Archived: Moundsley Hall Nursing and Residential Home

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People we spoke with told us that they felt their relatives were safe living at the home and their needs were met by staff that knew them. Staff also told us that they felt people were safe and their needs were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

We checked the medicines of people who lived at the home. We found that medicines were stored and administered safely.

Is the service effective?

We observed that people received appropriate care to meet their physical needs and maintain their comfort. All of the staff we spoke with told us about the individual needs of the people that lived there. At the last inspection it was found that not all the people that lived there had their needs met in a timely way. During this inspection we found that improvements had been made.

Is the service caring?

We observed that staff were kind and polite. We found that staff treated the people that lived there with dignity and respect. The people we spoke with were positive about how staff cared for them. All the staff we spoke with were able to tell us about people's individual likes and dislikes. People's wishes had been respected. For example we saw where one person indicated that they liked to wear a particular item of clothing. We saw that staff respected this.

Is the service responsive?

We found that the care records showed that people that lived at the home saw other professionals including speech and language therapists and doctors when their health needs changed. The provider had acted appropriately to guidance from other professionals when people's needs changed. People told us that they felt if their relative's needs changed the staff were always quick to respond and contact other professionals.

We found that the provider took action to address concerns that were raised during the inspection. This showed that the provider responded appropriately to ensure that people's needs continued to be met.

Is the service well led?

The previous inspection highlighted that the provider did not have a robust system in place to identify, assess and manage risks. During this inspection we found that improvements had been made. We found that the provider now had effective and robust systems in place to monitor the quality of the service. Regular audits and analysing risks and incidents meant that the quality assurance systems now in place enabled the provider to highlight and address shortfalls in a timely manner. We found that where incidents that occurred, the provider had assessed the risk and actioned it appropriately.

At the time of inspection the provider had applied to register the six homes on the site separately. This will mean that in the future each home will be inspected separately. The provider had already appointed new managers to ensure that all of the six homes each had a dedicated manager. The provider told us that these managers were in the process of becoming registered with the CQC. We found that staff felt that the changes made to the management of the home were positive, and staff told us that they felt supported in their roles.

During this inspection we spoke with 15 people that lived at the home, 20 care staff, eight family members, the general manager, clinical manager and the provider. We also looked at the care records for 13 of the people that lived at the home.

We found that some people's care records were not always accurate or completed when staff had delivered care and support to meet people's needs. This meant that people were not protected from the risk of unsafe or inappropriate care and treatment.

Some people told us that the care they received was good. One person who lived there told us: ''I like it, staff are nice. Food is very good. I go for walks'. Another person said: "Staff are good. They do support me and I do get a chance to talk. They have been fairly good'. However we also found areas of care that needed improvement. We found that people did not always have their individual needs met. Also people were at times not adequately protected from risks to their welfare and safety.

Some of the people who lived at the home were unable to talk with us. Therefore during this inspection we spent time at the home and watched to see how staff supported people, and talked with people about life at the home. We spoke with 10 people who lived at the home, six relatives, the management team, the provider and 10 staff.

We found that some improvements had been made since our last inspection in April 2013. There were enough staff to meet the care and support needs of people who lived at the home. Staff training and support had started to be provided so that staff had the knowledge and skills required to ensure people received safe and effective care.

We observed examples that showed us that people who lived at the home were treated with respect and as individuals. We observed kind and caring conversations during the day. We also saw that progress had started to plan and deliver activities. This made sure that people had the opportunities to lead as full a life as possible.

People and the relatives that we spoke with made positive comments about the way staff treated them and the care people received. One person told us: 'I feel very safe here, if I had any concerns or was worried about anything I would tell the manager.' Another person told us about the meals: 'Yes it's good, we are all putting on weight, there's a pretty good choice.'

One relative said: 'Yes, they (staff) are always polite to her and treat her nicely.' Another relative told us: 'I can ask them things and they do listen if I say I am worried about mum or think something's a bit not quite right.'

We found that if people's needs had changed staff did not always have the knowledge about this. This meant that people could be at risk from inappropriate and inconsistent care to meet their needs.

Some people who lived at the home told us about the improvements that could be made. One person told us: 'Sometimes the activities provided or organised could be a bit more adult..... It seems like they (staff) don't really think about people's different ability and interest levels.' Another person said: 'I want to be more independent but it's difficult, there are only two staff on in the evenings so it is difficult to do stuff individually if it needs any support from staff.'

We found that some people's care records were not always accurate or completed when staff had delivered care and support to meet people's needs. This meant that people were not protected from the risk of unsafe or inappropriate care and treatment.

We spoke with the general manager, clinical manager, four unit managers, one nurse, one agency nurse and four care workers.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. This was confirmed by the people who were using the service.

We spoke with six people and four visiting relatives. One person said: 'Can't go out because we need more staff to do that'. A relative told us: "I tell the nurses X needs the toilet but they don't always do it straight away'.

Four of the nine care records that we reviewed indicated that arrangements were not fully in place for people's care needs. A unit manager and an agency nurse gave us conflicting information about people's pressure sores. This meant that people may not have received appropriate treatments. People were not being stimulated to enhance their lifestyles.

We found that there was a shortage of permanent staff to meet people's needs. Agency staff were being used regularly. The registered provider told us that they were recruiting more staff.

We found that systems were in place to keep people safe. Staff had received training in safeguarding people and knew how to respond to concerns.

Some staff had not had appropriate training. Some senior staff had failed to regularly monitor staff practices to ensure that appropriate care was being provided.

People told us they knew how to make a complaint.