Moorhouse Nursing Home

Moorhouse Nursing Home (Moorhouse) is a nursing home that provides care to older people, people living with dementia, people with physical disabilities and complex medical needs. The home is registered to provide support to up to 38 people in one adapted building. There were 36 people living at the service at the time of our inspection.

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

Despite some positive experiences for people living at the Moorhouse, risks to people's safety and well-being were not always managed well. Lessons were not learned when things went wrong, and there was a lack of confidence in the internal management and clinical oversight of the service.

Staff were not deployed or led appropriately which meant people did not receive the care they needed in a timely way and the service was not cleaned to a satisfactory standard. Safe infection control processes were not consistently followed because no one had taken responsibility in this area.

Whilst registered nurses ensured most people received their medicines as prescribed, the systems in place to support and audit safe medicine management did not reflect best practice. Care records were also not always completed accurately which heightened concerns given the high use of agency staff who were less familiar with people needs.

There was a disconnect between staff and managers which impacted on both the quality and safety of people’s support. A negative culture across staff and management teams had developed with a focus on blame rather than reflective practice and teamwork. The provider acknowledged the impact of this and shared the additional support they were putting in place to manage this.

Since our last inspection, Moorhouse had extended its range of support to include care for people living with dementia. Neither the environment nor training of staff had been sufficiently adapted to deliver this support well. A lack of understanding of the principles of the Mental Capacity Act 2005 (MCA) had meant that people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People were largely positive about the staff that supported them and said that care staff treated them with kindness and respect. Kitchen staff had a good knowledge of people’s dietary needs and preferences which enabled people’s nutritional and hydration needs to be met.

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 good (published 18 June 2021)

At our last inspection we recommended that the provider seek advice and guidance in developing their strategic monitoring of the service. At this inspection we found that whilst significant actions had been taken to strengthen the provider’s oversight of the service, issues within the internal management of the service had meant that people’s experience of care had not improved.

Why we inspected

We received concerns in relation to the management, staffing and safety of the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements in each of the areas we inspected. You can see what action we have asked the provider to take at the end of this full report.

The provider has engaged fully with us both during and following this inspection. They have already sent us a detailed action plan of the improvements they have made and intend to make. Through feedback from our partner agencies who have continued to visit the service, it has been possible to evidence that the additional support going in to Moorhouse has enabled immediate improvements in respect of the most serious concerns we identified.

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

Enforcement

We have identified breaches in relation to the quality and safety of the care people receive, deployment of suitable and sufficient staff, cleanliness & suitability of the premises, obtaining valid consent and effective leadership and management of the service.

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

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 request an updated action plan from the provider to understand what they will do to further improve the standards of quality and safety. We will work alongside the provider and local authority to monitor their progress. We will continue to review the information we receive about the service, which will help inform when we next inspect.

Moorhouse Nursing Home (Moorhouse) is a nursing home that provides care to older people, people with physical disabilities and complex medical needs. The home is registered to provide support to up to 38 people in one adapted building. There were 19 people living at the service at the time of our inspection.

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

The new manager had worked hard to continuously improve the service since our last inspection. In addition to managing the impact of the pandemic, the manager had developed and supported her staff team to ensure people received a service that was safe and personalised to people’s individual needs.

The culture within the service was now positive and inclusive and people, relatives and staff felt empowered to share their ideas and opinions.

Provider presence and engagement with the service had also improved, but the development plan for the service was very much driven by the manager. In order to embed and sustain improvements we have made a recommendation that the provider seeks support from a reputable source in respect of developing the leadership skills at a provider level.

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. Risks to people were now identified and managed in a way that balanced their safety with their right to freedom.

Staff were kind and compassionate and people were able to make decisions about their support and followed daily routines and interests that were meaningful to them. Medicines were managed safely.

The home was safely maintained with systems now well-established to manage the risk of infection.

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 6 March 2020).

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 4 December 2019. Breaches of legal requirements were found. A further unannounced targeted inspection was carried out on 12 August 2020 where further breaches were identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety and quality of services provided.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Moorhouse Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Moorhouse Nursing Home (Moorhouse) is a nursing home that provides care to older people, people with physical disabilities and complex medical needs. The home is registered to provide support to up to 38 people in one adapted building. There were 21 people living at the service at the time of our inspection.

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

The provider had failed to ensure good management oversight of the service which had impacted on the care people received. There was a lack of monitoring and presence from the provider during the Covid-19 outbreak at the service which left people, staff and relatives at risk. Whilst people and staff told us they were reassured by the new manager they expressed disappointment at the support they had received from the provider.

Risks to people’s safety were not accurately recorded and monitored. Where accidents and incidents occurred, staff did not consistently follow processes to reduce the risk of them happening again. Infection prevention and control measures had not been implemented in line with the government guidance during the height of Covid-19 pandemic. However, measures had now been implemented and were being embedded into practice by the new manager who started three weeks prior to our inspection.

The service had experienced significant staff shortages during the Covid-19 outbreak. As a result, a monitoring system had been implemented to determine the staffing levels required. This had led to improvements in how staff were deployed, so people were not waiting for their care. The new manager has continued to monitor this process to ensure this is embedded. We have made a recommendation in relation to this.

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 Require Improvement (28 February 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about how risks to people were managed and the management oversight of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

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 identified breaches in relation to the provider’s oversight of the service and the safety of people’s care. Please see the action we have told the registered provider to take at the end of this report.

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 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.

Moorhouse Nursing Home (Moorhouse) is a nursing home that providers care to older people, people with physical disabilities and complex medical needs. The home is registered to provide support to up to 38 people in one adapted building. There were 31 people living at the service at the time of our inspection.

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

Despite some positive experiences for people living at the service, there was a lack of confidence regarding the way the service was managed. The views of people and their representatives were not always listened to and acted upon. Some people did not feel confident to express concerns, whilst others said they had, but this had not led to improvements. There was a disconnect between the manager and the staff team which had been noticed by people, relatives and visitors. The culture within the service was not open and inclusive.

Whilst staffing levels had been increased since our last inspection, staff were not always deployed appropriately to support people effectively across the service. In the morning people were left in communal areas without staff support for a prolonged period.

There was a lack of consistent oversight in the monitoring of the service. Governance systems had not always resulted in improvements being made or lessons learned. Recent changes at provider level were reported to be addressing quality assurance processes. As these were not implemented at the time of inspection, we were unable to judge the effectiveness of these.

People were positive about the support they received from care staff. They told us that care staff were kind and respectful towards them. Opportunities for people to engage in social activities was improving, although more work was needed to ensure this was extended to people who were cared for in their rooms.

People felt safe with staff and staff understood their role in safeguarding them form harm. Staff had completed training relevant to their role and nursing staff had taken steps to keep up to date with clinical best practice.

People’s needs were assessed and care plans were in place which provided useful information about people’s needs. People were supported to have 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.

Nursing staff had a good knowledge about people’s medical needs and took steps to keep people safe and well. Medicines were managed safely, and people’s nutrition and hydration needs were met.

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 14 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection which was brought forward based on the change to the rating at our last focused inspection.

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.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Moorhouse Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Moorhouse Nursing Home accommodates up to 38 older people, some of whom may be living with a physical disability, in one adapted building. At the time of our inspection there were 26 people using the service.

At the time of the inspection there was not a registered manager in post. The manager who was present was leaving and a new manager, who was also present, had been appointed three days previously. The new manager told us they would be applying to register with CQC as manager in line with the requirements of their registration. 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.

There were not enough staff to meet people’s needs which left them waiting for care to be delivered. Risks to people were not always managed effectively which placed people at risk of harm. Where incidents and accidents occurred, these were not analysed to reduce the risk of them re-occurring. There had been a high turnover of managers in the last six months which had affected the care being delivered to people. There was a lack of management oversight and audits on the quality of care were not being completed. Staff did not feel listened to when they raised concerns about staffing levels. We asked for information about how the service acted with external agencies but this was not provided.

People received their medicines when they needed them. The management of medicines was safe. People were kept safe from the risk of abuse as staff knew what to do should they have concerns about the standard of care provided. There were safe infection control practices in place which staff followed. The environment was clean and well maintained and safe recruitment procedures were in place.

We identified two breaches of the Health and Social Care Act 2008 (HSCA). You can see what action we asked the provider to take at the back of this report.

There was a registered manager in post. 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 registered manager was at the home during the time of our inspection.

We last carried out a comprehensive inspection of Moorhouse Nursing Home in December 2016 and a focused inspection in February 2017 where we found the registered provider was in breach of regulations. These related to staffing levels; staff had not received support, training, professional development and supervision in order that they could fulfil their duties and responsibilities. Following this inspection the registered provider sent us an action plan of how they would address these issues.

The inspection took place on 13 March 2018 and was unannounced. During this inspection we found that the concerns raised at our previous inspection had been dealt with, but we did identify new concerns about record keeping.

Not all records included all full guidance to help ensure that staff were able to deliver the care people needed. Accidents and incidents were recorded but not all had an analysis of why accidents or incidents had occurred or what action could be taken to prevent further accidents.

There were enough staff to meet the needs of the people but the deployment of staff requires monitoring, especially at weekends. Robust recruitment procedures were completed to ensure staff were safe to work at the service. People felt safe living at the home. Staff understood their responsibilities around protecting people from harm. The provider had identified risks to people’s health and safety with them, and put guidelines in place for staff to minimise the risk. Infection control processes were in lace that helped to reduce the risk of infection. People received their medicines as prescribed by their GP.

Staff received appropriate training and had opportunities to meet with their line manager regularly that helped them to provide effective care to people. Where there were restrictions in place, staff had followed the legal requirements to make sure that this was done in the person’s best interest. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that decisions were made in the least restrictive way. People’s nutritional needs were assessed and individual dietary needs were met. People could choose what they ate.

People had involvement from external healthcare professionals and staff supported them to remain healthy. The environment was suitable for people living with dementia.

People’s care and support was delivered in line with their care plans. People’s privacy and dignity was respected. Staff were knowledgeable about the people they cared for and were aware of people’s individual needs and how to meet them. People were supported with their religious beliefs and were able to practice their faith. Visitors were welcomed at the home and people could meet with them in the privacy of their bedrooms.

A variety of activities were available for people to take part both internally and externally on trips and excursions to places that interested them. Documentation that enabled staff to support people and to record the care they had received was up to date and reviewed on a regular basis. Staff were knowledgeable about people’s needs and had received training that helped to attend to the assessed needs. People would receive end of life care that was in line with their needs and preferences. Care plans included people’s requests about their end of life wishes that included if they wanted to remain at the home or be admitted to hospital.

Complaints were addressed within the stated timescales to the satisfaction of complainants. A complaints procedure was available to people, relatives and visitors.

The provider and staff undertook quality assurance audits to monitor the standard of service provided to people. An action plan had been produced and followed for any issues identified. People, their relatives and other associated professionals had been asked for their views about the service through surveys and resident and relatives meetings.

The interruption to people’s care in the case of an emergency would be minimised. The provider had a Business Continuity Plan that provided details of how staff would manage the home in the event of adverse incidents such as fire, flood or loss of gas or electricity.

We carried out an unannounced comprehensive inspection of this service on 22 November and 2 December 2016 and identified a breach of regulation 18 as the provider had not ensured that sufficient numbers of staff received support, training, professional development and supervision in order that they could fulfil their duties and responsibilities. As a result we issued a requirement notice. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation. The rating awarded to the service was Requires Improvement.

After that inspection we received concerns in relation to staffing levels at the home. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moorhouse Nursing Home on our website at www.cqc.org.uk.

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were insufficient staff available to safely meet people’s needs. Call bells were not answered promptly which meant people were waiting for extended periods of time before staff attended to them. People and relatives all said that there were not enough staff working in the home and that the staffing levels had been reduced recently which had impacted on the quality of care being provided.

There should have been regular analysis completed by the manager of call bell response times. However the call bell monitoring system had a technical fault which meant that the data was not available for this analysis to be completed. The manager told us this was being addressed by the software company.

There had been no review of recent accidents and incidents, people who had recent falls had not had their needs reviewed to minimise the risk of falls re-occurring.

MoorHouse Nursing Home is registered to provide support and accommodation for a maximum of 38 older people who require residential or nursing care. Services offered at the home include nursing care, end of life care, respite care and short breaks. The rooms are arranged over three floors. There are stair lifts and a lift to each floor. On the ground floor there is a large dining room, two lounges and further sitting areas. At the time of the inspection there were 24 people living at the home. People had a range of needs. Some people were living with dementia; others required nursing care whilst other people required minimal assistance.

The manager was not on duty on the first day of our inspection but came to the home for a short while whilst we were there and was present for the second day. They had been in post since 16 August 2016 and had submitted an application to be the registered manager with CQC. 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.

MoorHouse Nursing Home was last inspected on 7 and 8 April 2016 where it was rated as ‘Inadequate’ and placed into ‘Special Measures’. Five breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. These related to personalised care, risk management and medicines, consent, staffing and quality monitoring. Warning Notices were served in relation to Regulations 12 and 17. Requirement actions were set in relation to Regulations 9, 11 and 18. The registered provider sent us weekly reports that details steps that were being taken to make the required improvements. At this inspection we found that the Warning Notices and requirement actions had been met apart from the breach of regulation 18 and that the service had made improvements. It was no longer rated ‘Inadequate’ in any key area, and was therefore removed from ‘Special Measures.’ We did find that further work was needed to ensure the improvements were fully embedded, sustained and that actions continued to take place to improve the quality of service people received.

People said that the home had been through a period of instability due to a lack of consistent management. They said that since the manager had been in post management of the home and the quality of service people received was improving. The manager demonstrated an open and honest demeanour throughout our inspection. As a result of our feedback on the first day of inspection actions were taken immediately and evidenced by the second day. This demonstrated a commitment by the manager to improve the quality and safety of service that people received.

Staff had started to receive supervision and training and the manager had implemented a system for monitoring this. However staff did not have the necessary skills and knowledge to meet all the needs of the people who lived at the home. Further work was needed to ensure support and training was consistently and regularly provided to all staff. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) 2014.

Risk management systems had improved to reduce accidents and incidents occurring. However, further work should be undertaken to reduce falls and injuries associated with these. We have made a recommendation about this in the main body of our report.

People were happy with the meals provided at the home. Since our last inspection a ‘Resident of the Day’ system has been introduced. This included the person in question being seen by the Chef who asks for food preferences which are incorporated into the menus. There were gaps in people’s food and fluid records that could have placed them at risk of receiving ineffective care. We have made a recommendation about this in the main body of our report.

People in the main now received responsive care and treatment. However, care documentation was not always accurate and had the potential to impact on the treatment people received. We have made a recommendation about this in the main body of the report.

The choice of activities that people could participate in had improved. Access to further stimulation for people who lived with dementia would enhance their wellbeing further. We have made a recommendation about this in the main body of our report.

Understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had improved. As a result, people’s legal rights were being promoted. Further work was needed to ensure staff understood who could legally act on behalf of people in decision making processes. We have made a recommendation about this in the main body of our report.

Medicine procedures and practice had improved. On the first day of our inspection we identified some concerns with nurses understanding and procedures relating to the delegation of tasks. These were acted upon immediately and procedures reviewed by the second day of inspection.

People said that improvements had taken place in meeting their individual preferences. They also said that improvements on sharing their views had taken place but that they would still like further opportunities to be involved and kept informed.

Staff numbers and deployment had been reviewed and people now said that improvements had been made in the responsiveness of staff. Call bells were being responded to quicker. Robust recruitment checks were completed to ensure staff were safe to support people.

Quality assurance systems were now being used to monitor the quality of service people received. These had started to identify areas needing improvement and we found evidence of actions taken as a result. Systems should continue to be developed to drive improvements and the service provided to people.

People said that they felt safe from harm. Safeguarding procedures were in place and staff and the manager understood their responsibilities to protect people from abuse.

People said that they were treated with kindness and that their dignity was respected. Staff were observed treating people with kindness and compassion. Relatives said that they could visit at any time and that they were always made to feel welcome.

People told us they would feel comfortable making a complaint if they needed to and were confident that any concerns they raised would be addressed. Records confirmed that action was taken when issues were raised.

MoorHouse Nursing Home provides support and accommodation for a maximum of 38 older people who require residential or nursing care. Services offered at the home include nursing care, end of life care, respite care and short breaks. The rooms are arranged over three floors. There are stair lifts and a lift to each floor. On the ground floor there is a large dining room, two lounges and further sitting areas. At the time of the inspection there were 33 people living at the home. People had a range of needs. Some people were living with dementia; others required nursing care to manage pressure areas whilst other people required minimal assistance.

The home did not have a registered manager. The previous registered manager had not worked at the home since 10 March 2016. A new manager had been recruited and in post since 21 March 2016 and was present during 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 manager was in the process of submitting an application to register with us.

MoorHouse Nursing Home was last inspected on 12 October 2015 where it was rated as ‘Requires Improvement’. Four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. These related to personalised care, risk management, recruitment procedures and quality monitoring. Requirement actions were set in relation to these and the registered provider sent us a report that detailed steps that would be taken to make the required improvements. At this inspection we found that although initially the registered provider had taken steps to address the requirement actions these had not been sustained and issues remained in three areas. In addition, new areas of concern were identified.

There had been changes in senior management and of management of the home. These had not been managed well by the registered provider and had impacted on the quality and safety of service people received. The registered provider had not ensured the quality and safety of service was monitored or that action was taken to improve service delivery.

The numbers and deployment of staff on duty did not meet people’s needs. People told us that staffing levels impacted on their bathing and personal care preferences. People did not receive their medicines on time and some people did not have all the medicines they had been prescribed. People did not get the care and support they needed or wanted at the times they required this.

People with specific nursing needs did not receive care and treatment safely. Assessment and care planning was not robust and did not ensure that people’s needs were managed effectively. There were not enough nurses on duty to meet the nursing needs of people.

Staff did not receive sufficient supervision to understand their roles and to undertake their responsibilities. Some training had been provided but knowledge gained from this was not reflected in practice.

Although staff sought peoples consent when delivering care, formal consent processes were not being used. Staff were not following the requirements of the Mental Capacity Act 2005 for people who used bed rails and were not able to consent to the use of this equipment. Formal systems were not being used consistently to support people to be involved in making decisions about their care and support.

People told us they felt safe. However staff did not recognise that neglect was a form of abuse. Up to date information was not available for staff to refer to about definitions of abuse and how to report concerns.

Despite the concerns about staff levels people told us that staff were kind and caring. We observed that care was given with respect and kindness but it was clear that some people had to wait for too long for the help they required.

In the main, people said that they were happy with the meals provided at the home and we saw that people who chose to eat in the dining room had a positive experience. Activities were offered and people expressed satisfaction with these. People were aware of how to raise complaints. There were no restrictions on visitors and relatives told us they were always made welcome.

There had been an improvement in the recruitment records maintained for staff. These showed that suitable checks had been completed to help ensure staff were safe to care for people.

People had access to health care professionals such as a GP and when accidents and incidents occurred action was taken to ensure people received appropriate medical advice.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

One person who lived at the home told us 'it is very nice here, it is home here, the staff make it home.' Another said they were 'very happy' living at Moorhouse and relatives told us the 'atmosphere is friendly but staff are still professional.'

We found staff were knowledgeable regarding the individual needs of people who lived there. We saw they treated people with dignity and kindness assisting them in a calm and patient manner. Access to the home did not protect people's safety or security.

People who lived there told us they enjoyed the food, being offered a choice of meal and where to eat it. They liked the newly refurbished dining area.

The home was clean, tidy and free from offensive odour. Staff protected people from the risk of the spread of infection. Systems for the management of laundry were not always preventing the risk of cross infection.

Staff were supported to do their job by having the necessary training and being supported by the manager and other senior staff members.

People told us they knew how to complain, however none we spoke with had needed to do so. Any complaints which had been made had been managed to the satisfaction of all parties.

This inspection on 17 January 2013 was for the purpose of following up on whether the provider had achieved compliance with these standards.

The provider had informed us that the registered manager was on sick leave and that the deputy manager was managing the service, they assisted us during the inspection.

During this inspection we spoke with people who used the service and their relatives. People told us that 'the staff look after you well' and 'the care is amazing'.

People told us that the staff were polite to them and treated them with dignity. They felt that they were being given choices regarding their care.

We found that staff had updated their safeguarding training or were booked onto the training. The provider's safeguarding policy had been reviewed and staff were aware of the relevant policies.

We found that the provider had introduced systems to ensure that medicines were safely managed.

We also saw that the deputy manager had completed audits of the quality of the service and introduced systems to ensure that any adverse events were properly recorded. Resident's meetings were being held more frequently to enable people to provide their feedback regarding the service to the provider.

We found that people had their care needs assessed. Care plans had been devised to address people's needs. People we spoke to told us that they had been involved in their care planning. We found however that people were not given a proper choice in all aspects of their care for example bathing and a choice of main meal. We also found that not all staff had treated people with dignity.

People were not safeguarded from the risk of abuse. The provider had not reviewed their safeguarding policy and not all staff had updated their safeguarding training.

We found that there were not effective systems in place to ensure that medicines were managed safely.

We found that there was sufficient equipment to meet people's needs and that staff had received the appropriate training to use it safely.

Since the last inspection the manager had implemented their action plan in relation to staffing. We found that there were sufficient staff.

We found that the provider was not effectively seeking the views of people who used the service with regard to the quality of the service provided. They had not implemented effective systems to either audit the quality of the service or to analyse adverse events that had occurred. The manager had not completed the necessary risk assessments in relation to the storage of items.