The Moreton Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We saw that whilst people’s care plans and risk assessments were regularly reviewed, changes were not consistently recorded in all sections of the care plan to ensure they remained up to date and reflective of people’s current needs. This was in respect to people’s deteriorating health, such as mobility and nutrition.

People’s needs were assessed before they began using the service. These initial assessments identified and documented the support people required, including for example, support with personal care, medicines, communication, and diet and nutrition. Information gathered during the assessment process was used to develop personalised care plans and risk assessments. People using the service, their relatives, and relevant health and social care professionals were involved in these discussions to ensure individual needs and preferences were fully considered and met.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Records included guidance for staff relating to people’s health conditions, medicines support, nutrition and mobility needs. Recognised tools and guidance, including the Malnutrition Universal Screening Tool (MUST) and International Dysphagia Diet Standardisation Initiative (IDDSI) guidance were used to support the delivery of care.The management team had oversight of these and planned action appropriately with the involvement of family and the staff team. The service had links with other organisations such as tissue viability services and speech and language therapists (SaLT).

The service worked with a multidisciplinary team (MDT) to ensure relevant and up to date treatments were used. Advice given by SaLT team was followed in relation to food and liquid consistency as it applied to people individually. Kitchen staff were familiar with people’s needs in this regard and ensured all meals were adapted as needed.

Leaders kept up to date with legislation and evidence-based standards by regularly accessing the CQC and the Social Care Institute for Excellence website. Leaders worked together across the providers and other homes to share good practice.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff attended regular MDT meetings which helped ensure all parties involved with supporting people were aware of up-to-date needs and developments. Information was shared as needed in line with privacy legislation.

There was evidence of regular interactions between the clinical staff and other healthcare professionals, the GP conducted a ward round every week, and this was led by the clinical lead. The GP we spoke with said, “No concerns, they know their residents and contact us appropriately.” There was documentation within the care plans of involvement from podiatry, mental health team, and the tissue viability team. Staff reported that engagement with other professionals included family involvement to ensure people’s needs were supported and care plans were reviewed. This highlighted that there was an engaging and collaborative approach to people’s care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported to access services to improve their health and wellbeing, for example, chiropody, audiology, hairdressing and opticians. Dental care in the community was proving to be a challenge, but we were told that they have referred through the GP for advice on occasion. One person had recently attended a clinic for dental care and were awaiting hospital referral for tooth extraction.

A professional told us staff had responded appropriately when a person experienced difficulties with eating. Following assessment and treatment, the person was able to make choices about their food with staff and as a result was enjoying their food again and eating healthily. This meant people were supported to maintain their wellbeing, and quality of life.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Care records identified examples where care plans contained clear interventions and how to achieve outcomes, but daily records did not consistently demonstrate whether these had been achieved. For example, one person's care plan identified the need for staff to support emotional wellbeing with garden visits and activities to reduce social isolation and encourage participation.

However, daily records were task-focused and did not evidence whether these outcomes were being monitored or reviewed. For another person, records showed monitoring of falls, however, there was limited evidence showing how information from repeated incidents were being analysed to understand patterns and measure the effectiveness of interventions. As a result, opportunities to review progress and improve care were missed.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We saw that some practices during 1-1 support that could be seen as restrictive practice. Whilst there were details in the persons care plan as for the purpose of the 1-1 it did not detail the specifics of what close monitoring entails. There was also no reflection of the 1-1 being included in all the DoLS applications. For example, the placement of the staff in a chair in the doorway of the persons bedroom and sitting in front of the person to prevent them getting up and walking. From talking with staff, it appeared to be more of a lack of understanding of the purpose of the 1-1 than deliberate restraint. We asked one staff member what they considered their role with the person they were supporting on the 1-1 and they responded, “To stop them entering other residents’ rooms.” We also saw that some people were in recliner chairs and tilted back with no way of getting up on their own. This had not been considered by staff as a restriction but for their comfort, despite being able to walk.

Staff had received training in mental capacity and the importance of making decisions in people’s best interests. Staff were aware of the importance of gaining consent from people, one telling us, “Always ask first, never force a decision.” We did see staff asking people if they wanted a drink or assistance when walking.

Staff told us if they noticed any change in people’s ability to make decisions, they would immediately report to the manager, and a new assessment would be completed. People and their loved ones confirmed that people were given opportunities to make their own decisions. One visitor said, “Alway polite and ask my relative what they want, no concerns at all.” Another relative added, “I see carers always ask permission if they see someone needs help.”