Background to this inspection
Updated
12 May 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was undertaken by three inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
The Moat House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Moat House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection took place on 14 March 2022 and was unannounced. The Expert by Experience undertook telephone calls to people’s relatives on 15 March 2022. We met with the provider and manager to conclude the inspection and give feedback on 25 March 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with two people who used the service and 11 relatives about their experience of the care provided. We spoke with five members of staff, including, a senior, care staff, housekeeping and the cook. We also spoke with the manager, deputy manager and the area manager, who was a representative supervising the management of the service on behalf of the provider.
We reviewed six people’s care files and four staff personnel files. We looked at the provider’s arrangements for managing risk, medicines management, staff recruitment and training data, and the complaints process.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
After the inspection
We continued to seek clarification from the manager to validate evidence found. We looked at variety of records relating to the management of the service, including governance documents, policies and procedures.
Updated
12 May 2022
About the service
The Moat House is a residential care home providing the regulated activities personal and nursing care to up to a maximum of 72 people in one adapted building, over three floors. At the time of our inspection there were 24 people using the service.
People’s experience of using this service and what we found
People and their relatives told us the change in provider, and further changes in management had continued to make them feel unsettled, commenting on a lack of leadership. The previous registered manager resigned and cancelled their registration in November 2021. A new manager was appointed in December 2021 and was in the process of making an application to CQC to become the registered manager.
People and their relatives felt communication needed to improve. A continuing theme was the poor signal and bad reception which caused difficulties for people when contacting their family member and the service.
People did not always receive consistent, timely care and support from familiar staff who understand their needs. High turnover of staff and use of temporary agency staff has impacted on the services ability to meet people's needs, including those who received care in bed. People and their relatives spoke of loneliness and a lack of stimulation.
Risk management needed to improve. We found no evidence people had been harmed, however people were at risk of harm because systems were either not in place or robust enough to keep people safe and manage risks to their health and welfare effectively. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.
We have made a recommendation about decision making in accordance with the Mental Capacity Act 2005.
Improvements were needed to ensure people received personalised care responsive to their needs. Poor recording, and a lack of measures in place to encourage people reluctant to drink, put people at risk of dehydration and developing pressure wounds. People were supported to access healthcare services, however a consistent theme related to people’s lack of oral healthcare and access to a dentist.
We have made a recommendation about managing people’s oral health care needs.
We were somewhat assured systems in place for preventing and managing the risk of spreading infections were being managed effectively. Medicines were managed safely.
People did not always receive good quality care, support and treatment because staff training was not embedded into practice. Staff had completed a range of training to deliver safe and effective care but had not always followed current evidence-based guidance, standards and best practice.
Relatives commended the service for the end of life care provided to their family members. However, further work was needed to ensure advanced decision-making plans for end of life care are developed for all people using the service. This will ensure they have a comfortable, dignified and pain-free death in accordance with their wishes.
The provider had systems in place to acknowledge and respond to complaints about the service.
The service was not consistently well-led. Whilst the provider has governance systems in place, these were not yet well-embedded into the running of the service or being used effectively to drive the required improvements. These were not always reliable and effective in identifying risks to people’s welfare and safety. There was a limited approach to obtaining the views of staff, people who use services, external partners and other stakeholders.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 30 July 2021 and this is the first inspection. The service was previously registered under HC-One No.3 Limited. The last rating for the service under the previous provider was rated inadequate published on 3 December 2019.
Why we inspected
The inspection was prompted in part due to concerns received about poor management of people’s weight and pressure wounds and incidents including falls and skin tears not being reported and investigated appropriately. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.
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.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, person centred care, staffing and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.