Archived: Moreton

At the time of the inspection there were 26 people living at Moreton. One inspector visited the home and spent approximately eight hours there. We spoke with 12 people using the service, two visitors, the registered manager and seven staff supporting them which included an agency worker.

If you want to see the evidence supporting our summary please read the full report.

The questions we asked on this visit were:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service safe?

The service was safe because the registered manager had ensured there were enough staff on duty with the appropriate qualifications, skills and experience required to ensure people's needs were met. Care workers we spoke with told us the staffing levels allowed them to meet people's needs. We observed during the inspection care workers had time to talk to people as well as complete tasks. A senior member of staff allocated care workers to support specific people before each shift and ensured skill mixes and experience were considered.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We were made aware a DoLS application had been submitted to the local authorities DoLS team by the registered manager, who told us the circumstances of the need for the application.

Is the service caring?

The service was caring because we saw care workers had positive interactions with people. We saw care workers approach people with respect and kindness. People were assisted in a manner that maintained their privacy and dignity.

People living at the home and their visitors told us 'They look after me very well, if I want anything I only have to ask' 'This is a generous place, I am very grateful for the support I have received, I have been made very welcome'.

Is the service effective?

The service was effective because they had improved the accuracy of people's risk assessments regarding nutrition and had an effective system to identify people at risk of malnutrition.

Is the service responsive?

The service had been responsive because we found improvements had been made to people's care plans. We were told by care workers that the morning shifts had improved and they were more organised. This meant people were receiving planned care and having their needs met at a time which suited them.

One visitor told us 'The manager and staff have been working very hard to put things right at the home'.

This is a summary of what we found.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

This planned scheduled inspection was brought forward in view of some information of concern received via safeguarding processes relating to three people living at the home.

On the day of our inspection there were 27 people living at Moreton Residential Home.

The summary is based on our observations during the inspection. We spoke with ten people using the service, the registered manager, deputy manager and twelve staff supporting them.

We also spoke to three visitors and a District nurse who visits the home most weeks to support people with their care.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not always safe because we found that the home did not have sufficient staff on duty throughout the day and night to meet people's needs. We spent time observing care and support being delivered, spoke with people living at the home as well as some of their visiting relatives. We also spoke with staff and the registered manager. We looked at the dependency tool used by the service and asked about how this information was being used to review staffing levels in light of people's changing needs. Following the inspection visit, we reviewed their call bell monitoring information. This showed people's requests for support were not being responded to quickly enough which could place people at risk.

The registered manager ensured there were staff on duty with the appropriate qualifications, skills and experience required to ensure people's needs were met. People were supported by staff who had received appropriate supervision and training in the skills required to perform their roles.

The home had systems in place to manage the storage and stock of people's medication safely. People received their medication from staff that had been appropriately trained and competency regularly reviewed. We had concerns that people were not receiving their medication in the morning at the time they had been prescribed.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards ( DoLS). This legislation protects people's rights when they are unable to make decisions about their own welfare. Although no DoLS applications had been made, the registered manager was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

We found that the home was effective. We saw that people's health and physical care needs were assessed and their care plans and assessments were reviewed monthly. We saw personal support plans included personal hygiene needs, communication, mobility, nutrition and continence. The plans gave staff guidance regarding people's needs and how to support them. We saw the support plans did not guide staff regarding people's psychological needs. This meant people living with a mental health need were not always having care delivered effectively or in accordance with their needs. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. However people might be at risk of receiving inconsistent care due to support plans not giving staff clear guidance.

The home was well maintained and had processes in place to regularly review and assess so it any concerns were dealt with promptly and remained safe.

Is the service caring?

We found that the home was caring. We observed people were supported by staff who were understanding and sensitive to their needs. We saw staff showed patience and gave reassurance and encouragement when supporting people. We saw people living at the home were engaged in a variety of activities.

People living at the home told us they thought the care at the home was good. Comments included 'I am very comfortable here'. 'I am well cared for and have no worries'. 'Staff are extremely patient and very caring and always cheerful, nothing is too much trouble.

A visitor told us that they were pleased with the home and had been kept involved and informed.

A visiting district nurse told us 'the patient here always seem well cared for' and 'If I give the staff written feedback it is always acted upon'.

Is the service responsive?

We found the home were responsive. The home had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

We saw that people knew how to make complaints. The registered manager had acted promptly to complaints received in line with the homes complaints policy and procedure. People can therefore be assured that the home acts upon complaints, they are investigated and action is taken as necessary.

Is the service well-led?

We found that the home was well led. The provider undertook a monthly compliance visit. This showed that they worked with the registered manager, deputy manager and the staff to ensure the standards people expected at the home were maintained.

The home worked well with other agencies and services to make sure people received their care in a joined up way.

People living at the home and staff were asked to complete an annual satisfaction survey. We saw that the information gathered had been collated and shared with people who live at the home and staff. This helped to ensure that people received a good quality service at all times.

Infection control management was good at the home and care workers were responsive to the requests and concerns from people and their families relating to cleanliness. The home had experienced some domestic and laundry staff shortages over recent months but these were being rectified. One person said 'With all the staff being off we have noticed a drop in cleaning. It used to be excellent but now it is just good and sometimes not very good.' Another person said 'We did speak at the resident meeting about the cleaning so they do listen.'

People were happy with the way medicines was managed at the home. They said they were able to request additional medication which was provided promptly. One person said 'I have so many tablets each day, if anything was to go wrong it would be with me but, touch wood, I have never had a problem.' Another person said 'They are very good at getting things to me on time.'

We saw there were systems in place to monitor the effectiveness of the medicines system. Storage facilities were good and side effects of different medicines were monitored. We saw that people and their families were able to express concerns which were promptly responded to by staff at the home and the local GP.

People told us that they were treated well by care workers and were offered choices in relation to their daily lives at the home. One person said 'They are all polite and always give me choices. I can't fault the staff here.'

We looked at care records and saw that detailed plans had been made to provide person centred care. People who lived at the home and their relatives were positive about the service. One person said 'They look after me, I've got a nice view and a comfy room. It's a great place to live.'

Staff we spoke with understood how to recognise and report safeguarding incidents should the need arise. People told us they felt safe at Moreton. One person said 'Of course I feel safe here. I don't take any nonsense.'

We looked at staff files and found that appropriate background checks had been completed on staff at the home prior to employment. However, we found that some information was missing from staff files.

We looked at the quality assurance systems in place to monitor the quality of care delivered. Regular audits on many aspects of the service had been completed. We saw that the provider monitored the service and responded to feedback effectively.

We talked with five of the people who used the service. They told us that they liked living there, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us that, 'I like it here, it suits me.' Another person told us, 'I get on with my life, I have what I need.'

We saw that staff were supported through supervision, that they received training essential for caring for older people and when we spoke with them, we found that they were knowledgeable about the people they supported.

The service had appropriate safeguards in place to protect people from abuse and people told us that they felt safe living in the service.