Moorlands Lodge Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of the legal regulation in relation to consent.

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People and those close to them were involved in initial and on-going assessments.

Records were person centred and reflected what was important to the person. The registered manager told us, “Pre-admission assessments are carried out by myself, the deputy, senior nurse or care managers. If a person has nursing needs, it would always be a nurse assessing them.”

Pre-admission assessments contained details of the person, their likes and dislikes, health conditions and all aspects of their lives. Based on this, a plan was devised on how to best support the person. Care plans were developed from the initial assessments and were regularly reviewed and updated as people’s needs changed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The registered manager ensured they were up to date with best practice guidance and used a variety of tools to monitor people’s care. These included systems to monitor people’s skin integrity and risk of malnutrition. People’s weight was recorded regularly and appropriate action was taken if weight loss was identified. For example, discussing this with the GP to identify any underlying causes and a referral to the relevant healthcare professionals.

People’s nutritional needs were assessed, recorded and met. People’s opinion of the food on offer varied. Their comments included, “I’m not that fussy so it’s ok. We can have wine if we want it”, “I think it’s quite good when you consider how many they cater for. They give us a choice”, “It’s alright, not terrible food. A lot of it is not what I would like, so sometimes I get something else”, “My main complaint is that it’s never hot.I had an omelette for breakfast but by the time they came to help me get up it was stone cold” and “You’d hardly call it food, it’s a very poor standard, very badly cooked sometimes.”

We discussed the comments with the registered manager who told us they would raise this in the next meeting with people and relatives.

The chef demonstrated a good awareness of different swallowing conditions and how this impacted people’s food intake. The chef took part in heads of department meetings, to discuss dietary changes and so they could adapt meals for individuals. For example, they enriched the meals of some people who had low nutritional intake and were at risk of losing weight.

The kitchen was clean and there was a good stock of fresh food in the fridge. Food items were clearly labelled with dates and allergens. A recent food and hygiene inspection had awarded the home the highest score of 5.

The provider and the chef aimed to make people’s mealtimes pleasurable and meet their choices and needs. The chef said people were consulted about their preferences and this was considered when deciding the menu. People living with dementia were offered choice at the point of serving by showing them plated meals. This enabled them to see the meal and make their choice.

People were able to request options outside the menu and this was provided. For example, a jacket potato or an omelette. There was a variety of drinks and snacks available in different areas of the home so people could help themselves in between meals and at night, and these were replenished regularly.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us they enjoyed working at the home and there was a good culture and supportive teamwork.

People told us staff worked well together and communicated with them well in order to meet their needs.

The service worked closely with other agencies and professionals to help ensure a more holistic approach to people’s health and wellbeing. The registered manager told us, “We work closely with the GP practice who knows people really well. If we have any queries we can reach out to them. The tissue viability nurse comes if needed. The SALT [speech and language therapy] team comes when we need them to. They sometimes come and do a full assessment.”

The provider also accessed training for staff specific to their role and the needs of people who used the service. The registered manager told us, “An external provider comes and does clinical training for nurses. It’s a very detailed 6-hour day course that includes syringe driver, verification of death, diabetes and catheter care.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us their health care needs were met and their choices respected. One relative stated, “Even though my [family member] is here on respite care they have got to know [them]. The support is good. We as [their] family feel supported too”, and another said, “They try to encourage [family member] to do as much as [they] can for [themselves] but if [they] need help they are there.”

People were supported to access a range of health care professionals. Care records contained detailed information about people’s health conditions and how these might affect people. There were regular visits from health care professionals involved in people’s care, and communication between them and the staff and management was effective. The registered manager told us, “The chiropodist visits people if they want to. We also have a physio that comes in regularly. We work with them to identify feedback which we incorporate in the person’s care plans. They also help with people who need support with mobilising. The opticians come in as needed. We facilitate people attending appointments; we have 2 bank drivers, so they can support with trips out and attending appointments.”

Health care professionals said the staff and management team worked closely with them and communication was good.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. The registered manager explained, “We have weekly clinical meetings. Beginning of each month, I look at all data to identify trends or themes and look at where we might need to make improvements, and what we might want to put in place.” They added, “We also have monthly steering groups where we focus on high-risk areas. We then look at falls, what is in place, what we need to put in place to prevent re-occurrence.”

People said their healthcare needs were met. One person told us, “I think the medical team here are excellent. The doctor comes once a week.” The staff team were vigilant and ensured people received effective care so they remained as healthy as possible.

The service liaised closely with the ‘Hospital at home’ team. The registered manager told us, “They are a very useful specialist team. They will take blood for people, for example, post hospital discharge. They will continue the support until the person is well enough to discharge back to the GP’s care.”

Another person who was living with diabetes was being supported by trained staff to monitor their blood sugar levels and had regular reviews with the diabetic nurse and the GP. This helped ensure they remained healthy and in control of their condition.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider was not always meeting the requirements of the Mental Capacity Act 2005 (MCA). The information in people’s care plans was not always accurate or reliable. It was not always clear who had given consent and if they had legal authority to do so. For example, one person’s care plan stated their relative had Lasting Power of Attorney (LPA) for health and welfare but this was contradicted in the section for mental capacity documents.

A number of decisions had been taken without carrying out appropriate assessments. For example, some people were given their medicines covertly. Covert administration of medicines is when medicines are given in a disguised form without the knowledge or consent of the person receiving them. We found staff were not following the correct pathway as no mental capacity or best interests assessments were in place for this. No assessments were in place for another person for whom a sensor beam was in place in their bedroom due to increased falls risk and forgetting to use their walking aid.

Another person’s care plan stated they lacked capacity and there were a number of restrictions in place to protect them, such as preventing them from going out alone. However there was no mental capacity assessment carried out so no best interests decisions had been made about their care or the restrictions in place. The registered manager confirmed they did not have this in place. In addition, there was no LPA on file so no confirmation of the relative’s authority to make care decisions. The registered manager confirmed they did not have a copy of this.

The above meant systems were not always in place to ensure people’s rights were lawfully protected.

People told us staff asked for their consent and involved them in decisions about their care and support. They said their choices were respected. The staff received training in the principles of MCA and understood these. A staff member stated, "We get good guidance on mental capacity, so we know how to support residents' choices."