Moss Cottage Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care planning and delivery.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People did not always receive person-centred care that fully met their needs. Permanent staff knew people. However, there was a high reliance on agency staff, who were not always familiar with people's needs and preferences. One person told us, “The staff seem to know me well. Some of the regular staff know that I played [named activity] and about my family.”

We found inconsistencies in the recording of some specific care needs, particularly in relation to dietary requirements. Records did not consistently demonstrate that the correct care was being delivered. This was discussed with the provider during the inspection, and action was taken to ensure accurate information was available across all records.

Care plans lacked sufficient person-centred information. The provider was aware of this issue and was in the process of reviewing and developing care plans. Activity staff were also gathering additional information about people's preferences, interests, and life histories to support the development of more personalised care plans.

Throughout the inspection, we observed mixed levels of interaction between staff and people using the service. Some people received very little engagement from staff, while others experienced positive and meaningful interactions.

The home cared for a number of people who spent most of their time in their bedrooms. The provider was reviewing its activities programme to ensure there was sufficient time and resource to support these people on a regular basis with meaningful engagement, mental stimulation, and one to one activity tailored to their individual preferences and interests.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

We received mixed feedback about how people were supported. While the home enabled people to access community-based healthcare services within the home, information was not always communicated effectively, and people were not always prepared in time for appointments.

People did not always have clear and comprehensive information about their health and care needs available at the point of admission. In addition, advice and guidance from healthcare professionals were not always clearly documented or communicated across care records and information systems. This meant staff may not always have had access to the most up-to-date information required to provide consistent and effective care.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider was able to adapt information to meet people's needs, including providing information in translated and large-print formats. A pictorial menu was available, and a board was in place to communicate planned activities; however, at the time of our visit, this was not being used effectively.

People's communication needs were considered, and care plans had been developed to guide staff on how to meet these needs. However, the home may benefit from further consideration of how to support people whose first language is not English, to help ensure care is delivered in a person-centred way.

Most families felt communication was effective and reported that the home kept them informed of any concerns regarding their relative's health and wellbeing.

Theproviderhad processes for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The provider held meetings with people and their families; however, attendance was not always high. Despite this, feedback from people and relatives indicated that they felt able to raise concerns with the manager and were confident that these would be listened to. One family member commented, “At the beginning, the care was not great, staff weren't doing what they should, but now they have this manager things have settled. The manager checks in on [family member] daily and I know I can go to the manager to discuss any concerns.”

Surveys were carried out throughout the year to gather feedback from people and their families. Although response rates were relatively low, the feedback received was positive and reflected overall satisfaction with the service.

Complaints processes were in place, and complaints were responded to. However, there was limited evidence to demonstrate how the provider maintained oversight of complaints, identified themes and trends, and ensured that learning and actions arising from complaints were embedded into practice. This was further impacted by the high use of agency staff, which reduced consistency in the delivery and monitoring of care.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Processes were in place to ensure people could access the services they needed within the home. This included visits from healthcare professionals such as a chiropodist and optician. Some people were also supported to access private physiotherapy services, which had resulted in very positive outcomes. The local GP surgery conducted weekly ward rounds, alternating between in-person visits and remote consultations.

The provider acknowledged that further work was needed to support community engagement and work was ongoing in this area. One person told us, “I don't do any activities at all. I would like more conversations …. because it is good to talk.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People told us they did not always feel in control of the care and support they received from staff, and that their individual health needs and personal preferences were not always taken into account. The support provided to people who spent most of their time in their bedrooms to reduce the risk of social isolation was inconsistent. A family member acknowledged, “It's very difficult to run activities here when most people are in their own rooms.” The provider advised that further consideration would be given to the activities provision to ensure people received meaningful engagement and support tailored to their needs. We will review the effectiveness of these improvements at our next assessment of the service.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

While some information was available to guide staff on decisions people had made, for example regarding resuscitation in an emergency, and most people had a care plan relating to end-of-life care, these were primarily task-focused. There was limited information demonstrating how people and their families had been involved in discussions about their wishes and preferences as they approached the end of life, including those admitted on fast-track palliative care pathways due to a significant decline in their health.

The provider was aware that improvements were needed to make care plans more person-centred and was actively working towards this at the time of our inspection.