Archived: Moorlands Care Home

If you want to see the evidence supporting our summary please read the full report.

We carried out a visit to this home in June 2014 and identified concerns in relation to staffing levels, quality monitoring systems and records. We wrote to the provider and asked them to provide us with regular updates regarding their staffing and quality monitoring systems. They also provided an action plan detailing when they would reach compliance. This was a follow up visit to see if the actions identified within the provider's action plan had been addressed.

Is the service safe?

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

People told us that they were consulted about their care. However the comments provided to us during our visit raised concerns about some aspects of people's safety; for example people not having a call bell to summon help. We have told the provider to take action to address these concerns.

The home had systems in place to help managers and staff learn from events such as accidents, incidents, complaints, concerns and whistleblowing. However these systems were in the early stages of development and needed further work.

Is the service effective?

The home had appropriate arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. However the comments provided to us during our visit raised concerns regarding the effectiveness of staff being able to deliver care in a way that people wanted it to be delivered. We also identified a number of issues regarding people's mealtime experience and we have told the provider to take action to address these concerns.

Is the service caring?

We saw evidence of people being cared for by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. However some of the comments raised by people during our visit raised concerns about the way some people were being cared for particularly where their basic care needs were not being met. We have told the provider to take action to address these concerns.

Is the service responsive?

Since our last visit the service had reviewed their staffing levels, employed new staff and reviewed their care records. People told us they could talk to the new manager if they had concerns.

Is the service well-led?

The service had a new manager who was not yet registered with the Care Quality Commission. The manager was trying to develop a number of new systems and practices to bring about change and improvement at this service, including quality monitoring systems. However due to the short time the new manager had been in post we will continue to monitor this service so that we can be satisfied that improvements are made and people receive safe and appropriate care which meets their needs.

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive. Meetings had started to be held so that people could air their views.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them, speaking with relatives and other professionals and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff had not received training in this area which meant that they did not always understand when an application should be made, or how to submit one. This meant that people may not be safeguarded as required.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. However although evaluations were being carried out regularly the care plans were not always updated. This meant that the information was not kept up to date and did not always reflect any changes in people's care needs.

We found that medication was not always appropriately recorded and found that staff were not always signing medication records to document when topical ointments such as creams were given.

Staffing levels required review so that staff can deliver care to people safely. During our visit we were told that there had been many occasions where there was insufficient staff on duty. We were given examples of how this may impact on people's care. We have asked the provider to take action to address this shortfall in staffing.

Systems to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations were in the early stages of development and required further attention.

Records were in place detailing how people should be cared for. Records were not always stored securely which meant that people could not be confident that the information about them remained confidential and accessible only to those who needed it.

Is the service effective?

The home had some systems in place for gaining people's consent. People's health and care needs were assessed, but there was little evidence to demonstrate that people had been consulted about their care needs. This meant that staff may be unable to deliver care in a way that supported people.

Despite the concerns highlighted in the previous inspection report in October 2013 we found that the home had failed to address all of the areas of non-compliance in sufficient detail to demonstrate that they were now compliant. Although a number of improvements were noted we will continue to monitor this service to ensure that compliance is achieved.

Is the service caring?

People were supported by kind and attentive staff. All of the comments received regarding staff were positive and people said that they were kind, caring and treated people with dignity and respect. Comments included 'I have never had any concerns about staff attitudes or behaviours' and 'I have nothing but praise for the staff. They have been wonderful to my Mother.'

The observations we made during our visit demonstrated a warm and caring approach from staff towards people, however the current staffing levels meant that the quality of care delivered may be impacted upon.

Is the service responsive?

There was limited evidence to demonstrate that the home was responding quickly to any changes in people's care needs. This was particularly evident with end of life care where we found that care records had not been updated.

People and relatives we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the nurses about any issues and said action was taken quickly to resolve any problems.

We saw that the home had responded to some suggestions made during a meeting held in January with the administrators and most people we spoke with confirmed that they felt that the home would respond to any concerns if they were unhappy. However

some relatives felt that the home was slow in responding to the improvements required regarding the premises.

Is the service well-led?

The service does not have a registered manager and the acting manager had been moved to another service. Management arrangements within the home required urgent review so that there was a team of people able to offer guidance and support to those using the service, their relatives and to staff. Feedback from external agencies, such as doctors or social workers confirmed that people received their care in a joined up way.

Some of the relatives we spoke with said that management systems needed to be improved upon, particularly where issues with staffing had been identified.

Quality monitoring systems were in the early stages of development which meant that they were not identifying issues in a timely manner. We have used our regulatory powers to require the provider to send us regular updates about how the service is operating so we can continue to monitor this.

People told us that they were well cared for by staff; however we observed practice during our inspection that raised concerns about people's care and welfare. The home was failing to appropriately manage people's pressure care and to ensure sufficient nutritional intake which could impact on their physical well-being.

Although people received a choice of food, the dining experience could be improved to make it a more social experience.

People told us that they felt safe and could raise any concerns or issues with staff working at the home.

People told us they liked the staff but some people were concerned about whether there were enough staff on duty. We spoke to staff who told us that the low staff numbers were impacting on morale and client welfare.

We saw that staff received training and supervision to help keep their skills and knowledge up to date.

Quality monitoring systems were in place, however these were not always fully effective as although issues were identified and action plans formulated, the actions taken in response were not always satisfactory.

Records, although held securely, were not always up to date and did not always reflect people's needs appropriately.

During our visit we saw that improvements had been made. All of the people we observed during our visit were dressed appropriately, clean, shaven and looked well cared for. The people we spoke with said that they were well looked after and liked living at Moorlands. We spoke with a relative who told us that they could not fault the care provided. Staff told us that there were more opportunities for people to go out and that this was having a positive impact on people living at the home.

The provider had made improvements to the environment. They had carried out a programme of redecoration and replaced carpets and soft furnishings. A visiting professional and two staff who we spoke with confirmed that the improvements to the home had made a positive difference. The environment was bright, clean and welcoming. This meant that the home was a nice environment for people to live in.