The inspection took place on 26 and 31 October 2017 and the first day was unannounced. This meant the provider did not know we were coming. Peel Moat is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Peel Moat provides accommodation for up to 31 people who require personal care, some of whom are living with dementia. At the time of the inspection, 28 people were living in the service.
At the last inspection undertaken on 1 August 2016, the registered provider had breached Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the lack of risk assessments relating to the premises, risk assessments in relation to people at risk of choking, medicines management, staff training was not up to date and the registered provider’s quality assurance systems had not identified the areas of concern we found. We also made a recommendation because the home did not have features to support people living with dementia, such as reminiscence material, items of visual or tactile interest, or dementia-friendly signage. The overall rating for the service was requires improvement.
Following the last inspection we asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions, is the service safe, effective, responsive and well led to at least good. At this inspection, we found that improvements had been made in all areas and plans were in place to make further improvements.
The service had 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. The registered manager was absent and the deputy manager was available throughout this inspection. We were informed that the registered manager left the service shortly after our inspection and plans were in place to recruit a suitable replacement.
We raised concerns during the first day of this inspection about the recruitment process for a new member of staff. There were also concerns about a person’s deteriorating health and behaviour which had resulted in an incident. The deputy manager took prompt action to address both matters.
We saw that improvements had been made to the management of medicines and risk assessments were now in place for the premises. This included a risk assessment for the new alarm system, which had been introduced following feedback from the Coroner in relation to an incident at another of the registered provider’s services.
Risk assessments were in place for people who had identified problems with swallowing which meant they were at risk of choking.
Staff training was not up to date. However, this was because there had been a number of staff who had recently come to work at the home who were undertaking induction training. We recommended that the outstanding staff training is completed as soon as possible.
We saw that the service had created a dementia friendly lounge, which had reminiscence materials such as visual items including 1950’s ornaments and furnishings. Further improvements had been made to the environment with ‘dementia friendly corridors’ to help people make their way around the home.
Staff we spoke with told us they would have no hesitation in reporting any poor practice they witnessed from colleagues and were confident they would be listened to by the deputy manager and action would be taken.
There were enough staff available to meet people’s needs.
People were supported to maintain their general health and wellbeing.
Staff received training in the Mental Capacity Act 2005 (MCA) about their responsibilities when caring for people who lacked capacity to make a decision. The registered manager also understood the need to apply for Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.
People were offered a choice of food and had access to drinks.
People had their own rooms, which allowed privacy. Rooms were furnished in accordance with people’s choices and preferences. The home was clean, comfortable and homely.
People and relatives were complimentary about the service and made positive comments about the staff. They were happy with the care and support they received at Peel Moat.
Care plans were personalised and reviewed regularly. Staff were knowledgeable about people’s needs and preferences.
A new activities co-ordinator had been employed at the home. There had been an improvement in the activities available to people and the activities co-ordinator had had a positive impact on the atmosphere at the home.
There was a complaints procedure in place. In the absence of the registered manager people, relatives and staff told us that the deputy manager was approachable and always willing to listen and help.
Managers used a variety of methods to assess and monitor the quality of the service. These included regular audits as well as, staff, relative and resident meetings to seek their views about the service provided.
The service had been working hard to recruit the right staff and reduce the need for agency staff. This included promoting teamwork and confidence of staff through increasing their responsibilities and skills. This had led to a recent positive impact of staff morale at the home.