Archived: Moorland Nursing Home

Prior to the inspection taking place, we received several concerns about people’s safety and the management of the service. We carried out this inspection to check people were not at risk of receiving unsafe care.

Moorland Nursing Home is situated in a residential area in Poulton-le-Fylde. The service provides accommodation for up to 22 people. It is a care home that provides nursing and personal care. All areas of the home are accessible and there are aids to assist people with their mobility. Some rooms have en-suite facilities. There were 13 people residing at the home.

There was no registered manager at the time of the inspection. There had been no registered manager in place since May 2015. We were made aware by the registered provider an application had been submitted to register a new 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.

At this inspection visit carried out in June 2017, we found breaches in the regulations relating to safe care and treatment, person centred care, dignity and respect and safeguarding service users from abuse and improper treatment. We also found breaches in the regulations related to meeting nutritional and hydration needs, premises and equipment and good governance. There were further breaches in the regulations related to staffing, fit and proper persons employed, requirement as to display of performance assessments and notification of other incidents.

We looked at how the registered provider managed risk. The registered provider had failed to ensure risks were appropriately addressed to mitigate and manage risk. During the inspection process, we were informed one person who was living with dementia, left Moorland Nursing Home unsupported and the environment was not secured to prevent a reoccurrence of the incident.

Moorland Nursing Home had not been well led. There was no visible leadership and there was a lack of continuity in managerial and clinical oversight. The registered provider did not have robust arrangements to take appropriate timely action if there was a clinical or medical emergency.

We looked at how medicines were managed. We observed medicines being administered and noted the nurses did not follow good practice. They handled tablets and signed medicine administration forms before administering medicines. Documentation in relation to medicines was not robust and did not clearly guide staff about the administration of medicines, creams and powders.

Concerns related to a nurses clinical skills were disclosed during this inspection. They stated the nurse on shift failed to complete a clinical task safely. They raised additional concerns that the correct dressings were not available to manage people’s ongoing care requirements.

We looked at how the registered provider recruited staff. They had not documented staff members’ full employment histories, or gathered written explanations of any gaps in employment. One staff member’s application form was not in their file and the provider was unable to supply this during our inspection. We could not find information related to their Disclosure and Barring Home check (DBS) for one member of staff.

The systems the registered provider had in place to monitor and improve the quality of the service, were ineffective. The registered provider had failed to ensure all nurses working at Moorland Nursing Home maintained their professional registration with the nursing and midwifery council (NMC).

Staff actions meant people were not protected from malnutrition and dehydration. People were not always presented with food in a way that was easy to eat safely.

We found people’s dignity was not always respected and promoted. One person was provided with continence aids designed for an animal. The registered provider failed to ensure people were free from inhuman or degrading treatment (protected by Article 3 in the Human Rights Act).

Feedback from people who lived at the home indicated they were not always treated with dignity and respect. One person had their independence restricted preventing them from using the toilet independently. People expressed concern staff who spoke English, as a second language did not fully comprehend English. This affected how they engaged with people and hindered people’s ability to express their views.

We looked at staffing levels at Moorland Nursing Home. The registered provider did not continuously review staffing levels to respond to the changing needs and circumstances of people living at Moorland Nursing Home.

As part of our inspection, we had a walk around the home. We witnessed bedroom doors were lodged open with wooden wedges. Wedging or propping open a fire door can prove devastating as it allows fire to spread unchecked, putting lives and buildings at risk. We noted fire exits had had their alarms disabled.

As part of this inspection, we looked at audits. We noted some audits did take place, however, the information did not reflect our findings. Effective auditing systems were not consistently carried out to ensure care delivered was safe and person centred.

During the inspection visit, we were made aware of an incident whereby police had been called to the home to provide assistance. This was a notifiable incident, which should have been reported to CQC. This had not been completed.

As part of the inspection, process we looked to ensure the registered provider was meeting their statutory requirements in displaying their CQC rating. They did not have this on full display on the website as stated within the guidance.

Staff received training related to their role and told us they were knowledgeable about their responsibilities. However, staff failed in their responsibilities to identify, report and prevent abusive care practices taking place

We received mixed feedback on how the service managed complaints. It took one person seven requests before the manager met with them regarding a complaint. We also noted one person’s complaint had been documented and investigated in line with Moorland Nursing Home’s policy and procedures.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

We found people had access to healthcare professionals. There were established links with community based healthcare professionals.

People who lived at Moorland Nursing home had their favourite staff. Caring relationships had been established with these staff members.

Under Section 31 of the Health and Social Care Act 2008 we varied condition 2 of the service providers registration. Full information about CQC’s regulatory response can be found at the back of the full version of the report.

Moorland Nursing Home is situated in a residential area in Poulton-le-Fylde. The service provides accommodation for up to 22 people. It is a care home that provides nursing and personal care. All areas of the home are accessible and there are aids to assist people with their mobility. Some rooms have en-suite facilities. At the time of the inspection there were 14 people living at the home.

There was no registered manager at the time of the inspection. We were made aware by the provider an application had been sent for a member of the management team to be interviewed and approved as registered manager for Moorland Nursing Home.

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 10 March 2016, we found the provider was meeting the requirements of the regulations that were inspected. However, it was identified risk assessment of medicines, the application of topical creams and medicine audits required improvement. We also recommended, how the provider responded to complaints, required improvement. Since our last inspection, these areas have improved.

During this inspection, we noted the provider had systems that ensured people who lived at the home were safe. Records we looked at indicated staff had received abuse training. They understood their responsibilities to report any unsafe care or abusive practices related to safeguarding of adults who could be vulnerable. Staff we spoke with told us they were aware of the safeguarding procedure and knew what to do should they witness any abusive actions at the nursing home.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home.

Staff responsible for administering medicines were trained to ensure they were competent and had the skills required. We investigated and noted medicines were kept safely and appropriate arrangements for storing medicines were in place.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their relatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

Care plans were organised and identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Comments we received demonstrated people and their relatives were satisfied with the care delivered. The provider and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

A complaints procedure was available and people and their relatives we spoke with said they knew how to complain. One relative spoken with told us they had previously complained and were happy with the outcome. Staff spoken with felt the manager was accessible, supportive and approachable.

The manager had sought feedback from people who lived at Moorland Nursing Home and staff. They had formally consulted with people they supported and their relatives for input on how the service could continually improve.

The provider had regularly completed a comprehensive range of audits to maintain people’s quality of life and keep them safe.

We carried out this unannounced focused inspection on the 10 March 2016 to see if improvements had been made. We also checked complaints were responded to appropriately. This was because we received some information of concern the processes for complaints were not always followed.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Moorland Nursing Home’ on our website at www.cqc.org.uk’

Moorland Nursing Home is situated in a residential area in Poulton-le-Fylde. The service provides accommodation for up to 22 people. It is a care home that provides nursing and personal care. All areas of the home are accessible and there are aids to assist people with their mobility. Some rooms have en-suite facilities. At the time of the inspection there were 14 people living at the home.

At the time of the inspection there was no registered manager in place. 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. During the inspection we spoke with the manager. They told us they had recently started to work at Moorland Nursing Home and were committed to ensuring improvements were made.

At our focused inspection on the 10 March 2015 we found some improvements had been made. We found safe recruitment processes were in place to ensure people of suitable character were employed by the registered provider. Although we found the management of medicines had improved, we also found further improvements were required. This related to the risk assessment of medicines and the application of topical creams. In addition we found improvements were required in relation to the medicine audit being used. We have made a recommendation about the management of some medicines.

We looked at a completed complaint. We found this had been responded to within the timeframe specified within the registered provider’s complaints policy. However the response was not detailed and did not respond to the concerns raised. We have made a recommendation regarding this.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

People told us that they felt safe and secure living at the home. Most people spoke very positively of the qualities of staff team. One relative told us, 'The staff are very good, friendly and caring. They cannot do enough, you only have to ask'.

We saw that people were treated with dignity and respect. One person we spoke with gave a good example of how staff had responded positively to her request regarding a specific nursing task. Staff had continued undertake the task in a way that was acceptable, and the person was confident that this situation would continue, much to her satisfaction.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

The service was safe, clean, and hygienic. Equipment had been maintained and serviced regularly therefore not putting people at unnecessary risk. A bath that had been out of action for some time had been repaired meaning that people could use it safely again.

Is the service effective?

There was an advocacy service available if people needed it. This meant that when required, people could access additional support.

People told us that they were generally pleased with the level of care that was being delivered to them and that their assessed needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person's assessed needs and that personal preferences were accommodated. One person told us, 'On the whole everything is OK. When I first came here, staff sometimes did things their own way. Now they do things in my way. I like to have a laugh and a joke with them, they are cheerful'.

Health and care needs had been assessed and people had been involved, as far as they wished, in writing their plans of care. Although some people spoken with were unsure about their current care plan, they were unconcerned by this. On the care plans we looked at, each had been signed by the person or a close relative, to confirm their understanding and agreement to the content. People's preferences, interests, aspirations and diverse needs had been recorded and care and support provided in accordance with people's wishes.

The visitors we spoke with confirmed that that were able to see people in private and at a time of their choice. The relatives we spoke with also said that they had good communication with the staff team and were always informed of any changes or concerns.

Is the service caring?

People were supported by kind and caring staff. We saw that care workers showed humour, patience and gave encouragement when supporting people. Relatives commented, 'Everybody is so nice and genuinely caring. I could not fault it and I am not just saying that I really mean it'. Another relative told us, 'They (the staff) seem to be very caring people and are really good with us too'. A person living at the home said, 'I am quite alright. The staff are very friendly, it's very good'.

People using the service, their relatives and friends and other interested people had been given opportunity to complete a satisfaction survey that was on display in a communal area of the home. The registered manager explained that if any comments or concerns were highlighted on the survey she would speak with the person concerned to try and resolve the issue. We were also told that it had been a very long time since anybody had chosen to complete a survey. People preferred to speak directly with the registered manager. A person living at the home and the relatives spoken with confirmed this.

Is the service responsive?

The people we spoke with said they were satisfied with the arrangements in place to support social activities and social interactions. The members of staff we spoke with told us that although some people were hard to motivate and disinterested in structured activities, people did appreciate staff spending one to one time with them for a chat. This was confirmed my most of the people we spoke with. When asked if there was anything that staff could do to make things better, one person said, 'I enjoy the social side of things, when they (the staff) have time, they will come and sit with me and talk. It would be nice if it could be a bit more often, but I know they are busy'.

In the main most people were satisfied with the meals served. However there was some discrepancy. A relative said, 'My ***** appears to be enjoying her meals and I have eaten here at Christmas. I found the quality and quantity of food to be first rate'. One person told us, 'The food here is sometimes not so good; sometimes it is dishes that I have never had like hot dogs for tea'. However another person said, 'There is a decent menu put on with alternative choices available as well. The quality is very good, the cooks are good. I have bacon and eggs every day for breakfast, what have I got to complaint about. It suits me and if you don't want it you just have to say so. It's not a problem'. We saw that specialist menus such as a diabetic menu or blended foods were provided meaning that the individual dietary needs of each person were met.

People said that they knew how to make a complaint if they were unhappy about anything. Although no formal complaint had been made for quite some time, documents were available to record the complaint, the name of the person making the complaint, the process of investigation and the outcome. We saw that there was an 'open door' policy with people expressing their views, or queries as they arose. This meant that any concern or query could be dealt with immediately. People living at the home and the relatives we spoke with confirmed this to be the case.

Is the service well led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. Records were kept of all health professionals visits in respect of each person, which included the reason for the visit and the outcome.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a consistent service at all times.

Staff also told us that they felt very well supported by the registered manager and that they had opportunity to have their say that helped influence change. We were also told that the staff team worked well together for the benefit of the people living at the home. We saw that the staff team was stable meaning that people living at the home were cared for and supported by staff who knew them well.

A range of routine audits were in place including care reviews and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

One relative said, "I can come here at any time and they always make me feel welcome and involved." Another said, "I am a regular visitor and the staff are always polite, and try and get me involved as much as possible in the care of my relative."

A review of the way in which CCTV is used within he home needs to be undertaken order to ensure its usage meets the requirements of the Data Protection Act and other related legislation.

People living at the home told us that they felt safe. They said that they thought there were usually enough staff on duty. One person said that the staff sometimes looked busy, but added that they never rushed people, and always gave them enough time to complete a task.

Staff told us that by just talking to people, they informally got people's views about what they their care andf support needs. This was confirmed by people at the home. Some of the relatives we spoke with told us that the manager and staff always shared relevant information with them when neceassary.