Moorhouse Nursing Home

Updated 10 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Moorhouse Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Moorhouse Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 March 2023 and ended on 16 March 2023. We visited the location’s service on 7 & 8 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the course of our inspection activity, we spoke with 10 people and received feedback from 21 relatives about their experiences of using the service. We interviewed 8 members of staff and spent time with the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Feedback was also received from 4 visiting professionals.

We looked at a range of documentation relating to people’s care and the management of the service. These included the medicine records for 16 people and support plans for 7 people. We also reviewed the recruitment information of 5 members of staff and documents relating to the training and supervision of 8 staff. A variety of records relating to the management of the service, including incidents and accidents and audits were also viewed.

Updated 10 May 2023

About the service

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.