Le Moors

People's experience of using the service and what we found

People were not always safe because sufficient staffing levels had not been maintained at weekends. People had been supported by more staff during the week and this had helped to maintain their safety and wellbeing.

People had been supported to manage the risks they may experience by staff who had received training to keep people safe from avoidable harm and abuse. People received their medicines as prescribed from staff who had received training in the safe management of medicines.

People's needs had been assessed and staff supporting them had received training to help ensure they could support people effectively. Support for people who experienced anxiety and distress which may present a risk to themselves or others, would benefit from staff having more specialised training in this area. People who were unable to consent to live in the home had the rights upheld, the provider had applied for the appropriate legal authorisations.

People were supported by kind and caring staff. The effort staff made to understand and communicate with people had improved since the last inspection. Some relatives felt there had been big improvements in people's quality of life.

People were being supported to engage in an increased number of activities both inside and outside of the home. Staff continued to explore what people preferred to do.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The residential model of care meant people did not always have choice and control in their daily lives. There was a lack of choice in relation to the home and who they shared it with. People did not have information in place which detailed their rights and obligations. Lack of space for staff meant staff frequently had to take breaks in people's lounge/dining room. Staff would complete office tasks at the dining tables directly facing people sat in the lounge.

People's dignity was not always upheld due to the lack of access to basic facilities. We raised this with the provider but were not assured by their response that they had fully considered this impact.

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

Rating at the last inspection and update

The last rating for this service was inadequate published 10 August 2021 and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection though improvements had been made, not enough improvement had been made and the provider was still in breach of regulations. We have identified breaches in relation to; staffing, premises and made recommendations in relation to training, visiting and activities.

This service has been in Special Measures since 10 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We noted there had been improvements made but these still need to be fully embedded. We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Le Moors is a residential home which provides accommodation and personal care for up to eight people. Support is aimed primarily at younger adults with a learning disability or autistic spectrum disorder, but the service is also registered to support people with a physical disability, sensory impairment and people living with dementia. Accommodation is provided over two floors, with a lift providing access to both floors. At the time of the inspection seven people were living at the service, all of whom had a learning disability.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The provider did not have enough staff on duty to enable people to receive personalised care that met their individual interests and supported them to live inclusive lives. A relative told us their family member did not receive enough stimulation or support to access community-based activities. Staff needed to be supported to develop skills in recognised methods to communicate with people with a learning disability or autism. We have made a recommendation about this.

Staff had not been safely recruited. Infection control measures still needed to be improved. The visitor toilet was not fit for purpose. The provider had not ensured risk assessments were in place which considered the increased vulnerability of people living in the home to COVID-19. There was no evidence staff had taken any action to assess and mitigate the risks of people being unable to understand the government guidance they should self-isolate in their bedroom following admission to the home or to maintain social distancing.

The provider had not ensured there were regular checks of the environment. The manager had not completed required fire safety checks or documented the support each individual living in the home would require to evacuate the building in the event of an emergency.

Care records lacked detail about people’s interests, wishes and preferences. There was no evidence of goal planning with people who lived in the home to support them to live independent and fulfilling lives. We have made a recommendation about this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had not always ensured people’s ability to consent to their care and treatment in Le Moors had been assessed and applications made for DoLS authorisations where necessary. People in the home were undergoing regular testing in relation to coronavirus but there had been no assessments as to whether this was in their best interests when they did not have the capacity to consent.

The provider did not have effective systems to monitor the quality and safety of the service.

People appeared happy with the staff who supported them. Relatives had no concerns about the safety of their family members in the home and told us staff were kind and caring. Staff understood how to protect people from the risk of abuse. Medicines were safely managed.

The provider worked in partnership with community-based professionals to ensure people’s health needs were met. People appeared to enjoy the food staff cooked for them. Staff took appropriate action when nutritional assessments identified the need for specialist advice.

Some improvements had been made to the range of activities available to people within the home. Some easy read information was available to people living in the home, but this needed to be further developed to support people to make their own decisions and choices. The provider had a system to receive and investigate complaints.

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

The last rating for this service was requires improvement (published 28 February 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Why we inspected

This inspection was carried out partly as a result of whistleblowing concerns we had received regarding the care people were receiving in the home. The provider was in the process of investigating these concerns.

Although not part of this inspection, CQC is continuing to investigate the circumstances relating to the death of a person who lived at the service. The information shared with CQC about the incident indicated potential concerns about the management of people's risk of choking. In addition, potential concerns were indicated about staffing levels, staff training and management arrangements at the service. This inspection covered all these areas.

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

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

We found that at the time of the incident (see below for further information), people had not always received safe care and treatment. People’s dietary risks and needs had not always been managed safely, staffing levels had not always been appropriate to meet people’s needs safely and staff had not always completed the training necessary to keep people safe. There had also been a lack of effective management and oversight at the service.

During this inspection, we found that since the incident, improvements had been made to the management of people’s dietary requirements. Care documentation included up to date information about people’s dietary risks and needs and the staff we spoke with were familiar with how people should be supported with eating and drinking to keep them safe. People were receiving an appropriate diet, which reduced their risk of choking. Staffing levels were appropriate to meet the needs of people living at the service. Staff had completed the training necessary to keep people safe if they required emergency assistance, including if they were choking. Management arrangements at the service had improved. The provider’s representative visited the service regularly and checks and audits were being completed regularly, to ensure appropriate standards of quality and safety were being maintained.

Staff wore appropriate personal protective equipment (PPE) to ensure people were protected as much as possible from the risk of cross infection. Staff had received training on how to put on and take off PPE safely. Enhanced cleaning was being completed throughout the day, to ensure the home remained clean and the risk of cross infection was reduced. There were clear processes in place for visitors to the service. Due to the national lockdown, only essential visitors, such as health professionals, were allowed to enter the home at the time of our inspection. The provider was supporting people to stay in contact with family and friends through regular video calls and telephone calls. The manager was in the process of planning how visits would take place once lockdown restrictions were eased.

Rating at the last inspection

The last rating for this service was Requires improvement (published 28 February 2020).

Why we inspected

CQC have introduced targeted inspections to check specific 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.

This targeted inspection was prompted in part by notification of an incident following which a person who lived at the service died. The information CQC received about the incident indicated potential concerns about the management of people’s dietary needs and risk of choking. Concerns were also indicated about staffing levels, staff training and managements arrangements at the service. This inspection examined those concerns.

During this inspection we found evidence that improvements had been made by the provider since the incident. We found no evidence at the time of the inspection that people were at risk of harm from these concerns.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Le Moors on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Le Moors is a residential home which provides accommodation and personal care for up to eight people. Support is aimed primarily at younger adults with a learning disability or autistic spectrum disorder, but the service also supports people with a physical disability, sensory impairment and people living with dementia. Accommodation is provided over two floors, with a lift providing access to both floors. At the time of the inspection eight people were living at the service, most of whom had a learning disability.

People’s experience of using this service:

The service did not always apply the principles and values of Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not always reflect the principles and values of Registering the Right Support, because people received limited support to become more independent and develop new skills, were not supported by staff to develop goals or take part in activities and were not encouraged or supported to become involved in the community.

There were not always enough staff available to meet people’s needs. Improvements were needed to the management of people’s medicines and infection control practices at the service. The provider recruited staff safely and staff understood how to protect people from the risk of abuse.

Relatives felt staff had the skills to meet people’s needs. Some staff training updates were overdue and we have made a recommendation about this. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people with their dietary and healthcare needs and contacted community professionals when they needed extra support. The environment had been adapted but further improvements were needed to ensure it met the needs of people with a learning disability. We have made a recommendation about this.

Relatives liked the staff at the home and felt they treated people well. We observed that staff did not always treat people in a dignified and respectful way. Staff involved people in everyday decisions about their support. However, they did not always encourage them to be independent or develop new skills. We have made a recommendation about this.

Staff did not always provide people with care that reflected their needs and preferences. Staff knew people well; however they did not always offer them appropriate choices or opportunities which reflected their abilities. People were not supported to follow their interests or go out regularly. People’s care documentation was not always updated when their needs changed. The service did not always provide people with information in a format they could understand. We have made a recommendation about this.

Improvements were needed to the management of the service. Audits of the safety and quality of the service, such as medicines and infection control, had not been completed for many months. The provider did not have effective oversight of the service, as regional manager audits had also not been completed for many months. Staff worked in partnership with a variety of community agencies to ensure people received any specialist support they needed. Relatives and staff were happy with the management of the service. Staff found the registered manager approachable and were able to raise any concerns.

Rating at last inspection:

At the last inspection the service was rated good (published 19 July 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulation in relation to the management of medicines, infection control, staffing, person-centred care and governance. 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 ensure improvements are made to staffing levels, infection control, medicines management and the oversight of the service. We will monitor the progress of 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

Le Moors provides accommodation and personal care for up to eight people, including people with a learning disability and people living with dementia. At the time of our inspection there were eight people living at the service.

Bedrooms at the service are located over two floors and a lift is available. There is an open plan lounge and dining room on the ground floor. Bedrooms do not have ensuite facilities. However, there are suitably equipped toilet and bathroom facilities on both floors.

At the time of our inspection the service had a registered manager who had been in post since 2012. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During a previous inspection on 16 and 17 December 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management, the safety of the premises, assessing and monitoring the quality of the service and supporting people to be involved in the community. We carried out a follow up inspection on 1 June 2016 and found that the provider had made the improvements necessary to meet legal requirements.

During this inspection we found that the provider was meeting all CQC regulations.

Relatives and staff told us they felt the people living at Le Moors received safe care and staffing levels were appropriate to meet people’s needs.

We saw evidence that staff had been recruited safely and the staff we spoke with had a good understanding of how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.

There were appropriate policies and procedures in place for managing medicines safely and relatives were happy with the way people’s medicines were managed. People were supported with their healthcare needs and were referred appropriately to a variety of healthcare services. Local healthcare professionals gave us positive feedback about the service and told us they did not have any concerns.

Staff told us they received an appropriate induction, effective training and regular supervision. They told us communication between staff and with people living at the service and their relatives was good.

We observed that people’s needs were responded to in a timely manner and saw evidence that their needs were reviewed regularly. We saw staff treating people with patience, kindness and affection. One person living at the service told us they liked the staff there. Relatives told us the staff who supported their family members were caring.

The service had taken appropriate action where people lacked the capacity to make decisions about their care. Relatives told us they were involved in decisions about their family member’s care. They felt that staff respected people’s privacy and dignity and encouraged them to be independent.

Relatives were happy with the food provided at the home and we observed people being supported appropriately with their meals. Risks relating to people’s nutrition and hydration were assessed and managed appropriately.

A variety of activities were available at the service and people were encouraged to take part. However, the frequency of people being supported to visit the community and the variety of community trips available needed to be improved.

We saw evidence that the manager requested feedback about the service from people and their relatives. Questionnaires received from relatives demonstrated a high level of satisfaction with the service.

Relatives and staff felt the service was managed well and they felt able to raise any concerns. We observed staff and the registered manager communicating with people and each other in a polite and friendly manner.

The registered manager and regional manager completed a variety of audits which were effective in ensuring that appropriate levels of care and safety were achieved and maintained at the home.

We undertook this focused inspection on 1 June 2016 to check whether the provider had followed their action plan and made the improvements necessary to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Le Moors on our website at www.cqc.org.uk.

Le Moors provides accommodation and personal care for up to eight people, including people with a learning disability and people living with dementia. At the time of our inspection there were seven people living at the service.

At the home bedrooms are located over two floors and a passenger lift is available. There is an open plan lounge and dining room on the ground floor. Bedrooms do not have ensuite facilities. However, there are suitably equipped toilet and bathroom facilities on both floors.

At the time of our inspection the service had a registered manager who had been in post since 2012. 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 the provider had followed their action plan and legal requirements were being met.

People’s medicines were being managed properly and safely and the home environment was safe.

The registered manager had submitted appropriate applications to the relevant authority, where people needed to be deprived of their liberty to keep them safe.

Regular audits were being completed by the registered manager and the provider in relation to many areas of the service. These were effective in ensuring that appropriate levels of care and safety were achieved and maintained.

Communication at the service had improved and the handover of information between staff during shift changes was more effective. This meant that staff were able to keep up to date with people’s needs.

People were being supported to go out into the community more often. However, there was a lack of variety in relation to where people were being supported to go.

We reviewed information about two people's care and found their care needs were being planned for. We found the staff understood people's care needs and how to protect them from risk and harm.

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plans.

Suitable arrangements were in place to ensure people were safeguarded against the risks of abuse. However we did find additional arrangements were required to ensure people's finances were managed effectively.

We saw there were effective recruitment procedures and checks were in place to ensure people's health and welfare needs were met by staff that were and qualified to do their job.

We found suitable arrangements were in place to deal with and manage any complaints made about the home.

We found their rights to privacy; dignity and independence were upheld and respected.

People's care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments and daily care records. This meant people's care could be readily monitored and evaluated.

Staff told us they were supported by the management and had regular supervision and appraisals as well as receiving updated training.

The environment and safety and suitability of the premises was safe and suitable for the people living at Le Moors.

The service had implemented regular audits and risk assessments as well as consulted with service users and family members to monitor the quality of service provision.