Moor Park House Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff recorded incidents and considered issues that may have contributed to different situations. Managers monitored and discussed incidents during governance meetings, and we saw evidence of lessons learned being shared with staff. This was an improvement following the previous assessment.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was a robust pre-admissions process and policy, and we saw evidence of effective referrals to external agencies. People had hospital passports to make sure clear information was shared in a timely manner.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had a clear and up to date safeguarding policy. Staff completed safeguarding training and knew how to raise concerns. There were effective processes to make sure people were deprived of their liberty lawfully. The registered manager monitored and collated safeguarding alerts and made sure recommendations were implemented. Everyone we spoke with said they felt safe living at the home.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The registered manager conducted thorough risk assessments and reviewed them regularly. The provider undertook clinical simulations of various scenarios to make sure staff knew how to respond to risk. Staff undertook training about how to support people if they experienced distress, and the provider avoided the use of restraint. Staff had good knowledge about people’s risks and needs and mitigated them appropriately.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During the assessment we noticed the electrical charging room was left unlocked which could pose a risk if people or relatives accessed. This was rectified after we fed back to the registered manager. In 1 person’s bedroom, the floor required replacing and was causing difficulties with using the wheelchair. However, all health and safety checks had been made, for example fire safety, gas and electrical safety testing. There was a maintenance management system in place.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were recruited safely and the provider made necessary checks to ensure the suitability of staff. The provider used a tool to work out how many staff were needed on shift each day. Some staff and people told us they thought there were enough staff, but other people said they had to wait at times, and that staff were very rushed. The provider used agency staff although arranged for consistent staff. Staff completed training relevant to the role including learning disability training, and compliance rates were high.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were regular cleaning schedules, and the home was clean and tidy. There were effective infection control processes in place. The management team completed audits including for hand hygiene. We observed a good supply of protective clothing and hand sanitizer available in the corridor areas, and staff wore this at appropriate times.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Although most medicines were stored securely, we saw a container of thickener left in a communal kitchen area where people could access. Thickener is added to the drinks of people who are at risk of choking. Staff did not always check or record the temperature of the environment where medicines were stored. The registered manager addressed both these issues immediately following our feedback. However, there was detailed guidance for staff about how to administer medicines, including for ‘as and when’ required medicines. There was guidance in place about how to administer topical creams. This was an improvement following the previous assessment. Staff signed to say they administered medicines according to people’s prescriptions. The provider used an electronic system to manage medicines and checked staff competency regularly.