The Moreton Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

Incidents and accidents were recorded, however we were not fully assured that lessons had been learnt from these and appropriate actions taken to prevent a re-occurrence as there was minimal reflection in people’s care plans and risk assessments of actions taken.

The premises needed attention to ensure equipment was working efficiently and the environment was suitable and comfortable for the people who lived there.
Medicines were administered as prescribed and managed safely, however we identified some areas of practice that needed improvement in relation to PRN (as required) medicines and the management of medicines given in a covert way.
Staffing levels were sufficient to keep people safe and to monitor their health and well-being, which had contributed to good outcomes for people. Staff were caring and kind with people and had training and supervision to provide safe care.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Safety concerns and events were reported on, and an overview kept by the registered manager. However, the analysis approach was varied, whilst some were in depth detailed and with actions, others had minimum reflection of how it occurred, the steps taken to prevent it happening again and how lessons were learned to embed good practices going forward.

Staff could tell us examples of how they managed incidents, but outcomes and strategies were not always clearly documented or recorded within risk assessments. This meant it was not always possible to monitor improvements and positive outcomes or escalations of risk.

Leaders were able to give examples where some learning had been applied, such as actions taken in response to concerns and complaints. However, some relatives and staff did not feel able to raise their concerns about the service. We were told, “I have raised things, but nothing happened, so now I don’t always raise concerns,” and “It’s disheartening to raise things and be ignored.”

Safety checks were undertaken by staff, this included environmental checks, and risk assessments for both physical and mental health. This enabled the management team to embed the culture of continuous improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported to safely access systems and transitions between services as needed. The management team advised us that all people were assessed before admission to ensure their needs could be safely met. We were told by staff of one admission that was not appropriate, we discussed this with the registered manager who informed us that the person was moved to a different unit as soon a bed became available.

There was a thorough pre-admission process to ensure the service could meet people’s needs, both physically and socially. The care plan system also had a short plan of care for each person that could be printed off, that ensured a smooth transition to hospital should the need arise. People’s care plans included reminders for staff of what to do if a person’s physical or mental health needs changed and who should be involved in the ongoing care.

Staff and leaders demonstrated good knowledge of referring to external professionals when needed. Referrals to the multidisciplinary team had been requested via the GP, these included requests for support from Speech and Language therapists (SALT), the community nurses and the community mental health team. Staff also explained how they worked closely with the community rehabilitation team to prevent risk of people falling. Visiting professionals spoke of a positive relationship with the home and we saw that community nurses were informed of all new admissions and a GP visit arranged as soon as possible.

The provider did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Feedback from staff and visitors told us that not all incidents were reported on and followed through to ensure people’s continued well-being. We have asked the provider to investigate the concerns we were given information on and report back to CQC and the local safeguarding team as necessary.

Training records showed staff had completed safeguarding training. There was a system in place for recording safeguarding concerns which helped management have oversight over this.

Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at yearly safeguarding training.

People were supported with kindness and respect by staff who knew them well. There were a high number of people on 1-1 support and staff were seen to be respectful and interacted with the person without unlawful restrictions.

Staff were mindful of people’s characteristics and promoted their dignity. People were asked for their consent and were involved in day-to-day choices and decisions. For those who were at risk of falls when mobile, sensor mats were in use and the rationale documented for their usage.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff received training in the principles of the MCA and understood their role and responsibility in upholding those principles. The registered manager kept an overview of all DoLS applications and those that are completed, pending and those that were refused. Individual care plans were very well documented in respect of restrictions and the reasons for the restrictions.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Each person had individual care plans and risk assessments that were clear, comprehensive and up to date. Staff had access to peoples’ risk assessments and care plans. These provided sufficient information about people’s risks and mitigation strategies for staff to provide safe and effective care. Staff were able to tell us about the people they supported and the risks associated with their care. This included personal care, nutritional support, safe mobility and what to do when people become distressed. Staff told us, “We know our residents very well and so pick up when they are not well, we monitor their behaviour, weight and encourage them to eat and drink.” We discussed with staff, how they supported people who became distressed, they were able to tell us how they used distraction techniques, such as taking them to another area or their bedroom, using music or books. Records for these incidents were minimal with little reflection if the distraction techniques worked and this was being addressed. Staff also told us what strategies were in place for people at risk of falls. These included sensor mats, lowered beds, location checks, appropriate footwear checks, and 1-1 support.

We spent time with people and staff both in communal areas and in peoples' bedrooms. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance. Staff recorded these checks on the persons’ care documentation. People who were not eating or drinking enough were monitored carefully and staff recorded their intake. Call bells were in peoples' rooms, and there were risk assessments and strategies in place for those who couldn't use a call bell and we saw that staff checked people regularly to ensure their safety.

We observed equipment being used appropriately to reduce people’s individual risks, such as pressure cushions. People were assisted by staff in a safe way. Corridors were free from obstruction, allowing people to walk safely if they choose to.

Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation. However, these were not all correct and in line with people’s needs and room numbers. These were immediately rectified and the risk mitigated.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We observed some parts of the home were in need of repair, redecoration and that new furniture was required. People’s rooms were not all personalised, well decorated and comfortable. There was a lack of dementia friendly signage to assist people in moving around the units and not all clocks were set to the correct time. Dementia friendly signage helps orientate a person living with dementia and allow them to maintain their independence.

There were not enough dining chairs in dining rooms, which meant not all people could not sit at the table and therefore missed out on the meal time experience. It also meant staff could not sit and assist people with their meals in a safe way and in line with good practice guidance. New chairs were ordered and arrived during the assessment process.

Some areas of the home were potentially unsafe. For example, plug sockets in bedrooms and issues with windows that could not close due to poor maintenance. There were also trailing wires from people’s equipment that could be a trip hazard. The washing machines and a tumble dryer were not working efficiently, despite being reported on, over the past six months. All the cleaning trolleys in use had broken locks, which meant that whilst in use they could not be locked to protect the contents from people. The providers health and safety audits had not identified these issues and associated risks. The issues were immediately acted on and we have received an action plan of on-going work.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives told us, "I think the staffing is good, always very visible. Staff told us, “We have good staff, we use a lot of regular agency staff, but I believe we have more permanent staff starting soon,” and "We could do more outside trips if we had more activity staff, but we have enough staff to do our job well I think.”

Our observations showed us that staff were visible and available to support people’s requests for help and take the time to sit with people to engage positively, to assist them with food and drink if necessary. People received timely care, call bells were answered promptly. There were currently 10 people who were on 1-1 support and these were additional to the normal staffing levels.

We looked at 3 months of rotas and the staffing levels were consistently supported by relief staff to cover sickness and holidays. Care delivery was supported by records that evidenced that people’s care needs were being met.

Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions.

Agency staff checks were completed by the agency and supplied to the management team at The Moreton Centre. Not all information was current regarding their training, but this was updated during the assessment process. We were told this was an oversight.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

People and their relatives did not share any concerns about the cleanliness of the environment. We were told, “It’s clean, décor could be better, but it’s functional,” “It is a busy home but I would say it’s clean enough, and “No complaints really, it looks worn in areas, but clean.”

Staff had concerns regarding some equipment not working efficiently. It was found that the washing machines could not be used on the correct programme for soiled washing and this was a potential source of infection.

There was some miscellaneous equipment left on one unit which was not clean and was accessible to people. This was removed immediately to mitigate risk to people.

Some furniture that was in poor condition was a potential source of infection due to split coverings, some furniture required deep cleaning due to stains. There were damaged/missing tiles in communal bathrooms around toilets which meant cleaning was difficult. These were addressed immediately during the assessment.

The provider followed best practice guidelines regarding the prevention and control of infection which was updated as guidance changed. The provider’s infection prevention and control policy was up to date and all staff had received infection control and food hygiene training. Cleaning schedules were completed and regular audits were carried out and actions planned to address any shortfalls, however these processes had not identified the issues we identified. This is reflected in the well-led question.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

There were people who received their medicines covertly. Covert administration is when medicines are administered in a disguised format, sometimes in food and drink. We were not assured that the organisational covert guidance was followed in respect of being offered overtly up to 3 times before administering covertly. This was because the documentation seen did not support the rationale of medicine being given covertly on a regular basis. There was also no reflection of alternative methods considered and how they made the decision to administer medicines covertly. A new form has been introduced to guide staff and to ensure guidance was followed.

Protocols for 'as required' (PRN) medicines such as pain relief and anti agitation medicines were in place.These were generic and not tailored for each individual. Work was on-going on the Electronic Medicines Records (eMAR) to ensure PRN guidance for each person was specific to them.

Not all photographs for identification on the eMAR were recognisable as the person and this was a risk for when relief staff were working as people could not always tell the staff member their name.

These areas were fully discussed and amendments made to individual people’s documentation during the assessment process.

Staff showed respect to people within the service whilst supporting with their medicines. Staff approached people individually and waited with them whilst they took the medication. They used hand held devices to identify the person and record that they had taken them. The service had safe systems for appropriate and safe handling of medicines. Medicines were stored safely within locked rooms on each unit. Room and cupboard temperatures were recorded daily to ensure the medicines were stored at the correct temperature. Policies and procedures were in place and had been reviewed regularly. Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and these were recorded accurately. Risk assessments were in place for certain medicines. All discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed.