We carried out a review of the data available to us about Moorgate Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Moorgate Residential Home, you can give feedback on this service.
Moorgate Residential Home is registered to provide nursing and personal care for up to 37 people. Since our last inspection the provider had increased the service from providing care from 21 to 37 people. There were 32 people living at the home on the first day of our inspection.
Moorgate Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.
The home is a large detached house on the edge of the village of Yelverton on the Dartmoor park. The home is set over two floors with two passenger lifts providing level access to each floor. There were several communal lounges and two dining rooms where people could spend their time as they chose. People had access to a safe and secure garden area where they could sit if they chose.
At our last inspection in June 2016 we rated the service Good overall with the responsive domain awarded outstanding. At this inspection we found the service remained Good overall and Outstanding in the responsive domain. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Why the service is rated Good.
There was an excellent understanding of the importance of seeing each person as an individual, with their own social and cultural diversity, values and beliefs. They continued to recognise the importance of social activities and understood meaningful activities formed an important part of people’s lives. Staff were extremely passionate about the activities at the home being meaningful and appropriate. They had established people’s hobbies and interests and supported them to revisit them. There were numerous examples of people doing meaningful activities.
People’s care was centred around them as individuals and was responsive to their needs because staff had a good knowledge of them. Staff were able to tell us detailed information about people’s backgrounds and life history from information gathered.
People received very good care and support from staff who valued them as individuals. Staff were highly motivated to ensure people received care which was compassionate, friendly and kind. They treated people with respect and dignity. There was a friendly atmosphere at the home and a strong ethos from all staff regarding it being a family and people’s home. The registered managers and staff daily went above and beyond what was required to support people. We were told numerous incidences where this had been the case. Everyone we spoke with described a marvellous, caring, kind, friendly and respectful staff team. One person said, “It’s a brilliant, wonderful, lovely place.”
There were good staffing levels to meet people’s needs. Staff knew people very well and understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes. People where possible and appropriate family members were involved in developing and reviewing their care plans every month.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was well led by the registered manager. The culture was open and promoted person centred values. People, relatives and staff views were sought and taken into account in how the service was run. There were effective systems in place to monitor the quality of care provided. The registered manager made continuous changes and improvements in response to their findings.
The registered manager and staff were committed to ensuring people experienced end of life care in an individualised and dignified way.
People remained safe at the service. People said they felt safe and cared for in the home. People were protected because staff knew how to recognise signs of potential abuse and how to report suspected abuse. People’s care needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and met. Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.
Staff received a comprehensive induction and were knowledgeable. They had received training and developed skills and knowledge to meet people’s needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005.
People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service. People were supported to lead a healthy lifestyle and have access to healthcare services. Staff recognised any deterioration in people's health, sought professional advice appropriately and followed it.
People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the management team. There had been no complaints received at the service since our last inspection. Where there were niggles, or concerns the registered manager took action promptly to resolve them.
The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. People were protected from unsafe and unsuitable premises. Risks for people were reduced by an effective system to assess and monitor the health and safety risks at the home. The home had a pleasant homely atmosphere with no unpleasant odours and was very clean throughout. The furnishings were of a good quality and in good condition.
Further information is in the detailed findings below.
Our previous scheduled inspection of Moorgate Residential Home on 15 July 2014, found the provider had failed to protect people who used the service against the risks of unsafe or inappropriate care. They had failed to accurately record details of the care provided. Our following focused inspection, in October 2014 found the standard of record keeping had improved and this was being closely monitored.
Moorgate Residential Home provides accommodation and personal care up to a maximum of 21 people. Health care needs are met through community health care services, such as district nurses. There were 20 people using the service at the time of this inspection.
The service is required to have a registered manager because the provider is an organisation. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of Health and Social Care Act and associated Regulations about how the service is run.
A great deal of care and attention was given to ensuring people’s individual needs were met. This included understanding their physical, mental, social and psychological needs. A very full and well considered activities programme provided stimulation and interest for people based on their past histories and current interests and hobbies. The main lounge was awash with creativity, which was centred on providing a rich and interesting life for each individual living at the home.
Health care professionals spoke highly of the standard of care provided; they praised the skills of staff.
People’s medicines were managed for them in a safe way.
Staff were trained, supervised and supported in their roles. Recruitment protected people and the staffing numbers were under regular review.
Staff understood how to protect people from abuse and harm and uphold their legal rights.
People enjoyed the food provided, which was balanced and nutritious with choices at every meal and snack time. Individual preferences and special dietary needs were being met.
The home environment was pleasant, well maintained and homely. A new building, which will increase the lounge areas from one to three, was under construction.
Staff treated people with respect and dignity, kindness and patience. People privacy was upheld.
The registered manager and provider worked in collaboration and were very visible at the home. People and their visitors spoke highly of them. Any issue was dealt with straightaway. There had been no formal complaints.
There were robust monitoring systems in place at the home. This included the registered manager personally checking that improvements were working as expected, in case further improvements could be made.
People’s views were sought and acted upon promptly. Staff were encouraged and supported to look for innovative ways to improve the service, with the needs of the people using the service being the priority. People lived in a homely, nurturing environment.
On the day of our visit we were told there were 21 people living at Moorgate Residential Home. We spoke with one person living at the home and observed several others spending time in the sitting rooms. We spoke with the deputy manager who was the person in charge at the time of our visit. We looked at computer and paper records relating to people's care, medicine records and communication methods used by care workers in the home.
Below is a summary of what we found. The summary describes what we observed and the records we looked at.
Is the service safe?
People's computer and paper records included information which protected them from unsafe or inappropriate care. For example, we saw how any concerns, such as a change in mood, were communicated to other care workers and when the concern was dealt with this was recorded. We saw that people's care was under regular review and it was clear from records when risk increased and how people were protected through risk management.
Is the service effective?
Records showed where outside agencies, such as the district nursing service were involved in people's care. We also saw from records how people's health was monitored, through weight checks and dietary monitoring, where appropriate. The records provided information on who was involved in people's health care management and what actions were required to maintain people's health and well-being.
Is the service caring?
We observed care workers providing sensitive care. For example, one person was recently bereaved and the deputy manager shared a joke with them and a cuddle when they needed this. Care workers had a good understanding of the people in their care and were able to engage with them in the way they wanted. For example, one person did not like being asked about their past and so this was respected.
Is the service responsive?
Records showed information was in place to inform staff of people's preferences, likes and dislikes and how to care for them as individuals. Arrangements were in place to meet with people and their families to increase this information. We saw how people were supported to dress and live in the way that suited them. For example, one person liked to wear a dressing gown over their day clothes and another liked to visit the staff office. The atmosphere at the home was relaxed, inclusive and friendly.
Is the service well led?
The home's action plan to improve record keeping had been followed through and the home was found to have met that essential outcome. We also found innovation was improving people's lives, such as using hand held electronic pads to show people pictorial images to help them make decisions, such as what meal they would like. The pads would also provide a method by which care workers could make an immediate record of the care they had provided. This would promote accuracy of those records when brought into use the week of our visit.
Steps had been taken to help care workers understand the importance of good record keeping and make improvements. The provider was also monitoring how records were being managed.
We were able to observe most of the 21 people who used the service at the time of our inspection. We were not able to converse with everyone who used the service as a result of their health care needs which included various stages of dementia. The three people who we were able to speak with were happy with the care they received.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them and from looking at records.
If you want to see the evidence support our summary please read the full report.
Is the service Safe?
We found that the service was safe on the day of our inspection. The homes medication policies and procedures had been reviewed and updated since our last inspection.
We reviewed the homes Medication Administration Records (MAR) charts and found these records had been accurately and appropriately completed.
Is the service effective?
At the time of the inspection the service was not effective as the care provided had not been appropriately documented and recorded.
We found that people's care plans did not include sufficient detailed information about the care needs of each individual.
In addition the daily records of care did not include details of the care each person had received. It was not possible to identify from the daily care records any significant changes to people's care needs that had occurred.
Is the service caring?
We found that the service was caring at the time of our inspection. People told us 'the staff are very kind and not at all pushy', 'it's a lovely, homely place' and 'It's very nice and I love it here, it is one of the best places I have ever been'.
We observed the provision of care in the home's lounge areas after lunch using our SOFI (Short Observational Framework for Inspection) tool. We saw numerous examples of positive interactions between staff and people who used the service throughout our inspection of the home.
We also spoke with three relative who were visiting on the day of our inspection who told us 'they have fantastic patience with people' and 'they are very caring, you could not find anything better, in fact I doubt you could find anything to equal it'.
Is the service responsive?
At the time of the inspection we found the service to be responsive. We saw that the home had conducted a survey of people who used the service in January 2014. The results of the survey had been very favourable. Where minor issues had been reported rerecords showed appropriate actions had been taken by manager and staff to resolve them.
We found that the home had addressed and resolved the majority of issues raised by the Commission in the previous inspection report.
Is the service well-led?
At the time of the inspection we found the service to be well-led. The registered manager and one of the providers were present in the home on the day of our inspection. Staff members told us 'I love it here', 'managers listen to ideas and are very approachable' and 'we are a happy and established team'.
The service had a quality assurance system and we saw that staff had received appropriate training and support. This helped to ensure that people received a good quality service at all times.
A district nurse and GP said they had no concerns about the home and end of life care provided was 'very good'. They said that the home contacted them appropriately. However, in one case the home had not contacted a health care professional when they should.
People's families were involved in consenting to care where the person should have been consulted in their own right. Capacity had not been assessed and recorded. This meant that people's legal rights might not be upheld.
People received their medicines in a safe way but the arrangements for handling medicines could be further improved.
People lived in a homely, well maintained, pleasant and safe environment where individual needs were taken into account.
Comments and complaints would be dealt with promptly. We were told "They are very much listening to what we say".
The management of records did not protect people from unsafe or inappropriate care because there were gaps and some inconsistencies in information.
Most of the people who used the service at Moorgate Residential Home had a dementia and therefore were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.
We saw that staff treated people with consideration and respect. For example, we saw that staff quickly responded to people's care needs to ensure that they were kept comfortable and informed about what was happening, such as contacting the GP due to a physical illness.
Staff had knowledge of privacy, dignity, independence and human rights. For example, how to maintain privacy and dignity when assisting with personal care. They showed an understanding of the need to encourage people to be involved in their care. For example, staff recognised the need to promote positive experiences for people to aid their wellbeing through offering a range of activities to choose to partake in or spending one-to-one time with them.
Care plans that we saw reflected people's health and social care needs and demonstrated that other health and social care professionals were involved.
We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have. Staff we spoke with felt confident about responding to changing needs and knew what signs of abuse to look out for during their daily practice.
Staff told us they received health and social care needs specific training which they believed helped to equip them to do their job. Staff said they received supervision and appraisals and that the management team provided close supervision, advice and support.
The home conducted regular audits to ensure the health and safety of the people living there. These included checks on, medication, water temperatures, moving and handling equipment, including the passenger lift, fire safety and general environment/maintenance. The providers of Moorgate Residential Home stated that robust audits were essential, so that issues were dealt with proactively and not as a result of an incident occurring.