Moriah House Limited

Moriah House is a residential care home providing personal care to 43 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 50 people in one building across two floors.

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

The provider had taken action to reduce the risk open stairwells posed to people This risk had been assessed and mitigated with the installation of gates to all open stairwells and robust risk assessments were now in place.

Staff were undertaking a comprehensive training programme and improvements had been made however the training programme would need to be fully completed to ensure the risk of harm to people was mitigated.

We saw evidence of improved auditing which identified issues and action plans that addressed and monitored progress and improvements, however further improvements were still needed to ensure they can be sustained. Staff told us they were listened to and felt valued by the management team.

People were treated with dignity and respect. People and their relatives told us they were actively involved in making decisions about their care.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 for this service was inadequate (published 28 October 2021) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations, however further improvements were still needed to ensure they can be sustained by the new management team.

This service has been in Special Measures since 15 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 8 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing, overall governance and systems that safeguard people from risk of abuse.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moriah House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Moriah House is a residential care home providing personal care to 49 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 50 people in one adapted building over two floors.

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

People were not kept safe from risks that could impact their physical wellbeing. Staff were not kept up to date with training to safely meet people’s individual needs and protect them from the risk of abuse. People were supported to take their medicines safely.

There was ineffective systems in place to monitor the safety and quality of care being provided to people. People and staff felt they were not listened to by management. The provider did not ensure learning and improvement was taking place.

People were not always treated with dignity and respect. People were not being actively included in decisions about their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 February 2019).

Why we inspected

We received concerns in relation to the management of the service, safeguarding and training. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, staffing, safeguarding, dignity and care, and management of the service at this inspection.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

Alternative arrangements were in place to support people to maintain contact with their loved ones when face to face visits were not possible due to an infection outbreak. People were supported to keep in touch with their family members via video or telephone calls.

People who were isolating in their rooms had regular contact with staff who at the time of the inspection wore personal protective equipment (PPE) in line with the government guidance. The service had good supply of PPE.

The provider had erected ‘visiting pod’ to safely support visits in line with the latest guidance.

Some people living with dementia liked to walk around the home. Staff encouraged them to use specific separate communal areas, to keep them safe and maintain social distance.

Hand sanitising points were readily accessible throughout the home and staff used these frequently. The provider purchased fogging machine to allow thorough disinfection of the furniture items. Cleaning procedures were enhanced to include regular disinfecting of high touch points such as door handles and handrails.

The service was following the national guidance for anyone moving into the home and admissions were carried out safely.

People told us of a variety of reasons they felt safe at the home. They said they felt safe because of the quality of the care and support they experienced and because the staff were well trained. They told us their valuables and possessions were safe. People felt there were enough staff and that staff were attentive to their needs. Staff knew how to protect people from harm. People had their medicines on time. The home was clean, tidy and fresh.

People had a choice of healthy meals and their dietary requirements were met. The staff were knowledgeable about people’s food preferences. People had meals that met their cultural needs and were able to have their favourite meals. Staff made sure people saw their GPs and other healthcare professionals when they needed to.

People said they liked the way the with home was decorated. We saw that the home was well-maintained.

People are supported to have the maximum choice and control of their lives and staff support them in the least restrictive way possible; the polices and systems in the service support this practice.

The staff treated people with kindness and respect. People told us that staff spent time to have conversations with them which they enjoyed. Staff checked that people were warm and comfortable. Relatives could visit the home at any time and were made welcome by staff. Staff encouraged people to mix with others; people formed friendships with other people. We saw lots of interactions between people.

People took apart in activities. They joined in with games that promoted movement and exercise. We saw people reading, watching television and talking with other people and staff. People who wanted were supported to follow their faith needs.

The provider and registered manager ensured information was provided to people in a way they found accessible. People’s care plans included ‘communication passports’ which explained how they wanted staff to communicate with them.

People told us that if they had any complaints about the service they would tell the registered manager or staff.

People told us they were happy living at the home and felt well-cared for.

The registered manager carried out audits to assess the quality of people’s experience of the service. They carried out checks to ensure the premises were safe. The registered manager was supported by a senior manager who also carried out audits to verify what the registered manager reported to them. We found that the service had not informed CQC of four of incidents between people which fell into a category of abuse.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

About the service:

Moriah House is a registered care service providing care for up to 50 older people. It is situated in a residential area of Carlton, a suburb of Nottingham. On the day of our inspection visit there were 33 people using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at last inspection: Good (report published on 19 May 2016)

More Information is in the detailed findings below.

The service had a registered manager at the time of our inspection and an acting manager who was planning to apply to become registered. 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.

When we last inspected the service in February 2015 we found there were improvements needed in each of the five key questions we ask of services; whether the service is safe, effective, caring, responsive and well led. We found at this inspection that the provider had made the necessary improvements to the service.

People felt safe and were protected from the risk of abuse by staff who had a good understanding of their roles and responsibilities if they suspected abuse was happening.

The risks to people were reduced as staff understood risks that people may face and took action to ensure people’s safety. People received their medicines as prescribed and these were managed safely.

There were sufficient staff on duty to meet people’s needs and the number of staff required in the service was monitored by the registered manager.

People’s right to make decisions was respected and legislation to protect people who lacked capacity was being adhered to. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

Staff received training and supervision to ensure they had the appropriate knowledge and skills to provide people with safe and appropriate care.

People were encouraged to have sufficient to eat and drink and their health was monitored. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were treated with dignity and respect and had their choices acted on. We saw staff were, attentive, kind and supportive in their interactions with people.

People’s preferences as to how they received support were respected and we found that people were provided with stimulation and activities which reflected their interests and the level of support required.

People were given opportunities to express their views and be involved in the running of the service and there was evidence that action had been taken in response to people’s views. There were effective systems in place to monitor the quality of the service.

The home does not currently have a registered manager in post, however the current manager has managed the home for over six months and is in the process of applying to become the registered manager.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found-

Is the service safe?

The care planning system was thorough and action was only planned following an appropriate assessment of any risk. We saw there were systems to review care plans and analyse any incidents, such as someone who was at risk of or had fallen.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the provider had effective systems to involve people in planning their care, and obtaining people's consent for this to be provided. A staff member said, 'We have to act in people's best interest if they are unable to decide for themselves.'

We found staff were effective in meeting people's needs. A person who used the service said, 'I wash myself in the mornings and have a bath every week. I get help to have my hair washed.' Staff followed a recognised approach for working with people who had dementia. This promoted their dignity and ability to continue to do as much as they could for themselves.

Staff received effective support to enable them to carry out their duties. A staff member said, 'We get guidance sometimes on how to do things a better way.' A person who used the service said, 'I think staff know what they are doing.'

Is the service caring?

During periods of observation we saw staff responding appropriately to people's needs. We saw another person was hoisted in a sensitive and caring way. A person who used the service said, 'Staff speak very nicely, there is nobody who doesn't. I am very comfortable here.'

Is the service responsive?

We saw staff asking people's permission before they provided them with any support. A person who used the service said, 'I am asked first, I always say yes, but it is nice to be asked.'

Care plans described how staff should respond to people's identified needs. A person who used the service said, 'I'm alright, I have got a lot of independence.'

The current duty rotas showed the intended level of staff cover was not always provided. A person who used the service said, 'They (staff) have to work very hard.' A staff member said, 'We provide good care, except when we are short staffed.'

Is the service well-led?

The care planning system was thorough and action was only planned following an appropriate assessment of any risk. Staff told us the care plans were suitable and they were easy to follow. One staff member said they were, 'Informative and easy to read.'

An auditing system was being introduced to ensure the service was well led through an effective quality assurance system. However we found some records were not completed as required and others were not audited to ensure people received the care and support they required.

The provider responded to the views of people who used the service. A person who used the service said, 'I feel listened to.'

We looked at the records for six people who used the service. The records were not kept up to date as care needs changed. People's needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan.

During our tour of the premises we observed that the environment in communal and individual bedrooms looked generally clean.

We observed one staff member who was based in the conservatory/dining room during lunch. The staff member left the conservatory/dining room regularly throughout lunch which meant people did not receive assistance in a timely manner and staff were not always available to help.

Two of the three staff we spoke with told us they had not had any supervision meetings recently. Only one staff member had had an appraisal. We looked at the staff files and did not find evidence of supervision meetings or appraisals.

The latest complaints policy, which had been reviewed in April 2013, provided appropriate guidance about the complaints procedure at the home.

We saw that care plans, associated risk assessments and records related to support people needed all contained gaps. People's personal records were not accurate nor were they fit for purpose.

People told us they could choose what time they got up in the morning. One person said, 'You can please yourself what time you get up in the morning.'

Two people who use services told us there were enough staff. However, one person said, 'They're sometimes a bit short.' Another person said, 'You sometimes wait a long time to go to the toilet.'

People told us they were receiving good care. One person said, 'Staff look after you well and people that need extra attention get it.' Another person said, 'I can't fault the care. I've been very happy since I got here.'

We found that there were not enough qualified, skilled and experienced staff to meet people's needs at all times. We also found that people were cared for by staff who were not fully supported to deliver care and treatment safely and to an appropriate standard. Not all staff had received regular supervision and appraisal. A number of staff had not attended all mandatory training.

We found that the provider had notified the Care Quality Commission of events that required notifications to be made under the Care Quality Commission (Registration) Regulations 2009.