Moorhead Rest Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulations in relation to providing safe care and treatment and safe recruitment processes.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate safety events. Lessons were not always learnt to continually identify and embed good practice. The registered manager told us there was a robust system for reporting and reviewing accidents and incidents. However, we did not see evidence of the analysis of trends and themes to help reduce future risks. The accident and incident audit did not identify the time, or place people were falling, meaning there was no evidence of how to avoid future occurrences. We asked the registered manager to complete an analysis of incidents and accidents following our site visit.

Some people had alarm sensors in their bedrooms, which alerted staff when a person got up out of bed. This helped to minimise the risk of falls. However, the alarm only sounded in the area it was plugged. This meant when staff were not in the vicinity of the alarm, they may not be able to hear it sound. The registered manager took this feedback on board and provided a risk assessment as well as looking into ways to help reduce this risk.

Staff told us they were confident in reporting any safety concerns. One staff member said, “There is not a high number of incidents, some behavioural incidents, staff are confident in handling this.” Staff also told us people were observed for 24 hours following a fall. However, we did not see evidence of this in people’s care records. People and relatives felt safe using this service. One relative spoke positively of the steps the service took to re-assess a person’s mobility aids to ensure they mobilised safely. Partners felt the service took their feedback on board to improve people’s safety. They said, “When systems and knowledge gaps have been identified, [registered manager] has been responsive and has implemented good practice and national guidance (to support the safe delivery of care to people).”

The service worked with people and healthcare partners to ensure there was continuity of care, including when people moved between different services. People were admitted to this service safely and we saw evidence of initial assessments being completed for people. Staff told us, “New admissions (people) are assessed by the (registered) manager and (this is) shared with staff. Staff have time to read care plans and risk assessments. New people are observed for a couple of days so we can complete care plans.”

Processes were in place for when people needed to go to hospital. The registered manager said, “For hospital visits, staff provide hospital packs or care summaries containing essential information, (such as) medical history, medication, and communication needs to ensure continuity and safe care.” Partners told us referrals were made to their services as and when needed.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. People and their relatives raised no safeguarding concerns. One relative said, “Since the new manager took over it’s so much better and I feel it is much safer.” Another relative commented, “[Person] absolutely feels safe, I know [person] well and they have never asked to go home.” Staff told us people were safe and that they were confident in reporting any concerns. One staff member said, “I have had safeguarding training, we know how to spot types of abuse. If I had concerns, I would ring safeguarding myself at the local authority. There is a poster in the dining room with this information on. I would report concerns to CQC or the (registered) manager.”

The registered manager told us all safeguarding concerns were reported immediately, in line with local safeguarding procedures. We witnessed positive interactions throughout our site visit where people appeared comfortable around the staff team. Staff appeared to know people well. Staff had knowledge of DoLS (Deprivation of Liberty Safeguards) and were able to say what this meant for people living at this service. DoLS applications were applied for, as required and the registered manager had chased up any outstanding referrals.

The service did not always work well with people to understand and manage risks. Not all care plans held up to date information on people’s mobility needs and risks. Where people used a hoist or an alarm sensor, it was not always clearly documented in their care records. This meant people were at risk of inappropriate moving and handling or at risk of falls. We raised this concern with the registered manager who rectified care plans during our site visit. Falls were not always recorded well and when people had fallen, it was not clear from the care records whether the person had been monitored for signs of injury or distress. Records of people’s distressed behaviours were not robust enough to help mitigate future risks and it was not always clear what action had been taken to help a person in times of distress or whether distraction techniques had been successful. The registered manager shared the importance of completing behaviour records in full with staff during our site visit.

People and their relatives told us risks were managed well and raised no concerns in this area. Staff told us how distressed behaviours were managed. They said, “We do PBS (Positive Behaviour Support) training, everyone has different needs. One person we might be able to re-assure with distraction; others it is a change of staff face. Different people need a different approach.” We observed people in times of distress, and this was managed well by staff. Person-centred care plans were in place for people’s medical conditions; including diabetes which held a detailed account of how to care for a person and people’s specialised diets were documented clearly in individual care records and in the kitchen.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People and their relatives told us the environment was safe. One relative said, “There is CCTV in operation, and I have signed to say I am happy with this.” CCTV was in operation in communal areas to monitor for safety events. There was clear signage and people had signed to say they consented to the use of CCTV. We observed the environment to be safe. At our previous assessment we had concerns relating to unsecured doors, cluttered hallways and an unsafe outdoor area. These concerns had been rectified, and we had no concerns relating to the environment. Fire checks were being carried out as well as maintenance checks. The fire service visited recently and provided guidance on how the service could improve their fire procedures. Fire drills were being completed regularly, and PEEPS (Personal Emergency Evacuation Plans) were in place and appeared accurate.

Staff praised the changes that had been made to the environment. They said, “The environment is a lot safer. There is new flooring in most areas, and it is clean and tidy.” Staff were able to explain what the fire procedure was.

The service did not make sure staff were recruited safely. The registered manager had not ensured all checks for staff who were on a sponsorship scheme were in place and up to date. Agency staff profiles did not evidence these staff had up to date training and DBS (Disclosure and Barring Service) checks and there was no evidence agency staff had an induction when they first started working at this service. The rota did not evidence which agency staff were working, and the registered manager did not have this information readily available.

Staff who were newly recruited did not have all relevant checks including references. Some staff had been employed at this service for some time. At our last 2 assessments we noted staff recruitment files had not been audited or risk assessed to ensure any gaps in employment had been identified and any risks mitigated. This had not been completed to a high standard and recruitment files still lacked effective oversight. When staff had changed role, interview records did not evidence whether the staff member would be suitable for this role. Not all staff members names were on the supervision matrix which meant we could not be assured all staff were receiving appropriate supervision.

Although there were some gaps in the training matrix, most courses had a high completion rate. Feedback on staffing was mixed. One relative commented, “There is always enough staff on duty to keep [person] safe.” However, people commented on the use of bank staff at night who were not familiar to them which could lead to people becoming distressed. Staff told us they felt supported and that there was enough staff to manage people’s care needs. One staff member said, “There is enough staff for the amount of residents we have. It is very quiet now. Sickness is covered by bank staff. Managers help out on the floor; we are all a team. Supervisions occur regularly and are interactive. Training is good here.” We observed plenty of staff around during our site visit. People were monitored by staff, but staff allowed for people to have their own space and freedom to make their own decisions.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People and their relatives told us the environment was always clean and tidy. We observed the environment to be clean and there were plentiful supplies of PPE (Personal Protective Equipment) available at various stations around the service as well as guidance on the use of PPE and hand hygiene. The concerns found at our last assessment in relation to IPC (Infection Prevention and Control) had been resolved and a recent local authority audit in this area had been rated highly. We observed domestic staff cleaning people’s walking aids during our site visit.

Staff told us the service was clean. They said, “We recently had a brilliant IPC rating. The home is very clean and there is always PPE. (There is) always a housekeeper on every day. The housekeepers are very passionate and worked here for a long time.” Cleaning schedules were in place and included bedroom, communal areas and deep cleaning records. The kitchen appeared to be clean, and checks were being completed to ensure good food hygiene.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were kept secure; however, one medicine was not stored in line with legislation. This was rectified on the day of the site visit. The records showed for one medicine that was required to be given before all other medicines, this had not been given as per the manufacturer's instructions. Another person had a medicine administered by an external healthcare professional, such as a district nurse. The records showed this had not been given when it was due and staff had not followed this up. This placed the person’s health at risk. We found medicines to be given ‘when required’ had information available to support staff to know when to give the medicine, and when there was an option to give 1 or 2, there was information to support staff to know which dose to give. When people were prescribed topical preparations such as creams there were records in place to show the creams were applied. However, when people were prescribed a medicated patch, the manufacturer’s instructions to rotate the site of application was not followed and there were no records to show where the patch had been applied. This placed people at risk of skin irritation. When people had their medicines covertly, hidden in food or drink, we found the documentation to support the decision to give medicines in this way was not always in place.

Staff told us they completed medicines training. We saw records of training for a number of staff; however, we did not see records of training for all staff. Medicines related policies were in place, however they did not all contain sufficient information to support staff with the safe and proper use of medicines. Audits were completed; however, they had not been effective in identifying all of the issues found on this inspection.