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Moreland House Care Home Requires improvement

Reports


Inspection carried out on 19 February 2020

During a routine inspection

About the service

Moreland House Care Home is a residential care home providing personal and nursing care to people.

The service can support up to 50 people. At the time of our inspection there were 43 people living there. The service is purpose built and care is provided to people on the upper three floors.

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

Care plans were not always person-centred, and people were at risk of social isolation and did not engage in meaningful or relevant activities. There were systems in place to make sure people received their medicines safely. We recommended the service ensure PRN protocols are consistent. The service was purpose built but not always adapted with people’s needs in mind. We recommended the service considers the design and adaptation for people living with dementia or other sensory and communication related support needs.

Systems were in place to keep people safe from harm and risk assessments were designed to keep people safe. Recruitment practices were safe, and people received consistent care in a timely manner. The service was clean and well maintained. Accidents and incidents were analysed to prevent reoccurrence and keep people safe from harm.

Staff were supported through training and supervisions to provide effective care and support. People were supported to have their nutritional needs met and the service worked well with other health and social care professionals to provide holistic care and support and keep people well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they found staff were kind and caring and they were involved in their care and support. People felt they were encouraged to be as independent as possible and treated with respect and dignity.

Information was provided to people in an accessible format. People and relatives told us they felt able to make a complaint and were confident that complaints would be listened to and acted on. The service was good quality end of life care for people and their views and wishes had been considered.

People, relatives and staff spoke positively about the service and said it was managed well by the deputy manager who was applying to be the registered manager. There were systems in place to manage and monitor the quality of the service provided and the provider planned to audit the provisions and monitoring of activities for people. The management team had regular contact with people using the service, their relatives and the staff. The deputy manager liaised with other health and social care professionals to ensure a high-quality service was being delivered.

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 was requires improvement (published 21 August 2019) and there were three breaches of regulation. 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/ sustained, and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about end of life care; allegations of abuse and the management of falls. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the 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.

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

Enforcement

We have identified a breach in relation to person centred care.

Please see the acti

Inspection carried out on 9 July 2019

During a routine inspection

About the service

Moreland House Care Home is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 50 people. The service is purpose built and care is provided to people on the upper three floors.

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

The service was not always safe because medicines were not stored securely, records indicated people did not always receive enough fluids and pressure relieving mattresses were set incorrectly. Staff did not always undertake all required training. The service had failed to notify the Care Quality Commission when a Deprivation of Liberty Safeguard (DoLS) authorisation was in place for a person and quality assurance systems had failed to identify and address shortfalls within the service.

Systems were in place to protect people from the risk of abuse. There were enough staff working at the service and checks were carried out on prospective staff. Measures were in place to reduce the risk of the spread of infection. Steps were taken to learn lessons if things went wrong.

Assessments were carried out of people’s needs before they started using the service. Staff received regular one to one supervision. People had enough to eat and drink and told us they enjoyed the food. The service worked with other agencies to help meet people’s health care needs. 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.

People told us they were treated well by staff. Staff understood how to support people in a way that promoted their dignity, privacy and independence. The service sought to meet people’s needs in relation to equality and diversity.

Care plans were in place which set out how to meet people’s needs. People and their relatives were involved in developing these plans. People had access to a range of social activities and we saw people enjoying these on the day of our inspection. Complaints procedures were in place and records showed complaints were handled in line with the procedures.

Staff spoke positively about the leadership group and said there was a good working atmosphere. The service had links with other agencies to help develop best practice. Systems were in place for seeking the views of people who used the service and their relatives.

Rating at last inspection

The last rating for this service was good (published 12 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines and unsafe care, staff training, quality assurance and monitoring processes and notifications of DoLS authorisations.

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 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.

Inspection carried out on 6 September 2017

During a routine inspection

This unannounced inspection took place over two days on 6 and 7 September 2017.

Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 45 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

At the last inspection on 7and 8 September 2016, we found one breach of the Health and Social Care Act 2014. Medicines were not safely managed and we asked the provider to take action to make improvements to ensure that people who received their medicines without their knowing (covertly) or who had their medicines crushed were appropriately managed. The provider sent us an action plan detailing the action they were taking to meet these requirements. At this inspection we found that the actions had been completed and that people who received their medicines without their knowing (covertly) or who had their medicines crushed were now appropriately managed. People received their medicines safely.

Staff knew people and their needs well but some care plans were not sufficiently detailed or person centred. This was an area of ongoing development.

An activities worker was employed and social and recreational activities and events were available.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

Staff received the training and support they needed to carry out their duties. They provided people with the support they needed and wanted.

People were supported to receive the healthcare that they needed. They told us they felt safe at Moreland House and were supported by kind and caring staff.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.

The provider’s recruitment process ensured staff were suitable to work with people who needed support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.

Complaints were taken seriously and action was taken to address any concerns.

Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional needs were met and if there were concerns about their eating, drinking or their weight, this was discussed with the GP. Support and advice were sought from the relevant healthcare professional, for example, a dietitian.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided.

Inspection carried out on 7 September 2016

During a routine inspection

This unannounced inspection took place on 7 and 8 September 2016.

Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 47 people were using the service.

The service did not have a registered manager. 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 and associated Regulations about how the service is run.The current manager was in the process of registering with CQC.

At the last inspection on 23 and 24 September 2015 we asked the provider to take action to make improvements with regard to medicines storage and recording, taking action when possible abuse had occurred and dealing with emergencies. The provider sent us an action plan detailing the action they were taking to meet these requirements. At this inspection we found that the actions had been completed.

The arrangements for administering medicines were not always safe. People who received their medicines without their knowledge (covertly) were not managed safely. However, the issues found at the previous inspection had now been addressed.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

Staff received the training and support they needed to carry out their duties and to provide people with the support they needed and wanted.

People were supported to receive the healthcare that they needed. They told us they felt safe at Moreland House and were supported by kind and caring staff.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.

The provider’s recruitment process ensured staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs. We have recommended that the floor cleaning system be reviewed to ensure that people are not placed at risk of falls due to wet floors. We have also recommended that further consideration be given to make the internal environment more dementia friendly.

Complaints were taken seriously and concerns addressed but some people were not aware of how to complain or whom to complain to. We have recommended that action be taken to remedy this.

Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People told us that the food was good and that they could have a drink when they wanted. People’s nutritional needs were met and if there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.

We have recommended that lunchtime arrangements and support be reviewed to ensure that people have a more pleasurable meal time experience at a pace that suits them.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

An activities worker was employed and social and recreational activities and events were available. People told us that they particularly enjoyed the exercise activity.

People’s care plans were being reviewed and updated to ensure that they were clear and sufficiently detailed to enable staff to support them safely and eff

Inspection carried out on 23 and 24 September 2015

During a routine inspection

This inspection took place on 23 and 24 September 2015 and was unannounced on 23 September 2015.

Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 26 people were using the service. This was because in December 2014, when building work had been completed, Moreland House changed its registration from a 20 bed home providing personal care and accommodation for older people to a 50 bed home providing nursing and personal care or older people. The provider limited admissions to the service during the transition period.

We found that the arrangements for administering medicines were not always safe. Medicines records were not always accurate and we could not be confident that people received all of their prescribed medicines safely.

The systems in place to safeguard people from abuse and improper treatment were not effectively implemented.

People were supported to receive the healthcare that they needed. A healthcare professional told us, “From a medical point of view they are getting good support.”

People told us they felt safe at Moreland House and that they were supported by kind, caring staff. One person said, “Girls are marvellous. Make sure we’re safe.”

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs and provided care in a respectful way.

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.

Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People told us that the food was good and that they had a choice of food and drinks. We saw that people’s nutritional needs were met. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.

Staff received the training they needed to meet people’s overall needs. However they were not clear as to the action to take in the event of a person choking.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

The arrangements to meet people's social and recreational needs were limited. However this had been recognised by the provider and an activities worker had been recruited.

People’s care plans were being reviewed and updated to ensure that they contained all of the necessary information to enable staff to support them safely and effectively.

The service did not have registered manager but appropriate interim arrangements were in place. The service had not been consistently well managed but people were positive about the changes and improvements that were now taking place.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided. However we recommend that the provider monitoring reports clearly indicate any action required along with timescales for completion. Also that subsequent visits check and report on the progress made to complete the actions.

We found 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.

Inspection carried out on 29 November 2013

During a routine inspection

We spoke with five people who used the service, two family members, and five members of staff which included the registered manager. One person said, "staff are looking after me. Slightest problem and they will put it right." Another person said, "I like it here. The staff are excellent." We saw that staff had a good rapport with people living in the home. We saw people enjoying activities and chatting with staff.

There were systems in place in place for obtaining informed consent from people who use the service. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. A relative of a person told us, "my father's care plan is reviewed quarterly and they ask for my feedback and I sign it."

We saw that all areas, including bedrooms and communal areas, were clean. No odours were evident. Staff had access to, and we saw they used personal protective equipment such as gloves, alcohol gel for cleaning hands and disposable plastic aprons. One person told us, "always clean here. The staff wear protective clothing."

We found that the provider had taken action to ensure all staff received regular supervision and ensuring training needs were identified since our last inspection. The provider had addressed the concerns we raised at the previous inspection.

People using the service said they could talk to staff or the manager if they had any concerns or complaints. They also felt confident that staff members would resolve their problem. One person told us, "I would go to the office and complain. They would deal with it."

Inspection carried out on 4 January 2013

During a routine inspection

People were happy with the quality of care that they received and how they were treated by the staff team. One person said �I am quite happy here. The staff treat me nicely.� A relative commented �I believe the home has provided good care facilities for my mother.�

People felt that they were treated with dignity and respect. A relative commented �staff are respectful and kind to her.� We saw that staff maintained people�s dignity. For example by discreetly asking them if they wanted to use the toilet. We also saw that staff asked people what they wanted or liked. They offered choices of drinks at lunch time and asked people if they wanted something to protect their clothing whilst they were eating.

Although staff received training to carry out their duties and to support people who used the service there was not a consistent or organised approach for identifying staff training needs and ensuring that staff attended training. We also found that staff were not receiving regular supervision or feedback about their work practice. This limited their opportunity to discuss work practice and issues relating to the operation and development of the service.

The manager and the provider monitored the quality of the service via visits and audits. People who used the service and their relatives were asked for their opinions about the service provided. Action was taken to address any issues that were identified.

Reports under our old system of regulation (including those from before CQC was created)