The Moreton Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People's care plans and risk assessments were very detailed in some areas but not all personalised as information was not always accurate and reflected their changed needs. For example, mobility and mental health needs. There were areas of how to achieve outcomes, but these were not updated to reflect whether it was achieved or what worked and what didn’t. Not all care plans had been updated to reflect important changes. Daily notes were not detailed or personalised enough to inform staff of changes required.

Whilst there was information about what people enjoyed doing with their time and what was important to them this was not fully reflected with in their care plans as to achieved outcomes. In one person’s care plan it stated that the person was very active and got easily bored which impacted on their mood. It also stated that regular trips out were important, for their mental health and 2 staff needed to accompany them. However, it was difficult from their documentation as to how often this occurred and whether it had been achieved and benefitted their anxieties.

There were some very detailed mental health care plans, which also included incidents that had occurred and the management of the incidents.

The activity staff were a team of 2; they were very pro-active but not able to always spend time with people on a 1-1 basis due to people’s changing mental health needs and staff deployment. They, however knew people well and we saw that their interaction with people was positive. The activity room was a lovely area for people to attend group activities and for film afternoons. Ideas for activities, trips and external entertainers had been discussed at the last resident and family meeting.

Visitors told us, “The staff work hard, I’ve seen the staff playing games with people in the lounge and I feel they do a good job” and “I have had a few questions regarding what happens in the day for my relative, I was worried that they were just sitting, but staff explained what happens and gave me the activity plan, no complaints.”

The majority of people’s bedrooms were personalised and contained items that were important to them. Families confirmed they were able to bring in personal items to make their room homely.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Families told us, “A doctor visits, so does the chiropodist, I think they have a hairdresser but my loved one hasn’t needed a haircut so far,” “They let me know of appointments and any problems, it’s very organised, I think” and “I visit most days, it’s still new to me, but staff understand that and offer me teas and coffees, very kind.”
Staff told us that they worked alongside families and always informed families of any appointments and kept a record of the appointment and advice given.
A health professional told us, “Staff are generally very helpful, and know their residents well, it’s had a few changes in management lately, but it seems to be efficient service.”
There was evidence of regular partnership working with health professionals such as specialist nurses, and therapy teams. These records could be better linked to the care plans, but they showed responsive co-ordinated care. Staff were able to discuss how they ensured people were treated equally and fairly no matter their age, sexuality or their health diagnosis. They told us of their knowledge of the Equality Act and how they used this in supporting people and decision making.

The provider had not always supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The standard applies to all people with a disability, impairment or sensory loss and in some circumstances to their careers. Staff responded to people’s communication needs. These were assessed and recorded within individual communication care plans. These included specific information on how people’s communication needs could be met and what aided their communication. For example, those who needed spectacles or hearing aids had specific care plans.

However, in some people’s care plans it mentioned visual aids, such as picture boards, and a communication folder, but we did not see these in use throughout the inspection. For one person there were key phrases on their bedroom wall but nothing in place when in communal areas. Staff spoken with did not know of a communication folder or picture board for the person.

Systems to support people to communicate with staff, relatives and friends had been assessed and promoted. For example, video calls could be set up and staff supported people to phone their loved ones as necessary. All care plans were on a computer, and this enabled them to be printed off for family, hospital appointments and transfers. They could also be enlarged for those that had sight impairment.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, we were not assured that the management team had responded to people’s views.

People and relatives told us that they were provided with information in a timely way. Family spoke of meetings held where they could bring up any issues and discuss ideas regarding social events, staffing and other ‘home’ specific agenda points. However, whilst we saw the minutes from the last meeting, it had no date so were unsure whether some of the actions had been responded to. For example, access for families on the care plans remotely and a regular newsletter. Other issues raised by families included lack of communication about residents’ wellbeing, falls, infections, medications, and general updates. The registered manager has committed to improving communication with families, restarting regular monthly resident review/update calls and ensuring concerns and updates are documented properly on the Nourish system. We could not measure this at this time as there had not been a further meeting yet.

There was a complaints policy and procedure, we saw that concerns raised had been responded to promptly and thoroughly. The management team kept a log that ensured the registered manager had an overview. They told us they had an open-door policy, and we saw staff and relatives popping in to speak to the registered manager to share information and ask questions. Relatives told us, “I can raise anything face to face, the staff will take action immediately and I know it will be taken seriously.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Systems were in place to help ensure people were not prevented from receiving the care and support they needed due to their health or disability. The service management and staff told us they worked with external professionals to help ensure people received the relevant health and social care support they required. This was confirmed by people’s records which included support and guidance provided by external professionals who were involved in people’s care.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Information about people’s communication needs, cultural preferences, health conditions and any other factors that could increase the risk of inequality was gathered through initial assessments, regular reviews and ongoing conversations with people and their relatives.

The registered manager and activities co-ordinator told us there was a focus on creating varied events for all people and providing opportunities to connect with the local community, such as trips out in good weather and reaching out to external visitors, involving local young people and pets.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff worked closely with people to make plans about their future care. For example, people and their families were involved in planning how they would like to be cared for at the end of their lives. It was acknowledged that some people found these discussions difficult and so staff gathered information slowly and added important details after hospital admissions. There were some people without family and the care plan states an IMCA (Independent Mental Capacity Advocate) has been requested.

Care plans identified people's preferences at the end of their life and the service co-ordinated palliative care in the care home where this was the person's wish. Care plans contained information and guidance in respect of peoples' religious and resuscitation wishes. Most people had ReSPECT forms. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment and ensures their personal wishes are followed. Most people also had a DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) decision, also known as a DNR (Do Not Resuscitate) order,which were accessible to all staff and health professionals should a situation arise. Relatives and friends were supported with compassion through these difficult times. For example, visiting for those people at the end of their lives was extended, with the facility to stay overnight if wanted. DNACPR and ReSPECT forms were discussed with people and families, staff made sure people understood their options and what it meant to request withdrawing care, or not receiving care, to allow them a dignified death.