Town Moor House

Town Moor House is a residential care home providing care and support for people. The service also provides support for people living with dementia. The service can accommodate up to 28 people. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

Since our last inspection the provider had made improvements to safe care and treatment, person centred-care and good governance.

People were safeguarded from the risk of abuse. Risks in relation to people's care were identified and risk assessments detailed information about how risks could be mitigated. The home was clean, and people were protected from the risk and spread of infections. There were enough staff available to assist people to meet their needs in a timely way. Accidents and incidents were recorded and analysed to identify any trends or patterns. This helped to mitigate future risks and ensured lessons were learned. The provider had a safe recruitment process which assisted them in recruiting suitable staff.

A comprehensive training plan evidenced staff had received appropriate training to carry out their roles effectively. Competency assessments were also in place for things such as medication administration and moving and handling. People's needs were assessed, and care delivered in line with best practice. Care plans and supporting documentation included people's individual choices and preferences. We observed lunch being served and found people were supported to maintain a healthy and balanced diet which included their preferences. People were also supported with snacks and drinks throughout the day.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Throughout the inspection we observed staff interacting with people in a caring and considerate way. We saw staff gaining people's consent prior to carrying out care tasks. There was a homely atmosphere in the home and people appeared comfortable, happy and relaxed. People we spoke with were complimentary about the care and support they received.

Staff were responsive to people's needs and provided person-centred care. People were supported by staff who knew them well. The home had an activity co-ordinator who was responsible for arranging a suitable timetable of activities and arranging outings and entertainers coming into the home.

The management team carried out regular audits to ensure the quality of the service was maintained. The management team took appropriate actions to address any issues. People and their relatives had confidence in the management team and felt they were approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 July 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 July 2019, where breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person-centred care and good governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to all Key Questions.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Town Moor House on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was accessing the government testing scheme and the registered manager demonstrated good oversight of this.

The home was clean and well ventilated, with additional domestic hours being used to enhance infection control processes.

Pictorial signs reminded people and staff of the infection control procedures to follow to ensure their safety.Staff wore PPE appropriately.

People were supported to keep in touch with family and friends, and a COVID-19 secure visiting area had been developed. We saw this in use during the inspection.

Further information is in the detailed findings below.

Town Moor House is a residential care home providing care and support for older people. The service also provides support for people living with dementia. The service can support up to 28 people.

On the day of our inspection 26 people were using the service.

People’s experience of using this service and what we found

On the day of our inspection there were adequate numbers of staff available to meet people’s needs. However, deployment of staff was not effective. Agency staff were being used who did not know people. We looked at systems in place for recruiting new staff but found these were not always effective.

Medication systems were in place however, these were not always followed. Risks associated with people’s care and support had been identified, however, they lacked detail to ensure risks were managed safely. Staff understood safeguarding and whistleblowing procedures and would use them when required. Accidents and incidents were monitored, and lessons were learnt. However, one incident between two people was not reported.

Staff were knowledgeable about people needs, however, care was very task focused and institutionalised. Staff said training was good however, it was not clear if it was effective. Staff were supervised and supported. Staff felt the service was improving since the new manager had been in post.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received a balanced diet; however, people could be offered more support to ensure needs are met. People had access to health care professionals. The environment was not dementia friendly and there was limited accessible outside space. The outside space available was predominantly utilised as a smoking area for a small number of people who smoked.

When staff engaged with people they were mostly kind and caring. However, we observed some staff did not engage when providing support and were task focused. From care plans we looked at it was not possible to see it people were involved in their care planning. Staff we spoke with understood people’s needs however, did not always follow care plans to ensure they respected their choices. Care and support provided and observed was not person-centred.

We looked at care records and found they did not always reflect people’s needs. People did not always receive personalised care. People were listened to and complaints were appropriately dealt with and resolved. End of life care was included in the new electronic care plans to be used when required.

The service had an activities coordinator who was new in post and who was willing to learn to improve the quality of people’s lives but this is in the early stages. Care staff did not provide any social stimulation.

A new manager had been appointed and commenced employment at the service in March 2019. Audits were not always effective and had not always identified concerns raised on inspection. Although the new manager had acknowledged the shortfalls in the systems and was working with the provider to address them. The new manager was instilling positive values to improve the culture of service and one staff member told us, “The new manager is a breath of fresh air.”

People and relatives were involved in the service, quality questionnaires were sent out and regular meetings were held.

Rating at last inspection

The last rating for this service was requires improvement (published 26 July 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. Since our inspection we have been provided with a detailed action plan form the provider who is addressing the issues we identified at inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Town Moor House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Town Moor House is a 28 bed home providing care and support to older people. The home also provides care and support to people living with dementia. The home is a converted older property near the centre of Doncaster.

At the time of our inspection the service had 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.

People told us they felt safe. Staff were knowledgeable regarding safeguarding and were aware of how to identify possible abuse and the correct procedures to record and report. Risks associated with people’s care had been identified and staff were knowledgeable on how to manage the risks but documentation was not always reviewed or updated when needs changed.

We observed that there were enough staff available to meet people’s needs in a timely way.

Medication systems were robust; however, we identified issues that meant these were not always followed by staff.

Accidents and incidents were monitored and the registered provider ensured lessons were learnt. However, the monitoring could be more detailed to ensure a thorough analysis.

The service was clean and had a maintenance programme. Some areas required attention however; these had been identified by the registered provider. We also found the environment did not always meet the needs of people living with dementia.

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. The management team were aware of who had an authorised Deprivation of Liberty Safeguards or if any conditions were attached. Consent to care and treatment was sought in line with current legislation. However, we identified that best interest decisions were not always considered.

Staff received training on a regular basis. Staff were knowledgeable about their role. People received a nutritious diet, although documentation for recording this could be improved. People had access to healthcare professionals and staff followed their advice.

We observed staff interacting in a positive way with people. People told us the staff were very kind and caring. Staff were observed to be kind and considerate, the interaction we saw was very respectful. People’s privacy and dignity was respected. However, staff did not always respect people when they were discussing care and treatment in communal areas.

People received care and support that met their needs. Staff were aware of people’s needs and preferences. However, the care delivery could be more individualised and person centred.

A range of activities took place. People told us about the activities that they took part in and told us they were very good. People told us they felt able to raise concerns and complaints and were listened to. The registered provider learned lessons from complaints received and took appropriate actions.

Audits were in place to ensure policy and procedures were followed. However, we found they had not identified all the areas for improvement and could be more detailed. The registered provider had identified this and was improving the systems.

There was evidence that people had a voice and were given opportunities to be engaged and involved in the home.

Town Moor House is a care home which provides care and support for up to 28 older people. It is situated in Doncaster within easy reach of bus stops, shops and other amenities. At the time of our inspection there were 25 people using the service.

The service had a registered manager in post at the time of our inspection. 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 provider had a policy to protect people from abuse. Staff had received training in this area and were knowledgeable about how to recognise and respond to abuse.

We saw that people received their medicines in a safe manner. We looked at records in relation to medicine management and found each person had a medication administration record (MAR) in place. This clearly evidenced when people had been given their medicines.

Care plans we looked at contained risk assessments, highlighting any risks associated with the persons care and how best to manage the risk presented.

We saw that there were enough staff around to ensure people’s needs were met. Staff worked well as a team and were able to respond to people’s needs.

Staff we spoke with told us training was of a good standard and it assisted them to carry out their role. We saw a training matrix which highlighted what training staff required and when it needed to be completed.

People were supported to make decisions about their care and their choice was respected. Care plans included information about people’s likes and dislikes.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support.

We observed staff supporting people and found they were kind and caring and knew the people very well. We saw staff asked people what they would like and only proceeded with the persons consent. Staff we spoke with knew how to maintain dignity and respect. One care worker said, “It is important to involve people in their care. It is all about the person.”

We saw staff interacting with people and found this was mainly in line with their care plan. Care plans were reviewed on a monthly basis and we saw that where appropriate changes had been made to reflect the person’s current needs.

The provider had a complaints procedure displayed in the entrance are of the home. We spoke with people who used the service and their relatives and they told us they did not need to complain. People felt able to talk with staff if they needed to raise a concern and felt it would be dealt with appropriately.

During our inspection we saw the registered manager interacted well with staff and people who used the service.

We saw audits took place to ensure policies and procedures were being followed.

People who used the service were involved in the development of the home and were able to contribute ideas.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

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

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who used the service told us the staff were very kind. One person said, “The staff are very kind and I could tell them anything, they are easy to get on with.”

Is the service effective?

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with people who used the service and they told us the standard of care was very good.

People were provided with a choice of suitable and nutritious food and drink. Care plans contained people’s preferences regarding food, drinks and snacks. We spoke with people who used the service and they told us the food was very nice.

Is the service caring?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at care records and found that people’s needs had been assessed and care plans had been devised to meet their assessed needs.

We spoke with people who used the service and they told us they were satisfied with the care provided. One person said, “The staff are very caring and know just what I need.”

Is the service responsive?

We saw that care plans were reviewed regularly and any changes were made to ensure people’s needs were met.

The provider took account of complaints and comments to improve the service. The provider had a complaints procedure and logged complaints and the outcome. The provider had received four complaints in the last year. These had been resolved.

Is the service well-led?

We saw that audits had been completed and where actions had been identified these were addressed.

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. We spoke with people who used the service and they told us that they were asked their opinion in how the service was run. We spoke with the registered manager who told us a quality assurance questionnaire was sent out on an annual basis and they took action on comments raised.

We looked at the management of medicines. We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People we spoke with told us staff gave them their medicines at the correct times each day. We observed two people being given their medicines and saw the senior care worker administered medicines in a safe and caring way.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We looked around various parts of the service. We found it was clean and free from odours. The provider had a refurbishment programme in place to ensure living areas were appropriate for people with dementia.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff we spoke with were aware of their roles and responsibilities and of other members of the team. Records showed a training programme was in place to ensure staff kept up to date with current practice.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed on a monthly basis and updated as required. Six monthly reviews also took place with people who used the service and their relatives. This ensured people were involved in planning their care and treatment.

There were effective systems in place to reduce the risk and spread of infection. People we spoke with told us the home was spotless. We found the home was clean and well maintained.

There were enough qualified, skilled and experienced staff to meet people’s needs. During our inspection we observed staff were able to meet people's needs in a timely way.

People were given support by the provider to make a comment or complaint where they needed assistance. People we spoke with confirmed they could raise any concerns with staff and these would be acted on.