Moormead 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 inspection we rated this key question Requires Improvement. At this inspection the rating has remained as Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. We found guidance was not always clear in people’s care plans about how to support them with their health needs. The service did not follow the Mental Capacity Act principles in relation to decision-making with people. However, the service worked well with health professionals to ensure people received good health care.

This service scored 42 (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’s care and treatment were effective because they did not always record people’s health needs well. People’s needs were assessed on admission into the service; however, information had not always been transferred to care plan documents. For example, information about repositioning a person to reduce the risk of pressure ulcers had not been included in care planning and recording documents for staff to be aware of and act on. However, relatives said they were involved in assessments and had seen their relative’s care plan.

The provider did not plan and deliver people’s care and treatment with them, including what was important and mattered to them.Best practice had not always been followed in relation to pressure wound care. Staff had identified some skin damage the day prior to our assessment. A wound plan was appropriately put in place; however, the photograph was not taken and labelled in line with the provider’s policy. Additionally, no measuring tool had been used to accurately record the size of the wound on first identification of it. This meant it would be difficult for staff to adequately monitor the wound for signs of improvement or deterioration. The provider’s own wound plan document was not being used.Nationally recognised assessment tools were used to support people with aspects of their health, for example, Waterlow risk assessments were in place to support people at risk of pressure ulcers and the Malnutrition Universal Screening Tool (MUST) was in place to support people maintain a good weight. However, the records were not held in one place which meant it was difficult to have clear oversight of people’s health needs. Despite this, when concerns about people’s health needs were identified, they were escalated to healthcare professionals and recommendations were acted on.

The service used a nationally recognised tool to assess and respond when people’s health condition deteriorated.

The provider worked well across teams and services to support people.

The service had a handover system in place to share information. A staff member said, “staff come in to work 15 minutes early to handover,” The staff member confirmed this was an informal arrangement and was something the staff do. We reviewed handover records as part of the inspection and identified them to be difficult to read at times, as they were hand-written. The provider had not taken action to improve the quality of hand-written notes to ensure they were legible for all who used them.

There was a system in place to record information from visiting health professionals, and we received positive feedback about the service from a health professional.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Guidance around people’s food and fluid intake was not always clear in people’s care plans. For example, one person’s section on nutrition said, “Staff and chef to make sure [person] has enough food and fluids during the day.” However, there was no guidance about how much daily fluid and food would be appropriate for the person to reduce the risk of dehydration and malnutrition. However, records showed people received support to access healthcare, inside and outside of the service. For example, records showed a person had been supported by staff to see an optician. Staff told us people were supported by staff to attend other appointments at the local hospital.

The service routinely monitored people’s health and contacted other health professionals for advice where people’s health was deteriorating or staff had concerns about people’s health. Staff worked with other health professionals to provide the best possible care for people. Records showed staff had recorded when people’s general wellbeing had changed and had sought appropriate advice or referrals. A visiting health professional fed back positively to CQC about the nursing care people received in the service.

The provider did not always tell people about their rights around consent or respect these when delivering care and treatment. The service failed to ensure they were working within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. Where they lack mental capacity, any decisions made on their behalf must be in their best interests and as least restrictive as possible.

A review of people’s Mental Capacity Assessments (MCA) identified these assessments were not decision-specific. For example, we reviewed one MCA document for a person which included two different decisions. These decisions were in relation to the use of bed rails and the receiving of care and treatment at the service.

For those where it was deemed needed to keep them safe and no capacity to give consent, the provider could not demonstrate any other least restrictive measures had been considered, and for those who had capacity to consent we were not assured they had made an informed decision when giving consent. For example, records showed a person had capacity to make decisions around having bed rails in place, as we were provided with a consent document from 2018. however the provider could not demonstrate how the person understood the risks associated with the use of bed rails and how often they reviewed the person’s consent regarding the use of bed rails.