This was an unannounced inspection carried out on the 09 October 2015.
Moorfield House is registered to provide accommodation and personal care to up to 33 people. The home is located in Irlam, on the corner of Moorfield Road and Liverpool Road, close to local shops and bus routes.
At the time of our visit there was a registered manager in place, though they were not present during the 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.
At the last inspection carried out in April 2014, we did not identify concerns with the care provided to people who lived at the home.
During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
During the inspection we checked to see how the service managed and administered medication safely. We found people were not always protected against the risks associated with medicines, because the provider did not have appropriate arrangements in place to manage medicines safely.
We were told that night staff did not administer medicines. During our inspection we identified a number of people who required the administration of PRN medication, this is medication given as and when required such as Paracetamol to relieve pain. This meant no member of staff was able to administer any PRN medication during the night-time if it was required.
We found that a number of records we looked at were prescribed at least one medicine to be taken ‘when required.’ We found that all medicines prescribed in that way did not have adequate information available to guide staff on to how to give them. We found there was no information recorded to guide staff on which dose to give when a variable dose was prescribed. It was important this information was recorded to ensure people were given their medicines safely and consistently at all times. We also found there was no information recorded to guide staff as to where to apply creams to ensure people were given the correct treatment.
We found one medicine, which was dated the 12 August 2015, where manufacturer’s instructions clearly stated that the medication once opened should be thrown away after 28 days. We spoke to a senior member of care staff who confirmed that the medication had been opened on the 12 August 2015. We found that contrary to manufacturer’s instructions the medication had not been disposed of as instructed and was in fact still being used by the service. We were told by the member of staff that the medication would be disposed of immediately.
We found that the registered person had not protected people against the risk of associated with the safe management of medication. This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment.
We found people on pureed diets received the leftovers from the previous day’s lunch, which was stored in the fridge. We asked how people on a pureed diet were given a choice. The cook told us they were not offered a choice.
The cook also explained that when the drinks trolley was taken around in the morning, it was at that time other people were asked what they wanted for lunch. We were also told there was no choice on Fridays as people just wanted fish and chips. However, according to the menu there should have been the choice of battered fish or cottage pie, plus two desserts. What was offered was a fish cake, chips and mushy peas and no cottage pie.
When we asked about this we were told that all the residents had asked for fish, however, when we spoke to one person just before lunch about what they wanted for lunch, after explaining the options available, they told us they wanted cottage pie. There was no alternative potato or vegetable available. In addition, there was only weak squash available to drink in plastic cups. One person complained that their squash was warm. Though they received an apology, no attempt was made by staff to replace it, or to add an ice cube. The meal experience was very task orientated.
This was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, person centred care, because the provider had failed to provide person centred care that reflected personal preferences.
We found the service undertook a limited number of audits including environmental, medication and food safety. A medication audit had also been undertaken by an external pharmacist. We were provided with no evidence of how the service monitored falls as a means of identifying any trends and how the service learnt from complaints or concerns raised by people. We spoke to the clinical manager about the effectiveness of auditing by the service, especially in light of the concerns we identified in respect of medication, dementia friendly environments, the meal time experience, activities and stimulation.
The service was also unable to demonstrate how they regularly sought the views of people who used the service and took regard of any complaints, comments and views made. Though questionnaires had been devised, these had not been circulated. The last residents meeting was in April 2015, with no other evidence available of other resident or family meetings. There was no suggestion box available for people to suggest improvements in the quality of the service.
This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service failed to assess, monitor the quality of service provision effectively.
You can see what action we told the provider to take at the back of the full version of the report.
People who lived at Moorfield House and their relatives told us that they or their loved ones were safe living at the home.
We found the home had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. We looked at the service’s safeguarding adult’s policy and procedure, which described the procedure staff could follow if they suspected abuse had taken place.
We found people were protected against the risks of abuse, because the home had appropriate recruitment procedures in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults.
On the whole, we found there were sufficient numbers of staff on duty during the day to support people who used the service. However, several members of staff raised concerns that they did not always feel there were enough staff on duty to meet people’s needs, especially during the night shift.
Senior staff confirmed they received formal training in subjects such as safeguarding, first aid and the Mental Capacity Act, which we confirmed by viewing the training matrix. Most staff were either in the process of undertaking a National Vocational Qualification (NVQ) in care or had completed the programme.
We looked at the service supervision policy, which stated that supervision would be undertaken at least six times each year and more often if a performance problem was under discussion. Though we saw evidence of supervision having been undertaken, it was not consistent with the service policy.
We were told by the clinical manager that apart from three people who used the service, most people were either living with memory issues or dementia. We found the home did not have adequate signage features that would help to orientate people with this type of need. We saw no evidence of dementia friendly resources or adaptations in any of the communal lounges, dining room or bedrooms. This resulted in lost opportunities to stimulate people as well as aiding individuals to orientate themselves within the building.
We have made a recommendation in relation to environments.
People and relatives consistently told us that staff were kind and caring. Throughout our inspection, where we observed interaction between staff and people who used the service, it was kind and respectful.
During the inspection we saw several examples of where staff at the home had been responsive to people’s needs. For example where people were required to be weighed weekly or monthly, there were records to suggest this had taken place.
Care plans were comprehensive and of a good standard. All care plans provided clear instructions to staff of the level of care and support required for each person. We found that care plans were reviewed on a monthly basis.
During our inspection, we checked to see how people were supported with interests and social activities. On the day of our inspection we did not observe any activities being undertaken with people. We were told by staff that the service did not have an activities coordinator.
Staff told us the management were approachable and supportive.
The home had policies and procedures in place, which covered all aspects of the service. The policies and procedures included; safeguarding, whistleblowing, consent and medication.