Archived: Morningside Rest Home

Morningside Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 up to 31 people. It is situated in the town of Winsford in Cheshire and has parking to front and a garden to the rear. The service is situated across two floors and primarily supports older people and people living with dementia and physical disabilities.

The service is run by a manager who is registered with the CQC. 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.

There were leadership issues within the service. The registered provider had not appointed a nominated individual as required by law. A nominated individual is responsible for monitoring and managing the activities being carried out by the service. This showed poor leadership and placed the service at risk of deterioration.

During this inspection we identified that people were not always safe. There were portable heaters in people’s bedrooms which were unguarded and well in excess of safe temperature levels. The registered manager had completed a risk assessment around these, however this was poor and did not protect people from the risk of harm. We asked for these to be removed and for alternatives to be sourced.

The registered manager had failed to complete an audit of accidents and incidents for December 2017 and January 2018. This had been highlighted as an issue at the previous inspection in August 2017. This placed people at risk of potential harm and showed poor management of accidents and incidents.

Care was not always provided in a person-centred way. We found that adaptations had not been made to the environment in line with best practice to make it dementia friendly. In one example best practice guidance was not being used to implement positive behaviour plans to improve a people’s wellbeing. Action had not been taken to make changes to the meal time experience despite people requesting this. We raised these issues with the registered manager for them to address.

People’s confidentiality was not always protected, and personal information was not stored securely. We observed the registered manager leaving the door to their office open and unlocked, which meant people’s personal information was not secure. Mail marked as ‘private and confidential’ was also being stored at the entrance to the premises in pigeon holes which meant it was accessible to anyone entering the service.

People each had individual care plans in place, some of which contained a good level of detail. However we observed examples where care records did not always reflect the care that was being provided to people. In other examples the daily monitoring records did not contain relevant or all the necessary information. This meant that care records needed to be reviewed to ensure they contained correct information.

We spoke with the local authority who shared information from discussions they had had with staff. Some staff had reported feeling unsupported by the registered manager, and had commented that there was a negative culture within the service which was impacting on staff morale. The local authority had shared this with the registered provider for them to look into.

Quality monitoring processes had failed to identify issues which had been picked up by the inspection process. This showed that they needed to be made more robust. Where improvements had been made these had not been done so over a sustained period of time, so the registered provider could not yet demonstrate that this had been fully embedded into day-to-day practice.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and knew how to report their concerns to the local authority.

People were supported to take their medication as prescribed. Medication audits were carried out on a monthly basis by a pharmacist to help identify and address any issues. Medication records were being signed appropriately by staff and controlled drugs were being stored securely as required by law.

Staff had received the training they needed to carry out their role effectively. New staff were supported to gain the necessary skills and qualifications and shadowed experienced staff to gain knowledge of the role.

We observed positive interactions between people and staff using the service. People and their family members commented positively on staff and told us they felt at ease in their company and found them to be welcoming.

The overall rating for this service is ‘Requires improvement’. We are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Morningside Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home is registered to accommodate up to 31 people in one adapted building. At the time of the inspection there were 17 people living at the service.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe, effective, caring, responsive and well led to at least good. At this inspection we found that improvements had been made in some areas, but not others. We also identified additional areas that required improvement.

There was a registered manager in post for part of the inspection. However, following a previous inspection we carried out in August 2017 we issued a Notice of Decision to cancel the registered manager’s registration due to significant failings we had identified within the service. During this inspection our decision came into effect and the manager’s registration was removed.

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 registered provider had taken steps to recruit a new manager however these had not been successful. There were no clear arrangements in place to ensure effective management of the service whilst a new manager was being recruited. We issued a requirement under Section 64 of the Health and Social Care Act that the registered provider give us information relating to this by the 13 July 2018. This information was received on the 19 July 2018.

Quality monitoring processes had not always identified issues within the service. The registered provider had employed an external consultant to support with monitoring the quality of the service; however the content of their findings had not been released by the registered provider to management within the service which meant that this information was redundant.

At the last inspection we identified issues around the safe use of portable radiators. At this inspection we found that this issue had been addressed. However, we identified other areas of concern in relation to people’s safety.

We observed one person being pushed in a wheelchair without foot rests which caused the person to catch their foot and wince in pain. In another example the kitchen was left unlocked and unattended for a period of time. There were people in the service who were without the ability to assess risks for themselves and would be at risk if they accessed the kitchen without support.

Parts of the service were not always kept clean. For instance, some parts of the service had a strong odour. In the conservatory the fan had a thick layer of dust on the blades, chairs were dirty and there were cigarette butts piled up in and around a plant pot outside the conservatory’s back door. These issues had not been identified and addressed.

People were not always supported to have maximum choice and control of their lives and the policies and systems in the service did not support best practice. For example, a mental capacity assessment had not been completed for one person who had been placed on a diet. In another example an application had been made to restrict one person who did not meet the criteria for restrictions under the Mental Capacity Act 2005.

Outcome based support was not always implemented and best practice guidance not always used. At the previous inspection we asked the previous registered manager to put a positive behavioural plan in place for one person. Whilst this had been done it was basic and did not fully support staff to provide effective support. Staff told us they did not always know how to support this person and had not received relevant training.

Care records did not always contain up-to-date information about the support people required. For example, updates had not been made to a person’s care record following a fall, despite this having highlighted significant issues with supporting this person after having fallen. In another example a person’s care record gave specific information regarding the action that should be taken in respect of a person’s continence needs. We reviewed monitoring charts which showed that this process had not been followed.

At the previous inspection we raised issues regarding the lack of adaptations to the premises for people living with dementia. At this inspection we did not find that any action had been taken to address this.

During both days of the inspection it was apparent that there was a lack of meaningful activities available to people. There was no activities co-ordinator in place to support with this. This placed people at risk of becoming bored or socially isolated.

Morale amongst staff was low and this had been picked up by people using the service. One person made comments which showed they had been made privy to information about the internal politics amongst staff. This showed a lack of professionalism because staff had failed to put appropriate boundaries in place between themselves and the people they supported.

Staff told us that they did not feel supported by management within the service or the registered provider. During the inspection a number of staff left the service as a result of feeling unsupported. This has been an ongoing issue which the registered provider has persistently failed to address.

People had received their medication as prescribed. At a previous inspection we placed a requirement on the registered provider’s registration that a medication audit be carried out by a pharmacist on a monthly basis. We checked and found that this was being done.

Positive relationships had developed between people using the service and staff. We observed examples where staff supported people in a kind and gentle manner. Staff were respectful when supporting people to attend to their personal care needs.

Care records contained personalised information about people using the service. This helped staff get to know the people they were supporting and facilitated the development of positive relationships.

A registered manager was in post who had been registered with the CQC since September 2014. 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.

Morningside Rest Home is registered to provide personal care and accommodation for up to 31 older people. At the time of the inspection there were 29 people using the service. The service is spread over two floors and has parking to the front and a garden to the rear. It is set in a residential area within the town of Winsford in Cheshire.

At the last inspection in January 2017 we identified concerns in relation to the safe administration of medication and the efficacy of audit systems. Following the inspection we imposed a condition on the registered provider which meant they had to employ an external professional to monitor and manage the safe administration of medication. At this inspection we identified that issues in relation to medication had been resolved, however issues around audit systems had not been resolved. In addition we identified further concerns about the service.

Audit systems were not effective. These had failed to identify issues found during the inspection in relation to the safety of the environment, infection control, care records and people’s safety. The registered manager and registered provider had failed to take action in response to incidents that had occurred to prevent these from happening again.

The safety and security of the premises was not sufficient to protect people from harm. One person had fallen down steps at the rear of the premises, and one person at high risk of falls had been able to access the stairs. In one incident a person at risk of leaving the premises without support had been able to do so, and on another occasion staff had managed to stop a person just prior to them leaving the premises. On one occasion the kitchen was unlocked and unattended for a substantial amount of time. The front door was not locked on our arrival, and the side gate was open which enabled access in and out of the premises through patio doors into people’s bedrooms. Prior to leaving on the first day of the inspection we ensured that the registered manager had taken action to address these issues.

Parts of the environment had not been maintained to an adequate standard. A hand rail in the passenger lift had fallen off and hit one person on the foot. Infection control procedures were not always robust. Stains were found to three people’s beds, and one person’s carpet was badly stained. Hand washing facilities were not available in one bathroom, placing people at risk from infection.

Adaptations had not been made to the environment to promote the wellbeing of those people living with dementia. For example there were steps in the back garden which posed a risk to people who were at high risk of falls. The registered manager had temporarily cordoned these off with a garden chair. In addition there were no objects to help people to orientate themselves within the service, in line with best practice.

Risk assessments were not always up-to-date or fully completed. For example malnutrition risk assessments had not been completed to enable a full analysis regarding the risk of people losing weight. In another example a person had been assessed as low risk of falls despite having sustained a number of falls over a two month period.

Deprivation of Liberty Safeguards (DoLS) had been applied for by the registered manager. However the registered provider was not able to fulfil their responsibilities under the Mental Capacity Act 2005 (MCA) due to failings in ensuring the premises was secure. We identified examples where people had managed to leave the premises without the required support which showed that staff had failed to adequately safeguard them from harm.

Supervisions were not being completed as required. At the last inspection in January 2017 we also identified that these were not completed. This meant improvements had not been made. Supervision enables the registered manager to maintain a record of staff performance. They also help keep staff accountable for any performance related issues.

Not all staff spoke to people in a kind of dignified manner. The registered provider had completed a survey in which some people had stated that “one or two” staff were not always kind to them. During the inspection we identified one member of staff who shouted at people in the lounge area, demonstrating an undignified and disrespectful approach. We raised this with the manager as a potential safeguarding and performance related issue. Following the inspection we raised this with the local authority.

People’s confidentiality was not always protected. Staff handover took place in the lounge/ dining room during which personal information about people was discussed. Other people were present in the dining room whilst this was taking place. The staff office was left unattended at times, which left confidential information at risk of being accessed by unauthorised individuals.

People’s care records did not always contain up-to-date or accurate information. This meant that staff did not always have access to important information about people’s care needs.

There were sufficient numbers of staff in post to meet people’s needs. People commented positively on the number of staff available, and told us they did not have to wait long for support when they pressed the call bell.

Recruitment processes were safe and helped ensure that people were protected from harm. Checks had been completed on staff prior to their employment to determine their suitability for the role.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection was unannounced and took place on the 8 and 9 October 2018. At the last inspection carried out in June 2018 we identified breaches of Regulations 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified issues relating to the culture within the service, compliance with the Mental Capacity Act 2005, the completion of risk assessments, the provision of adequate training and quality monitoring/ oversight within the service.

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.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to make the required improvements across each of the five key questions, to bring the service up to ‘good’. An action plan was not forthcoming. At this inspection we identified that whilst some improvements had been made, there remained ongoing issues within the service.

Morningside Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service was registered to support 31 people, however at the time of the inspection there were 15 people living at the service.

There was no registered manager in post within the service. The previous registered manager had left in July 2018 after we cancelled their registration. A registered manager is a person who has registered with CQC 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. A new manager had started at the service five weeks prior to this inspection, however they had not yet started the registration process.

At this inspection we identified breaches of Regulations 9, 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the previous inspection we spoke with the registered provider about their lack oversight of the service. The registered provider had repeatedly failed to address issues and make improvements which had resulted in ongoing breaches of the Regulations. Following this inspection, we spoke with the registered provider who had not read the report from the previous inspection and was not aware of what improvements needed to be made. This showed a continued lack of engagement.

Quality monitoring systems were in place however action was not always taken to make improvements. The registered provider had not responded to an audit that had been sent by the manager outlining areas of the service that needed improvement. This impacted on the required resources being made available to make improvements.

At the previous inspection we found that risks assessments were not being completed as required. There had been some improvements in relation to this, however risk assessments that were in place did not clearly outline to staff what processes should be followed to keep people safe. We also found that two unoccupied rooms which were being refurbished and containing trip hazards had been left open and were accessible to people. Action was taken to address these issues by the manager.

Following this inspection we received concerns regarding the heating system which had stopped working during one weekend. Staff had failed to use the ’on-call’ system which resulted in people being placed at risk of discomfort for longer than necessary. The manager confirmed this issue was addressed immediately on their return to work.

Issues identified at the last inspection relating to the cleanliness of the service had been partly addressed, however some of the furniture needed replacing because this retained stains even after being cleaned. The registered provider had not made resources available to address this.

Care plans were in place for people however these did not always contain the relevant information staff needed to support people. We raised this with the manager in relation to one person and immediate action was taken to address this. We also highlighted other areas within documentation that needed improvement, such as information recorded on fluid balance charts which the manager told us would be addressed.

At the last inspection we identified that staff did not always have the relevant skills or knowledge needed to support people with managing behaviours that challenege. At this inspection we identified that whilst the registered provider had not taken any action with regards to this, the manager had employed staff who had the necessary skills. The manager informed us that staff would be supported to share and learn from each other.

At the previous inspection we identified that mental capacity assessments had not been completed as required. At this inspection we found this remained an issue. We observed generalised mental capacity assessments and also identified areas where capacity assessments may be required, but had not been completed.

We previously identified significant issues with the culture within the service. Staff were previously very negative and had failed to maintain professional boundaries by involving people in their disputes with other staff members. At this inspection we found improvements had been made. Staff presented as much happier and family members we spoke with commented that they had noticed this. This change had been affected by the manager who had introduced new members of staff into the service.

Staffing levels were appropriate to meet people’s needs. Throughout the inspection we saw there were enough staff in post and people did not have to wait long to be supported.

We reviewed recruitment records and found that staff had been subject to the necessary checks prior to employment. This helped ensure that people were protected from the risk of harm.

Staff had the skills necessary to carry out their role and support people where required. There was an induction process in place for new staff which included a period of shadowing experienced members of staff.

People commented positively on the food that was available. Alternative options were available where people did not like what was on offer and portions were generous. This helped ensure people had enough to eat and drink.

At the previous inspection there were no activities available for people. At this inspection action had been taken to rectify this. Activities were scheduled daily by an activities co-ordinator which helped prevent the risk of people becoming socially isolated.

The last inspection was undertaken on 7 July 2016. During that inspection we found that the registered provider was not meeting legal requirements. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of the management of medication; safety and maintenance of the premises and governance of the service. An action plan was received from the registered provider and they stated they would be compliant by 10 October 2016.

Morningside Rest Home is registered to provide personal care for up to thirty one older people. At the time of this inspection twenty-eight people lived at Morningside. The home is in a residential area of Winsford and is close to shops and other local amenities. There is car parking facilities to the front of the premises.

The service has 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 2008 and associated Regulations about how the service is run. The registered manager was available during one day of these visits.

We found that medicines were not managed safely. People had not been given their medicines on some days as prescribed and medication administration was not always recorded.

The quality assurance systems in place were not effective and did not identify, assess or monitor the quality of care and facilities provided to people who used the service. Issues we found during our inspection had not been identified or addressed by the registered provider or registered manager.

During the last inspection we raised concerns about the lack of training and awareness of the staff team about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found that staff had now received this training. 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 and family members told us that the staff were kind, caring and friendly. Comments included “The staff are lovely” and “The staff are very kind”. People and family members told us that they saw the registered manager regularly and that she was “Always available” when they needed to speak with her.

We found that there were enough staff members on duty within the home and people and family members confirmed this. Family members told us they were welcomed into the home by the staff and always offered refreshments.

Risk assessments were in place for a range of activities. We saw that these were monitored on a regular basis and were up to date. Care plan information was centred around the person and we saw that these documents had been reviewed and updated on a regular basis. Appropriate referrals to healthcare professionals had been made where concerns had been identified in regard to people’s health.

People and family members told us they were happy with the food. They said “The food was lovely” and “We always get a choice”. During the mealtime we saw that staff were kind and friendly towards people and that this promoted a positive dining experience for people.

Staff attended regular training sessions in areas such as moving and handling, infection control, health and safety and safeguarding.

Improvements had been made to the environment, décor and the service was clean and free from offensive odours.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘Special Measures’.

Services in special measures will be kept under review, and if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Morningside is registered to provide personal care for up to 31 older people. The home is in a residential area of Winsford and is close to a range of shops and other local amenities. There are car parking facilities to the front of the premises. At the time of this inspection there were 28 people living at the home.

There was a registered manager in place at this service, who has been registered for twenty-two months since September 2014. 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.

At the last inspection on 30 June 2015 we found that a number of improvements were required. These were in relation to medication administration and staff awareness of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and notifications of significant incidents and events that affected people or the running of the service. We asked the registered provider to take action to address these issues.

After the inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breeches identified. They informed us that they would meet all the relevant legal requirements by the end of December 2015. However, whilst the registered provider had made improvements they had not fully met their own action plan.

During our visit we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of the report.

People did not always receive their medication as prescribed. People’s medication records had not been appropriately signed at the time of administration and errors were found in the medication records. Medication was not always stored in a safe and secure way.

The home was not always clean. Some shower and bath rooms were dirty and there was a risk of cross contamination where fittings and equipment were chipped and damaged. The management of infection control was poor.

Although some refurbishment and redecoration had taken place within the home, some communal areas had damaged walls and door frames and furniture was in need of replacement. Externally the garden was overgrown with weeds, window frames had bare wood exposed and peeling paint visable.

Staff recruitment processes were in place which included a Disclosure and Barring Service check. Two references were undertaken, however, most references we saw did not ensure that references were robust or gave an impartial view of a prospective employee’s character. We have made a recommendation about accessing suitable references.

The quality assurance system in place failed to monitor the quality of the service provided. The systems did not always identify areas of concern or where improvements were required. Policies and procedures were not up to date and did not reflect current legislation or guidance.

Some staff had completed a range of training courses, however, concerns remain that many staff had not completed all the training required to maintain and develop their knowledge and skill base. Training records indicated that many courses had not been completed by the staff team and a recommendation was made to ensure that all training was brought up to date.

People told us that they were happy with the care they received at the service. People said they staff were kind, friendly and caring towards them and that they supported them to meet their needs.

People said they felt safe at the home with the staff team. Staff had been trained to recognise and report any signs of abuse. Safeguarding issues that had arisen at the service since the last inspection had been appropriately reported and actioned.

Care plans were person-centred and risk assessments were completed and were up to date.

The staffing levels were good and sufficient staff were observed on the days the inspection took place. Good support was given to staff by senior management and meetings and supervision sessions were undertaken.

People told us the food was good and that they had access to drinks whenever they wanted them. Care plans showed that a nutritious diet was encouraged.

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

Is the service safe?

The service had the correct systems in place to manage risks, safeguarding matters, staff recruitment and this ensured people's safety.

We undertook a tour of the home. We found it to be clean and free from unpleasant odours. We saw that the d'cor was improving, with the two lounges being recently redecorated.

We looked at the staff recruitment and selection. We saw four staff files and noted that appropriate recruitment processes had been undertaken. This included checks to ensure that staff were able to work with vulnerable adults.

The service required improvement because although the acting manager was aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, none of the staff had undertaken training in this area.

Is the service effective?

The service was effective as staff ensured people's needs and preferences regarding their care and support were met and they knew the people they supported well. Staff had training in place and this was focused on the needs of the people who lived at Morningside.

We looked at care plans and other care records for seven people who lived at Morningside and they all had an assessment of the person's health and social needs completed. The care plans were up to date and reviewed on a monthly basis.

Is the service caring?

The service was caring because staff had the right approach and people and their relatives were all positive about the care and support given. People had their privacy and dignity respected.

Many of the people who lived at Morningside were not able to talk to us, so throughout the day we observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

Is the service responsive?

The service was responsive, as people had their care and support needs assessed and kept under review and staff responded quickly when people's needs changed. Although no complaints had been received recently, a system was in place should the need arise.

We saw the complaints policy and procedure and noted that no complaints had been made since the acting manager was in post. People who we spoke with said they had no complaints or concerns regarding the home.

Is the service well-led?

The service is not well led and requires improvement. There was currently no manager at this service. The service was led by the deputy manager. There were sufficient staff to meet people's needs and they were competent and knowledgeable. Audits were in place to identify trends in the service, and when necessary action plans were produced and acted upon.

We spoke with six people who used the service, three relatives, a visiting professional, five staff members and the acting manager. People who used the service said: 'The staff are very nice', 'I am well looked after' and 'I am happy here.' People we spoke with confirmed they were well cared for and their dignity and privacy were respected.

Relatives commented: 'My relative has settled well here', 'The staff are very helpful' and 'The home is clean.'

Visiting professionals said: 'The home is of a good standard', 'The home appears clean and cared for' and 'Staff seemed to know the people they care for.'

Staff commented: 'The training here is excellent', 'We have regular meetings', 'The culture in the home is changing, for the better', 'The staff team are like a family to me' and 'The deputy manager seems to know what they are doing.' Staff spoken with confirmed that they didn't have any concerns about the welfare of people they supported. They also commented that things were settling down and improvements were being made within the home.

We had also received information of concern from a number of people and also from Cheshire West and Chester Social Services. These concerns were about the care plans, standards of care, the environment and food, management of medication and staffing levels and support.

We looked at care plans and other care records for four people who lived at Morningside and they all had an assessment of the person's health and social needs completed. The care plans had been reviewed during the last month. At our previous inspection the care plans and risk assessments needed to be brought up to date, which had now been completed.

We looked at menus and food that was available to people who lived at Morningside. We found there was a good variety of traditional meals available and people said they enjoyed the food.

We looked at the management of medication and we found that there were some gaps in the medication record sheets; prescribed creams were left in people's bedrooms with no risk assessments in place; staff took a long time to administer the morning medications and some medication processes needed to be reviewed. This meant that there was a risk people may not have been given thier medicine as prescribed. Staff had received training in medication and people who lived at Morningside confirmed that staff supported them with administration of medication when necessary.

We undertook a tour of the home. We found it to be clean and free from unpleasant odours. We saw that the d'cor was tired and dated and the home needed to be refurbished both internally and externally. The home did not employ a regular maintenance person and we noted that tasks they would normally undertake had not been completed such as checks on hot water system and general maintenance around the home. This meant that ongoing maintenance, refurbishment and redecoration had not been planned for or completed.

We looked at the staff rotas and the staffing levels in general for the home. We discussed staffing issues with the manager and they confirmed that the current staffing levels met the needs of the people who lived at Morningside. The manager explained there were some staff vacancies at present and that they were currently recruiting for care and domestic staff.

We spoke with four people who used the service, two relatives, two visiting professionals and four staff members. People who used the service said: 'The staff are nice', 'I like the food', 'The staff are marvellous, l like them very much' and 'The staff are kind.'

Relatives commented: 'I have no complaints', 'My relative is well looked after', 'Staff are very helpful' and 'Staff are very good with my relative.' They didn't have any concerns or complaints about the home.

Visiting professionals said: 'I always find people tidy and the home doesn't smell offensive', 'The staff are helpful', 'I don't have any concerns' and 'Bedrooms are clean and tidy and care is always delivered in private.'

Staff commented: 'It's great here now with the new manager', 'The staff support each other' and 'I like working here.' All the staff said they got good support from the management team and that the new manager was always there to listen to staff and has a high standard.

Some of the people who lived at Morningside were not able to talk to us, so throughout the day we observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

We also carried out this visit in response to concerns reported to us by Cheshire West and Chester social services about the standards of care and care planning not safely supporting people's needs. We found that improvements were needed to care plans and risk assessments to ensure staff had sufficient information to protect people from inappropriate or unsafe care planning and care delivery.

We spoke to four people who used the service and to three relatives who were happy with the care and support provided. Some comments made were: -

'I'm very happy here. It's a lovely place.'

'The staff are good and thoughtful. I'm well cared for.'

'The staff are very good. They keep us informed. My mum is well looked after.'

We spoke to two visiting health professionals during our visit. Both said that appropriate referrals were made to them and that they were appropriately contacted for advice. Both described the staff as caring. One said that advice given was followed and one said that advice given was not always consistently followed which meant that the needs of the people who used the service may not have been consistently met.

We spoke to three relatives who were happy with the care and support provided. They described the staff as supportive and caring.

We spoke to two health professionals who told us that a good service was provided at the home. We were informed by a service commissioner that a recent complaint had been received and that the manager had taken appropriate action in response.

During our visit we observed that staff were respectful, attentive and had a caring attitude towards the people who used the service.

We found that there had been an improvement to record keeping and the staff recruitment process since our last visit. This ensured that people were protected from the risks of unsafe or inappropriate care or treatment.

We found that people were assessed before they began to use the service and they had care plans that identified their needs. People were appropriately supported with their nutritional needs. The home was clean with adequate systems in place to promote infection control.

We found that improvements were needed to ensure the suitability and safety of the premises.

We spoke to four people who used the service. They said they were well looked after and happy with the service received.

We spoke to one relative who told us that they were happy with the care and support provided.

Information provided by health and social care professionals indicated that people's needs were appropriately met.

Records showed that people had been assessed before they began to use the service.

Staff were aware of the action to be taken to safeguard vulnerable adults from abuse.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated.

Improvements were needed to recruitment procedures and to record keeping in several areas, including, quality monitoring and care planning. These improvements were needed to ensure that the people who used the service had their safety and well-being adequately promoted.

Cheshire LINKs* had undertaken a recent visit and their report was not yet available. Cheshire West and Chester Council had been involved in investigating some complaints about the home within the last twelve months. Overall, they had found that the home had taken appropriate action.

LINKs* are networks of individuals and organisations that have an interest in improving health and social care services.