Archived: The Moors Care Centre

The Moors Care Centre is a residential care home providing personal and nursing care to 57 older people and younger adults at the time of the inspection, some of whom may be living with dementia. The service can support up to 70 people.

The Moors Care Centre accommodates people across four separate units spread over three floors, each of which has separate adapted facilities. One of the units provides residential care, two units provide dementia care and one unit provides nursing care.

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

The provider had made significant improvements following the last inspection. There was a culture of continuous improvement and learning. The registered manager and provider completed quality assurance checks across the service. Improvements were being made to records and audit systems. These changes had yet to be embedded.

Improvements had been made to medicines to support their safe use. People were satisfied with how staff supported them with these. Risks to people were well managed to keep them safe. People presenting with behaviours that may challenge the service were offered effective support to calm and reassure them.

People were supported to maintain and improve their health wherever possible by a consistent and skilled staff team. Staff worked with healthcare professionals to seek advice and followed this. Positive outcomes were achieved for people, such as improved physical health and weight gain.

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 and staff enjoyed caring relationships, promoting their dignity and treating them with respect. The kind, thoughtful support from staff helped people accept care. People were at the centre of their care, making decisions about this, which were respected, including unwise choices.

Care was provided in person-centred ways. People were supported to maintain their interests and relationships with family members. Staff recognised the importance of people being able to remain in the service until the end of their life and were committed to ensuring people and their families were given additional support at this time.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 3 September 2018).

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 programme. If we receive any concerning information we may inspect sooner.

At the last inspection in October 2017 the provider was found to be in breach of three regulations (10, 12 and 17) in relation to dignity and respect, safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of: Is the service safe? Is the service caring? And is the service well led? to at least good. This inspection was carried out to check that improvements to meet legal requirements had been made. We found that sufficient improvement had been made at this inspection to say that the breaches of regulation had been met.

Following the last inspection the provider had enlisted various internal resources to support the service to improve systems and process. This had included appointing a new manager and two deputy managers. The area manager was now acting as Clinical Lead for the service. At this inspection the provider was still working to embed improvements in some areas. The manager was recruiting to and supporting the current staff team whilst encouraging positive change and ensuring staff understood their responsibilities. The provider was committed to making further improvements and we were confident this would happen.

The Moors Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Moors Care Centre provides nursing and personal care for up to 70 people. The service supports older people and people over the age of 18, who may be living with dementia, mental health problems, physical disabilities or sensory impairment. At the time of our inspection there were 63 people who used the service.

The accommodation for people was located over three floors and in four named areas. Bilsdale was located on the ground floor, Eskdale was on the middle floor and Bishopdale and Nettledale were on the top floor.

The provider did not have 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. The manager submitted their application to register with CQC following our inspection. They made themselves available during the inspection and assisted us with finding documentation and other information we required.

People told us they received their medicines on time and as prescribed. However, we found that the arrangements for storage and administration of medicines could be improved. Excessive heat in the service meant medicines were not always stored at the optimum temperature and some mistakes were being made with the new medicine system. Medicine management practices were being reviewed by the manager. We have made a recommendation about this in our report.

The quality of care being delivered had improved, but there was further work needed to ensure changes in care and support were documented and reviewed in a timely manner. We have made a recommendation about this in the report.

There was an audit process in place, which the manager and staff were completing. However, this was not always effective as the latest medicine and care plan audits had not picked up the concerns above. The manager supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw that the manager was making progress in improving the quality of the service and this was recognised by staff, people and relatives who spoke with us.

Improvements had been made to the way the provider managed and acted on safeguarding issues and carried out risk assessments and monitoring of risk. People told us they felt safe living at the home. We found staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. Safeguarding training had been carried out with all staff to improve their knowledge and confidence in speaking out if they witnessed any abuse. The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw that the manager was making progress in improving the quality of the service.

Improvements had been made to the staffing levels in the service. We found the management team were monitoring people's needs and adjusting the staffing levels accordingly. A moderate level of agency staff continued to be used, but active recruitment for permanent staff was also in place.

Staff had completed relevant training. We found that nurses and care staff received regular supervision and yearly appraisals were planned in. This helped them to fulfil their roles effectively.

Staff knowledge of people's needs had improved and there was a better understanding of the importance of good communication.

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

People were able to talk with health care professionals about their care and treatment. People told us they could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the District Nursing Team.

Improvements had been made to how staff respected people's privacy and dignity. People said staff were also friendly and caring.

People knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. People had access to complaints forms if needed and the manager had investigated and responded to the complaints that had been received in the past year.

The Moors Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection

The Moors Care Centre accommodates 70 people, including older people and people over the age of 18, who may be living with dementia, mental health problems, physical disabilities or sensory impairment. At the time of our inspection there were 58 people who used the service. The building has a basement floor containing utility facilities and a cinema. There are a further three floors offering single room accommodation to people who used the service. The top three floors all have various communal spaces including lounges and dining rooms. The ground floor level also has a café facility and a hairdressing salon.

We carried out an unannounced comprehensive inspection of this service on 2 May 2017. After that inspection we received concerns in relation to the care of a person who used the service. The concerns raised included allegations of abuse, poor care and poor management of the service. As a result we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to the key questions of: is the service safe, is the service caring and is the service well-led? You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for (The Moors Care Centre) on our website at www.cqc.org.uk

The provider is required to have a registered manager for the service and at the time of our inspection 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. The registered manager was not at the service for this inspection. The deputy manager assisted us throughout the inspection.

Safeguarding policy and procedures were in place and staff had received training. We found that although the service usually reported safeguarding alerts appropriately, there were occasions where incidents had not been reported internally and to relevant external authorities / bodies including CQC.

The assessment, monitoring and mitigation of risk towards people who used the service with regard to accidents/incidents, medicine management, food and hydration, falls, oral care and pressure care was not robust. This meant people’s health and safety was at potential risk of harm.

On-going internal and external investigations had shown that people were not always treated with respect and dignity and evidence had been found of poor care practices by certain staff.

The system used to determine the number of staff and range of skills needed to meet the needs of the people who used the service and keep them safe at all times was not effective. Staffing levels and skill mix had not been reviewed consistently. We asked the provider to send us an up to date review, which they did in the agreed timescale. Staff recruitment was carried out safely.

Care files were completed in an inconsistent manner, with some documentation not being completed and care plans not always up to date. This meant staff did not always have appropriate records to show how they were meeting people’s needs. However, people who spoke with us said they felt safe and well cared for. They took part in activities and had access to church services.

The provider’s complaints policy and procedure was not being followed consistently. Some relatives felt their concerns were being ignored or not answered robustly.

The management within the service did not effectively operate the quality assurance systems that were in place. Audits completed by the registered manager showed there were a number of recognised concerns with regard to documentation and people’s health and well-being. However, insufficient action had been taken to mitigate these known risks.

Most staff supervisions were carried out as a group which did not give staff opportunity to speak to the management team in a confidential way about any concerns they may have. Meetings for staff and people who used the service were not held regularly and this limited people's opportunities to feed back their opinions and views of the service.

The shortfalls identified at this inspection in the monitoring and oversight of the service meant that at least one vulnerable person had experienced unacceptable standards of care from several members of staff. Inadequate monitoring of the service and the person in day-to-day charge had created risks to the health, safety and welfare of people who were receiving a service.

We saw that people received their medicines in a safe way.

We have found a breach of Regulation 12: Safe care and treatment; Regulation 10: Dignity and Respect and Regulation 17: Good governance during this inspection. You can see what action we told the provider to take at the back of this report.

The Moors Care Centre is a care home with nursing provision for up to 70 people. The service provides accommodation and support to older people and people over the age of 18, who may be living with dementia, mental health problems, physical disabilities or sensory impairment. At the time of our inspection there were 55 people who used the service. The building is new and purpose built with a basement floor containing utility facilities and a cinema and a further three floors offering single room accommodation to people who use the service. The top three floors all have various communal spaces including lounges and dining rooms. The ground floor level also has a café facility and a hairdressing salon. At the front of the service is a car park for visitors and staff and there is disabled access into the building.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us they felt safe and were well cared for. The registered provider followed robust recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way. Medicine management practices were being reviewed by the registered manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

People that used the service were supported by qualified and competent staff that were regularly supervised and who were to receive their first appraisal in 2017 regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes, but the consistency of how this was recorded was variable. People who used the service received additional care and treatment from health professionals based in the community. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

Staff were knowledgeable about people’s individual care needs and care plans were person centred and detailed. There was a range of social activities available and people’s spiritual needs were met through in-house services and one-to-one pastoral care when requested.

People told us that the service was well managed and organised. The registered manager assessed and monitored the quality of care provided to people and this was checked during the registered provider visits. People and staff were asked for their views and their suggestions were used to continuously improve the service.