Archived: Moor View

Moor View Care Home is a residential care home that was providing personal care to six people with mental health needs. The service is registered to provide care to up to 17 people.

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

People were not always safe. Medicines were not always managed safely and staff did not feel adequately trained to manage medicines. There was evidence of staff working outside the registration of the service in relation to administration of medicines.

Some staff lacked confidence in developing and understanding risk assessments.

Not all staff understood how the emergency call system worked and staff had failed to report issues with the system.

Staff had not been provided with all the training they needed to carry out their duties and were not always supported in their roles.

Staff followed the provider's COVID-19 policy and infection and protection government guidelines.

There was a lack of effective and consistent management of the service. Staff did not always feel supported by the management team.

The provider’s systems for assessing and monitoring the safety and quality of the services provided were not effective in identifying shortfalls and improving the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 23 January 2019). At this inspection we found breaches of regulation 9 (Person centred care) and regulation 17 (Good governance).

Why we inspected

This inspection was prompted in part due to concerns received about management and safety. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led. No areas of serious concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Moor View Care Home is a residential care home that was providing personal and nursing

care to 11 people with mental health needs on the first day of inspection. When we returned for a second day there were ten people using the service. The service is registered to care for 17 people.

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

Although there was evidence of some improvement in the service, we found some aspects of the running of the service and the person-centred approach were still not meeting regulations. Information about safeguarding concerns was inconsistently managed and there had not been enough progress in improving the approach to care planning and delivery. The provider was still not able to demonstrate how they were providing meaningful rehabilitation and recovery in line with the service aims.

There was some improvement in the assessment and management of risk, however further work was still needed. Staff recruitment practices and the management of medicines were now safe.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were offered choice, however some further improvement was needed to people’s care plans in relation to choices they may wish to make.

There had been considerable improvements made to the living environment which was clean and well maintained. People told us they liked this.

Staff had training and support in place to help them be more effective in their roles, however we found not all staff had a clear understanding of the rehabilitation and recovery aims of the service. People’s end of life wishes had not been explored, meaning staff would have no guidance to follow if someone became critically ill.

We made a recommendation about the provider continuing to improve the effectiveness of people’s care plans.

People had support to maintain their overall health, however there were no plans or training in place to ensure oral care was well managed. People’s hydration and nutrition were adequately managed, and people were now able to prepare their own meals if they wished.

The manager was not always open and candid when we asked questions or requested information. Although there were systems in place to monitor quality in the service these had not always been effective drivers for improvement in the overall care provision.

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 Inadequate (Published 13 June 2019) and there were multiple breaches of regulations. The provider completed an action plan to show what they would do and by when to improve. At this inspection insufficient improvement had been made, and the provider was still in breach of regulations.

This service has been in Special Measures since November 2018. During this inspection the provider demonstrated that some improvements have been made, however the service remains rated as inadequate in one key question. Therefore, this service remains in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to providing person-centred care and the overall running of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.

The overall rating for this service is ‘Requires Improvement’, however Well-Led remains rated as ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

People’s experience of using this service:

People were not safe because risks had not been properly identified and mitigated.

Safeguarding processes were in place but incidents were not always recognised as safeguarding concerns, and therefore not reported appropriately.

People were not always consulted about matters affecting them and decisions were sometimes made on behalf of people, without seeking their consent.

Some staff knew people well and understood their personal preferences. However, care was not person centred and people had limited opportunities to work towards their goals and aspirations.

There was little evidence the provider had respect for people or regard for their dignity because the environment and furnishings were not clean or well maintained.

Care and support records were not efficient or effective enough for staff to locate information about people's care, risks and support needs.

People and staff told us the new manager was beginning to make a difference in the home.

Staff said they felt supported through training and supervision and they gave positive comments about the manager.

We found there was not enough robust oversight of the quality of the provision and there were three continued breaches in the regulations since the last inspection, with four new breaches identified.

Rating at last inspection:

At the last inspection the service was rated inadequate overall (Report published 8 November 2018)

The service had not improved sufficiently at this inspection and the rating remains inadequate.

Why we inspected: This inspection was based on the previous rating and our ongoing concerns about the quality of the care provided. At the last inspection there were three breaches identified. These were in Regulation 12 safe care and treatment; Regulation 13 safeguarding and Regulation 17 good governance.

At this inspection, the three breaches continued and a further four breaches were identified. These were in Regulation 9 person centred care; Regulation 10 dignity and respect, Regulation 11 need for consent and Regulation 15 Premises and equipment.

Enforcement: The service met the characteristics of Inadequate in all the key questions of safe, effective, caring, responsive and well led. We are taking enforcement action and will report on this when it is completed.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The service remains in 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

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

Moor View is a nursing home which accommodates 17 people, living with complex poor mental health in one main two-story adapted building with two adjacent bungalows. The home has garden areas.

There was a registered manager at the home, although they were not present during the inspection because they were on leave. 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 in October 2015, we rated the home as 'good'. At the time of this inspection, the home was in the process of changing from a residential care home, to a service which provided rehabilitation and re-ablement. There had also been a period of unsettled management and we found there were weaknesses in how the home was being run. We identified three breaches in the regulations, relating to regulation 12 safe care and treatment, regulation 13 safeguarding people from abuse and improper treatment, and regulation 17 good governance.

Recruitment of staff was in progress and there were satisfactory procedures in place to make sure staff were suitably checked before working with vulnerable people.

Risk assessments were not always clear or well organised in people's support plans and some risks were not adequately assessed. Records to show premises and equipment had been checked for safety were not robustly in place. Accidents and incidents were not thoroughly recorded or concerns appropriately reported.

Support for staff to carry out their roles was in place, but not always consistent or sufficient for all staff. Staffing levels were satisfactory to meet people's physical needs, but not to support them with skills in independence or activities they wished to do outside the home.

People were mostly supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice, and although staff understood legislation around people's mental capacity, documentation for consent and decision making was not robust.

Staff had a kind and caring approach and showed respect when interacting with people and good regard for people's privacy and dignity. Staff had discussions with people about their daily routine, although there was limited evidence of people being involved in their own care planning or discussing future goals.

Systems and processes for assessing and monitoring the quality of the provision, including identifying risk, were weak. Audits were not robust and there was little evidence of management oversight of the service.

The overall rating for this service is ‘Inadequate’ and the service therefore is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

We found that the staff team at Moor View provided effective support to people who used the service. They demonstrated good knowledge of people's complex needs and spoke about them in a caring and non-judgemental way.

People were protected against the risks associated with medicines because the provider

had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We looked at a sample of care records and saw that people were involved in making decisions about their care. We also saw evidence of regular care reviews and action taken by staff when a person's needs had changed.