Background to this inspection
Updated
21 August 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This unannounced inspection took place on 20 June 2018 and carried out by two inspectors. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the completed PIR and previous inspection reports before the inspection.
We reviewed other information we had about the provider, including notifications of any safeguarding or other incidents affecting the safety and well-being of people using the service. By law, the provider must notify us about certain changes, events and incidents that affect their service or the people who use it.
We spoke with eight people who used the service. It was not always possible to ask everyone direct questions about the service they received because some people had cognitive impairment as a result of dementia. However, all the people we spoke with could express how they felt about where they were and the staff who supported them. We observed interactions between staff and people using the service as we wanted to see if the way that staff communicated and supported people had a positive effect on their well-being.
We also spoke with seven care workers, the cook, the activities coordinator, the acting manager and the business manager. The business manager wrote to us after the inspection and provided some additional information we had requested.
We looked at six people’s care plans and other documents relating to their care including risk assessments and medicine records. We looked at other records held at the home including three staffing files, meeting minutes, health and safety documents and quality monitoring audits. We spoke with two health and social care professionals who had regular contact with the home before this inspection.
Updated
21 August 2018
This unannounced inspection was undertaken on 20 June 2018 and was carried out by two inspectors. At our last inspection in April 2016 this service was rated ‘good’. At this inspection the service has been rated as ‘requires improvement’.
Morriss House is a ‘care home’ for older people, most of whom are living with dementia. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service is registered to accommodate a maximum of 25 people. The provider had reviewed the number of bedrooms provided at the home and had reduced the number of bedrooms to 19. At the time of our inspection there were 13 people living in the home. Most of the people using the service had been living at the home for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.
The registered manager had recently left the home and we were informed that an advert had been sent out for a new 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 2008 and associated Regulations about how the service is run.
The systems used to identify, mitigate and monitor risks lacked detail. Although staff knew people well and knew how to keep them safe, this information was not always recorded.
Care planning and the assessments of people’s needs did not always reflect current evidence-based guidance, standards and best practice. Care plans were basic and lacked sufficient detail to ensure new staff would understand the holistic needs of everyone.
Records required for the running of the service were not always available for inspection. Systems used to monitor and audit quality and safety at the home were inconsistent and ineffective.
Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.
There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.
Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the manager and deputy manager.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always supported this practice.
Staff understood the principles of the Mental Capacity Act (MCA 2005) and associated Deprivation of Liberty Safeguards (DoLS). Staff knew that they must offer as much choice to people as possible in making day to day decisions about their care.
People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs people had.
All parts of the home, including the kitchen, was clean and no malodours were detected.
People had access to healthcare professionals such as doctors, dentists, chiropodists and opticians.
Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.
People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care. Records of past complaints were not available which made learning from past mistakes difficult.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, meeting nutritional and hydration needs and good governance. You can see what action we told the provider to take at the back of the full version of the report.