29 September 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Our inspection was unannounced and the team consisted of one inspector, an assistant inspector a specialist advisor 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. A specialist advisor is a professional who has expertise in a specific area. Our specialist was a nurse.
We checked the information we held about the service and the provider. This included notifications that the provider had sent to us about incidents at the service and information that we had received from the public. We used this information to formulate our inspection plan.
We also used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
We spoke with eleven people who used the service and three relatives. Some people were unable to tell us their experience of their life in the home, so we observed how the staff interacted with them in communal areas.
We also spoke with six members of care staff, two nurses, the cook, the maintenance person, administration manager and a member of the domestic staff, a visiting professional and the registered manager. After the inspection we contacted the activities coordinator and their comments and information have been included.
We looked at the care records for six people to see if they were accurate and up to date. In addition, we looked at audits completed by the home in relation to falls, incidents and infection control, the meetings and feedback events and recruitment folders for three staff to ensure the quality of the service was continuously monitored and reviewed to drive improvement.
29 September 2018
The inspection took place on 14 May 2018 and was unannounced. At the last inspection we rated the home overall as ‘Requires Improvement.’ There were also regulatory breaches in safe care and treatment, staffing, dignity and respect and good governance. At this inspection we found the required improvements had been made. The new overall rating for this service is now ‘Good’ and within the responsive section we found the home to have achieved a rating of ‘Outstanding’.
Morton Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home specialises in supporting people living with dementia and providing end of life care. The home is divided into three separate parts each with its own distinct name, we have referred to these within the report as units. Each unit provided accommodation and communal spaces in relation to a lounge area and dining space. One unit had an enclosed garden which was accessible to people from all three units. The home benefits from large open grounds, which had a range of shelters and people were encouraged to enjoy the surroundings. The service was registered to provide accommodation for up to 66 people. At the time of our inspection 52 people were using the service.
Morton Grange has a registered manager. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager and provider had been in post for over 15 years, which this demonstrated stability and consistency to the service.
The provider ensured that each individuals needs were identified and considered in the programme of events. People were supported to have value based activities and to explore new areas of interest. The large outdoor spaces which were available people embraced and had also been encouraged to access events outside the home. The community was encouraged to be part of the home and strong links had been made to engage with different generations. Some events were planned; however, there was the enthusiasm for spontaneous events to capture the moment or an opportunity.
The care plans contained details of people’s needs, history and preferences which enabled the care to be delivered in a person centred way. Consideration was made in how information was provided to people and a range of methods were used to support ways to communicate. People’s cultural needs were considered and respected. Religious opportunities were available for people to maintain their spiritual connections. Information was provided in a range of formats and the areas of the environment considered to support people living with dementia when moving around the home.
People were integral to the decision making and this included all aspects of their care requirements. When people neared the end of their life the home ensured that all aspects and considerations were available to make this time reflective of the individuals wishes. Staff had received training and the home had achieved the platinum award in the National Gold Standard Framework for End of Life Care.
A monthly newsletter shared information which included activities and how people or relatives could be included in the home. This also reflected initiatives the home had taken part in and the benefits this had provided to people.
The provider had increased the staffing levels to provide a good level of support, which ensured people’s needs were met. Staff had received the necessary training in how to protect people from potential harm and knew how to report any concerns.
When risks had been identified these had been assessed and measures put in place to reduce the risks. The home was maintained and any repairs were completed swiftly and cleaning schedules ensured the home was protected from the risk of infection.
When people required medical support or guidance on maintaining their health this was available and care staff worked with them to ensure people’s wellbeing. Medicine was managed safely and in accordance with people’s prescribed 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 ensured they obtained consent before providing care.
Staff had received training to support their role and individual interests in developing their care career. People enjoyed the food and their dietary needs had been considered. Individual’s health was monitored and referrals made to support these needs.
The home had been decorated with the support of people and consideration had been made to help people orientate within their environment. Staff members had established positive relationships and people told us they felt cared for. People’s privacy was respected and they were able to choose how to spend their day.
The registered manager understood their registration with us and informed us of any incidents or events. Audits had been completed to consider how the home was being run and if any areas required changes or improvements. Complaints had been addressed and any responses had included an apology and the outcome, along with lessons learnt to avoid a repeat of the situation.
People’s views were considered with all aspects of the home. Questionnaires reflected a positive feel for the atmosphere of the home and the care people received. Suggestions and requests were embraced and used to drive changes.