was assisted by a deputy manager and the provider's regional operations director. A new permanent manager was due to start in the week following our inspection.

Nurses and heads of unit took the lead on each shift. Other staff such as a head housekeeper, had specific responsibilities in relation to the day to day work. These arrangements showed that there was a structure in place for overseeing the running of the home to make sure that the appropriate procedures were being followed.

Audits and director's visits were being undertaken. This meant that areas for improvement were being identified for the benefit of the people who used the service.

During the day we were able to speak with people, either in their rooms, at lunch or as they moved around the home. In addition, we observed people who mostly rested throughout the day in their room,

We observed that care workers were attentive and treated people with dignity and respect. We found that people were well cared for and were very positive about the care and support they received from all of the staff. People were happy to talk with us.

We found that the home was well maintained, with appropriate furnishings and decor. The home had made adaptations such as hand rails to enable people to maintain their independence. We found that most areas of the home were clean, however in some areas, the level of cleanliness had not been maintained.

On the day of our visit we saw that several people were taking part in a cooking group making 'ginger bread' men. Everyone was engaged and seemed to be enjoying themselves. People told us there was a range of activities they could take part in, if they wished.

People received appropriate care which met their needs. Care plans were reviewed monthly and contained assessments which were specific to that person. During our visit we informed the manager that one carpet in a bedroom did not smell fresh and a bathroom was not clean, they said they would follow this up.

People told us they felt safe in the home and would tell the staff if they had any problems with other residents or if they did not like something. One relative said, "Yes, absolutely no worries at all, it's a fantastic home". People told us they knew how to make a complaint if they needed to.