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Real inspection cases

Read our latest case studies on what our inspectors do during a visit, and how we make positive changes to health and social care services.

Residents at a care home in Hampshire are now receiving better care after the home made significant changes following a series of CQC inspections earlier this year.

At the start of 2013, Moorwood Cottage Care Home was struggling to provide good care to residents - many of whom had very high nursing and dependency needs.  

What did our inspector do?

Serious concerns were identified and enforcement notices issued following a number of unannounced inspections by CQC inspector Julia Adey and a clinical expert in the field of nursing care. These notices related to care and welfare, nutritional needs and staffing levels.   

“Moorwood Cottage took our concerns very seriously,” says Julia. “They started to implement some new ways of working very quickly.

“The culture of a place doesn’t change overnight, but some of the initiatives put in place in those first few weeks set the tone for the significant improvement that we have seen over the last months.”

What changes did the care home make?

A new registered manager

Image of Gary Briggs, Registered Manger of Moorwood Cottage Care Home
Gary Briggs brought with him some innovative ideas about how Moorwood Cottage might tackle some of the organisational issues staff were facing. These organisational issues had resulted in people not getting the high quality care they needed.

Gary said: “We haven’t stopped working to improve things for the benefit of our residents.

Next on my list is to further improve the clinical training for all of our staff at Moorwood, which I’m hoping to start in the next few months. I am delighted with the progress that we’ve made, and look forward to keep driving up the quality care that we offer at Moorwood Cottage Care Home.”

Updated care plans

Within a month all the care plans for residents at the home had been reviewed and rewritten. This ensured the individual needs of the residents had been identified. 

Better monitoring of people's needs

Moorwood introduced a system of ‘intentional rounding’ – this is a structured process where staff carry out checks with individual people at set intervals.

Gary Briggs explained: “Intentional rounding is a simple and effective way of monitoring people at regular intervals throughout a 24 hour period. At Moorwood Cottage we use it to record the checking and changing of incontinence pads, and the position and turning of those who are unable to reposition themselves.

“This means that not only are we systematically recording key information about our residents, but it is consistent, clear and easy to read so all staff can manage the care needed.”

A ‘fluids champion’ was appointed to ensure that people were supported to drink and changes were made to the way in which care was delivered by staff. These changes meant that staff could work more efficiently as part of a team.

Julia also highlighted the fluids champion as an excellent initiative.

“When we visited in March we observed that people who were unable to access fluids independently were often not supported to drink,” she said.

“But the appointment of a ‘fluids champion’ meant that a system was in place to support people to drink more regularly. Fluid charts were maintained for all people who were unable to drink without support.

“This meant that fluid intake was monitored daily and staff could ensure that people’s fluid intake was sufficient for their needs.”

Improving staff rotas

The staff rota for both nurses and care workers was reorganised so that they worked more effectively.

“We can now see that nurses take charge of the care. Care workers now work in teams with an extra care worker available to assist with personal care and nutrition,” said Julia.

“This new way of planning the work and organising the teams meant that people’s needs could be met without hiring new staff.”

What is the quality of care like now?

Gary Judd, director of care for Adiemus Care Ltd, the provider for Moorwood Cottage said: “We had to hear some tough messages from CQC at the start of this year, but I am really pleased with the progress that’s been made by the manager and staff at Moorwood Cottage.

“The wellbeing of our residents is our number one priority and with the support of CQC we are making sure that we continue to improve the standards at Moorwood Cottage so that we can rightly be seen to be delivering high quality care.”

Moorwood Cottage - who voluntarily agreed not take in any new residents whilst they were making the changes and improvements - has now started to open their doors again.

Julia explained: “Whilst there are still elements at Moorwood Cottage that need to be worked on, I am really pleased with the positive reaction that we have had from the staff and management. They have embraced the new practices that have been introduced.

“The regional manager and the registered manager worked hard to move from a position where CQC were really concerned about the care being offered, to a place where we can see a big improvement in the environment, culture and most importantly the health of the residents,  who tell us they feel happy and safe.”

An innovative assessment checklist for granting leave under Section 17 of the Mental Health Act has led to improvements in care for detained patients at a mental health trust in Hampshire.

The 'Five Cs checklist'

The ‘Five Cs checklist’ was introduced by St James Hospital Southsea in 2012 after a visit by our inspector Yasin Rahim.

“For people detained under the Mental Health Act, periods of leave from a mental health ward are often an important element of a recovery programme,” said Yasin. “[They can help] patients begin to reintegrate back into community life.

“However it’s also an area of potential risk for patients, which is why when we visit mental health trusts the process by which nurses and clinical staff authorise leave is a key area that we look into.

“Ensuring there are clear and consistent risk assessments in place can greatly reduce the chances of patients going missing or causing themselves harm.”

What are the five Cs?

The Five Cs checklist makes sure staff consider the following when planning and granting leave for detained patients:

  • circumstances of where someone is going
  • clothing worn
  • consideration of risk
  • current mental state
  • contingency plan

“Over the last nine months, I have been in regular touch with the staff at St James. I’m impressed with the ‘Five Cs’ system they have put in place.” said Yasin. “It is a simple approach, yet incredibly effective. The added reminders around the staff areas, including a laminated credit card-size copy of the ‘Five C’s’ handed out to all staff means [the checklist] has now become standard practice in the hospital.

“I’m reassured that the welfare and safety of the people using the services at St James are not at risk and individual’s needs are being considered,” he adds.

What difference has the five Cs made?

Kinsella Kieran, Head of Adult Mental Health Acute and Residential Services at St James, said:

“The ‘Five Cs’ have made a big difference to how we approach Section 17 leave. [They] give the staff assurance that when any of our patients are on home leave, they have had a proper individual assessment and we know where they are and when they’re coming back.

“Because we have done a full assessment and are more confident about procedures, patients tell us that they feel that they are receiving safe and supported care. [This] creates a happier environment for our patients to focus on their rehabilitation.”

“It’s our job as inspectors to not just regulate and report on poor care, but to also drive up the quality of care being offered,” said Yasin.

“It’s been very satisfying to work with the staff at St James Hospital - [they] have worked hard to continue to improve their services and the positive impact this has on their patients,” he added.

New Directions provides care exclusively for people with Prader-Willi syndrome (PWS) in five care homes on the East Sussex coast.

What is Prader-Willi syndrome?

People with PWS can have highly complex needs and often need help to live independent lives, including extensive support with their diet to prevent obesity - one of the syndrome’s main features.

Making improvements

In the last few years inspector Caroline Johnson has been visiting the New Direction homes and has seen them grow in confidence. As a result of better care, people have been able to manage their weight and have reported big improvements in their health.

The service has:

  • improved care planning
  • used the current best practice techniques
  • researched latest guidance
  • closely involved their residents in the development of their own plans

Caroline reports, “New Directions has done fantastic work over the years to support people with PWS.

"When a lot of people move to a New Directions care home they are morbidly obese and have complicated health issues exacerbated by their weight.

"When new residents arrive, they are given a clear programme with a strict diet and regular exercise included, which is continually updated throughout their time with New Directions.”

Regularly reviewing restrictions

Each of the homes has restrictions in place around access to  food, which everyone is  aware of and understands, including the kitchen area which residents can only enter under supervision. Staff are encouraged to eat with residents at mealtimes and they have the same choice of controlled meals as the residents.

These restrictions are reviewed regularly and are only in place for as long as they are needed to maintain the health and safety of the residents,

Some of the homes that had been in operation a long time had relaxed restrictions on access to the kitchen areas but the larders remain restricted.

Caroline went on to say, “There are clear guidelines in place and because of this, people know where they stand and what is expected of them. One person recently told me when I inspected that they finally had people who understood their condition and who could support them, adding that this was the first time in their life they had felt safe. This is a pretty powerful message, and shows that the provider must be doing something right.”

New Directions are expanding their service and have recently registered to set up a home care agency to provide support to people with PWS in supported living settings.

Caroline adds, “Of course, New Directions cannot be complacent about the services they run and we will continue to monitor them to check they meet the required standard, but the feedback we have had from people in their homes are telling us that the services provided really help build self esteem and make a really positive difference to their lives.”