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Inspection carried out on 9 September 2019

During a routine inspection

About the service

Morning Stars is a residential care home providing personal and nursing care to 17 people at the time of the inspection. Morning Stars accommodates up to 20 people living with a mental health condition in one adapted building.

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

Audit systems were not always effective in checking the quality of the service and ensuring that all documentation was up to date. For example, audit checks on care plans did not identify that Personal Emergency Evacuation Procedures had not always been updated when people’s needs changed.

People told us they felt safe. Systems were in place to keep people safe and staff understood how to protect people from abuse. People’s risks were assessed and reviewed when their needs changed. People were supported by a sufficient number of safely recruited staff. Medicines were administered safely. People lived in a clean and tidy environment and staff understood how to prevent the spread of infection. When things went wrong, the registered manager ensure that lessons were learned to reduce the risk of future reoccurrence.

People’s needs and choices were thoroughly assessed and reviewed when needed. People’s diverse needs were considered within the assessment process. People were supported by staff who were well trained and knowledgeable to meet their needs. People were supported with eating and drinking where needed and encouraged to maintain a healthy diet. People were able to access healthcare support when needed and referrals were made in a timely manner. Staff worked closely with other professionals to ensure people’s needs were met in an effective way. People were encouraged to decorate and furnish their rooms in a personalised way.

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

People were supported by kind and caring staff. People were encouraged to express their views and be involved in making their own decisions. People’s privacy and dignity was respected and their independence was promoted by staff.

People received personalised care that was appropriate to meet their needs. People’s communication needs were considered and staff communicated with people in a way they understood. People were encouraged to engage in activities of their choice. People’s concerns and complaints were listened to by the registered manager, investigated and action taken where needed. People’s end of life wishes were discussed with them so detailed preferences were known at that stage of their life.

People and relatives told us the registered manager was approachable. The registered manager encouraged a person-centred approach to people’s care which staff understood and followed. The registered manager understood their responsibilities and statutory notifications were submitted to CQC as required by law. People, relatives and staff were encouraged to provide feedback to improve the service. The registered manager was proactive in continuous learning and disseminating policy changes to staff. The service worked closely with other agencies to ensure people’s needs were met.

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 requires improvement (published 21 March 2019) 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection progra

Inspection carried out on 5 February 2019

During a routine inspection

This inspection took place on 05 February 2019 and was unannounced. At the last inspection completed in August 2017 we found the service to be rated as ‘requires improvement’. We also found the provider was not meeting the regulations around providing good governance of the service. At this inspection we found the provider continued not to meet this regulation and remained rated as ‘requires improvement’.

Morning Stars accommodates up to 20 people who have been diagnosed with one or more mental health conditions. At the time of our inspection there were 18 people living in the service.

There was a registered manager in post. 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.

People were not protected by robust safeguarding systems that ensured all relevant concerns about people living at the service were reported to the local safeguarding authority.

People were not supported by care staff who understood how to uphold their rights through the effective use of the Mental Capacity Act 2005 (MCA). People were not supported by staff whose training was consistently effective and always gave them the skills and knowledge required.

People were not supported in a consistently caring way. While some interactions were kind and caring and positive examples were seen, we saw other interactions that indicated care staff were not consistent with this support. People’s independence needed to be promoted further and improvements needed to be made to how people’s privacy and dignity was respcted and upheld.

People did not always feel heard and that their concerns were listened to and acted upon. The registered manager had developed quality assurance and governance systems although these were not effective in identifying the areas of improvement required within the service.

People were supported by care staff who understood how to minimise the risk of harm such as injury to themselves. Risks associated with behaviours that could challenge others were managed effectively. People were supported by sufficient numbers of care staff who were recruited safely. People received their medicines as prescribed.

People enjoyed the food and drink they received. People had access to a range of healthcare professionals and appropriate support was provided to enable people to access healthcare services.

People had access to leisure opportunities and activities although this was limited. Improvements were needed in the range of opportunities available to people that met their own individual needs and preferences.

We found the provider was not meeting the regulations around safeguarding people, dignity and respect and good governance. You can see what action we told the provider to take at the back of the full version of the report. 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.

Inspection carried out on 22 August 2017

During a routine inspection

We last inspected this service on 06 April 2016. At that time we found that people were not consistently receiving a good or a safe service. We found the provider was not meeting one of the legal regulations, and we required the registered manager and registered provider to take action to address and improve this situation. At this inspection we identified that improvements had occurred throughout the service, however these had not been adequate to ensure that people all received a safe, good quality service, or to achieve compliance with the legal requirements. At our last inspection we identified that the systems in place to ensure the quality and safety of the service (Governance) were not effective. We are currently considering what further action we need to take.

There was a registered manager in place at the time of our inspection. 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.

Each registered service needs to have a system for checking the safety and quality of the service provided. [Governance.] While there were a range of checks and audits in place that had been undertaken by the registered provider, the registered manager and the staff team within the home these had not been entirely effective at identifying shortfalls within the running of the service, or areas where improvements were needed. The checks had not ensured that the improvements we said were needed last time had all been made. Issues that we identified with the cleanliness of the property, with some aspects of people’s care records and with medicines for example had not been picked up by these checks. The home remained in breach of one legal regulation. You can see what action we told the provider to take at the end of this report.

While this inspection identified that improvements had been made to people's safety, we found that people were not consistently provided with a safe service. Recruitment practices had improved, and people were now supported by staff that had been subject to robust checks before starting work. Risks in the premises had been removed and people’s bedrooms were safer. Our review of medicines management identified some concerns with the way boxed medicines and creams were managed. We could not be confident that these had always been administered as prescribed. Action was taken by the senior staff at the time of our inspection to address this. A wide range of health and safety checks and servicing had been undertaken as required on most of the services and equipment at the home, however the passenger lift had not been serviced and thoroughly examined as is required. We were informed after our inspection that action had been taken to address this.

The formal systems in place to ensure that restrictions to people's liberty were identified, and the required applications made to the supervisory body were good. This was an area that had improved since our last inspection. However when we spoke with members of the staff team their knowledge about the impact of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) on the people they were supporting was not sufficient to ensure people would be supported consistently or safely. This was brought to the attention of the registered manager and they were able to describe the action they would take to improve upon this situation.

People told us that they enjoyed the food served. There were some innovative practices around encouraging people to eat a healthy diet and to try foods they had not previously experienced. People told us that they had been supported to see a wide range of health professionals to ensure both their physical and mental health needs were met. The re

Inspection carried out on 6 April 2016

During a routine inspection

Our inspection was unannounced and took place on 6 and 7 April 2016. At our last inspection on 4 and 5 February 2015 the service needed to make improvements to the arrangements in place for staffing levels, improve opportunities for people to take part in activities, ensure staff had an understanding of Deprivation of Liberty Safeguards and ensure that monitoring systems were effective.

Morning Stars is a care home which is registered to provide care for up to 20 people. The home specialises in the care of people who have mental ill health needs. At the time of our inspection there were 19 people living at the home.

There was a registered manager in post and they were present during our inspection. 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 we found some improvements had been made since our last inspection. However, we found that the service did not consistently implement effective quality monitoring processes to ensure that the risks to people’s health, safety and well-being were identified, monitored or addressed. Therefore appropriate actions were not always taken to reduce the risk of harm happening to people. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager was not always fulfilling their responsibilities for sharing information with us that they were legally required to do so. However, action was taken at the time of the inspection to ensure the important information was shared with us.

Recruitment procedures were in place but were not always robustly applied.

People were supported by staff that were kind, caring and respectful and knew them well. People were treated with dignity and respect. Staff understood people’s needs well. Staff received the training and support they needed to carry out their role.

Medicines were stored and administered safely, and people received their medicines as prescribed. People were supported to have their healthcare needs met.

People were supported to make everyday decisions themselves, which helped them to maintain their independence.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed eating.

Inspection carried out on 4 and 5 February 2015

During a routine inspection

The inspection took place on 4 and 5 February 2015 and was unannounced. At the last inspection on 14 July 2014 we found that the provider was meeting the requirements of the Regulations we inspected.

Morning Stars are a residential care home providing accommodation for up to 20 people with mental health needs. At the time of our inspection 19 people were living there.

The registered manager had resigned and a new manager had been appointed. 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 and associated Regulations about how the service is run.

Everyone who lived at the home told us they felt safe. Relatives and staff spoken with all said they felt people were kept safe. We saw that the provider had processes and systems in place to keep people safe and protected them from the risk of harm.

The provider had identified that improvements were needed with how they managed medicines and had taken some action to address these shortfalls.

We found that there were not always enough staff to meet people’s identified needs .People did not have enough opportunities to take part in activities and hobbies they enjoyed The provider ensured staff were recruited safely.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Acts protect the human rights of people by ensuring that if there are any restrictions on a person’s freedom and liberty, they have been appropriately assessed. Some staff showed they had limited understanding of the MCA 2005 and DoLS legislation.

We saw that people were supported to have choices and received food and drink at regular times throughout the day. People spoke positively about the choice and quality of food available.

People were supported to access other health care professionals to ensure that their health care needs were met.

People told us the staff were very caring, friendly and treated them with kindness and respect. We saw staff were caring and helpful.

People were given the opportunity to maintain and promote their independent living skills.

The home was clean and well maintained so it provided a pleasant place for people to live.

People told us they were confident that if they had any concerns or complaints, they would be listened to and addressed quickly.

The provider had management systems to assess and monitor the quality of the service provided. This included gathering feedback from people who used the service, their relatives and health care professionals. However these were not always effective in identifying the concerns we noted during our inspection.

Inspection carried out on 14 July 2014

During a routine inspection

We inspected Morning Stars on a weekday and found that 17 people were at home and two people were in hospital. We observed people during the day and talked to some people in the communal areas and at lunch time. We talked with the manager and the deputy manager. We looked in detail at the care records of three people. We spoke with two professionals and three members of staff. We also spoke with one of the directors of the home. One person told us, �Everything here is OK, the staff are OK.�

We last inspected this service on 29 November 2013. At that time we found that two areas of the home were in need of maintenance work, and a door lock was broken. We also found that there were some restrictions to peoples� autonomy and choice of where they spent their time within the home as an internal door was kept locked. We found that the manager had not reported some incidents to us. At this inspection we found that these issues had been addressed.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were enough staff on duty to meet the needs of people who lived at the home. There were procedures in place to safeguard people from abuse. The manager had a good understanding of issues around safeguarding and her role in protecting people. Staff understood how to safeguard people they supported. There were policies and procedures in place to make sure that unsafe practice would be identified and people would be protected.

Risk assessments and health and safety measures were in place and regularly reviewed. These kept people safe. The director told us, �Every month I walk through the building and talk to everyone to give people the chance to tell us is there are any issues.� We saw people were cared for in an environment that was safe and suitable for their needs.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of people�s care and support needs and that they knew them well. People told us that they were happy with the care that had been delivered .The service worked well with other agencies and services to make sure people received their care safely and effectively. We saw that people were treated with dignity and care. All the people we spoke with told us they were satisfied with the care and support they received. A visiting health professional told us, �The home is very informative. They are very good at communicating with us.�

Is the service caring?

All staff were aware of peoples choices, preferences and support needs. We found the care and support was delivered with dignity and people�s decisions were respected. We saw the staff and manager were patient and gave encouragement when they supported people. One person told us, �The staff ask you what you want and you get what you asked for.� A health professional told us, �The clients are very well treated. We write the care plans and the home follow them, I�ve no concerns.�

Is the service responsive?

We saw clear and detailed records that ensured the manager could make timely and informed decisions about a person�s care and support. There were enough staff on duty to provide adequate care and support. There were cooks and domestic staff to ensure good food was provided and the environment was clean. A member of staff told us, �The directors are very responsive, when the manager mentions something the directors get it done.�

Is the service well-led?

The systems in place to ensure the quality of the service were regularly assessed and monitored to ensure they were robust. There was a clear structure of supervision responsibilities within the staff team. Staff had regular training and learning opportunities. The manager was aware of their responsibilities in meeting the essential standards of quality and safety. Staff we spoke with told us they thought the manager was approachable and provided good support. One member of staff told us, �There�s lots of training and the manager is very good. If there�s an issue they are on it, they leave no stone unturned.�

Inspection carried out on 29 November 2013

During a routine inspection

There were 18 people living there on the day we inspected. We spoke with nine people, five staff members, the manager and registered provider.

Most people that we spoke with told us that they liked where they lived and that the staff were friendly and helpful. One person told us, �I do my own shopping and I cook my own food�. Another person told us, �I have been out today to see a friend I can do what I want. I would like a drink now but the kitchen is locked�.

People received their medication as prescribed by their doctor to ensure their health and well-being.

Some parts of the home needed improvements so that the home was comfortable, safe and pleasant for people to live in.

Recruitment processes were adequate and ensured that staff employed were suitable to work there which protected people from the risk of harm.

Monitoring systems in place to improve the service had not always been timely and effective.

Inspection carried out on 14 January 2013

During a routine inspection

We found that service users who were happy to talk to us in detail were extremely positive about the level of support they were offered to meet their individual needs. Once we had reviewed key policies and procedures and examined clients' personal files we were therefore comfortable in deciding that the service was 'one that both respected and involved the people who used the service in all aspects of their care', and provided a service that was both safe and appropriate to the specific needs of the user, 'safeguarding people who use the services from abuse'.

The culture of staff development and training in the organisation was clearly evidence in our interviews with staff, as was the detailed focus on monitoring the quality of the service provision from the management team. Therefore overall we found the service to be compliant in the five outcomes we reviewed.