Morton Close

Morton Close is a residential care home providing personal care and accommodation up to a maximum of 40 people. At the time of our inspection there were 16 people using the service. The care home accommodates people in one adapted building with bedrooms on the ground and second floor and the main communal areas on the third floor.

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

Since our last inspection the provider had invested significantly in many improvements which reduced risks and helped improve the quality of care people received. Despite this there were some areas where further improvements were required.

Medicines were not always managed safely which placed people at increased risk of harm.

There was no registered manager. A registered manager was required to ensure staff received appropriate direction and support and to ensure improvements were embedded, sustained and further developed.

The provider was not always proactive in identifying and driving improvements and learning lessons. We made a recommendation about this. It was too early to assess the sustained effectiveness of the revised care records and audit processes because work to improve these areas was still ongoing. However, the actions taken so far showed improvements were being made.

Overall, there were enough staff to meet people’s needs and keep them safe. On some occasions the provider’s assessed safe staffing levels had not been met due to staff sickness. We made a recommendation about this. Staff received training to carry out their roles. Robust recruitment processes were in place.

People’s personal emergency evacuation plans not always clear and personalised. We made a recommendation about this. Significant improvements to the safety and cleanliness of the environment and management of infection had been made since the last inspection.

Further improvements were needed to ensure safeguarding incidents and CQC notifications were consistently identified and reported by staff. We made a recommendation about this. People felt safe. Risks were assessed and staff put measures in place to reduce risks to people’s safety, health and wellbeing. The analysis and recording of accidents and incidents had improved.

Staff were caring and treated people with respect and dignity. 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 relatives were involved in making decisions about their care. Further work was required to ensure people’s feedback was consistently acted upon.

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 inadequate (published 18 January 2023) and there were breaches of regulations. 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. However, the provider remained in breach of 1 regulation.

This service has been in Special Measures since 18 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 8 and 17 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, dignity and respect, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Morton Close on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to the management of medicines. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Morton Close is a residential care home providing personal care and accommodation up to a maximum of 40 people. At the time of our inspection there were 27 people using the service. The care home accommodates people in one adapted building with bedrooms on the ground and second floor. The main communal areas on the third floor.

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

People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks. The home was not clean and infection control was not effectively managed. Medicines were not managed safely which placed people at risk of harm. There were not enough staff to meet people’s needs and keep them safe. The systems and processes for learning lessons were not robust. We were not assured people would always be protected from the risk of abuse.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People’s dignity was not always maintained. Staff did not consistently treat people with respect, kindness and compassion. Staff were task orientated which meant people did not always receive the support and comfort they needed. Communication needed to be improved. Staff and people using the service were not always kept informed of key changes and the provider did not ensure they continuously sought people’s views.

Significant and serious shortfalls were identified which impacted on the safety and quality of care people received. Systems to assess, monitor and improve the service were not effective in identifying shortfalls and securing improvements. Opportunities to learn lessons and make improvements to the service had not been taken. There was a lack of effective leadership and management by both the provider and registered manager. Staff did not work effectively with other health professionals to ensure people received joined-up care.

The provider was responsive to the inspection findings and provided assurance they would make the required improvements to improve the safety and quality of care.

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 18 April 2019). No breaches of regulations were identified. However, we recommended the provider review night staffing levels to ensure there were sufficient numbers of staff on duty to meet people’s needs. At this inspection we found improvements had not been made to address this concern and staffing levels were unsafe. The provider had breached a number of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, caring and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

After the second day of our inspection our concerns for people’s health and safety were so serious, we wrote to the provider and requested a response about how they would take immediate action to ensure people were safe. The provider sent us an action plan and assured us they would take action to mitigate the urgent risks to people and ensure appropriate improvements were made to the safety and quality of care provided.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Morton Close on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified breaches of regulations in relation to safe care and treatment, dignity and respect, staffing and good governance at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

This inspection took place on 21 November and 6 December 2018 and was unannounced. Our last inspection took place on 27 June 2017 at that time the service was rated ‘Good’ overall with no breaches or regulations.

Policies and procedures were in place to ensure people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. However, we found the correct procedure had not always not been followed.

People’s needs were assessed before they moved into the home. However, the assessment documentation we looked at was not always show how the provider concluded they were able to meet people’s needs.

The care plans in place provided staff with information about people’s needs and preferences and identified specific risks to people’s health and general well-being, such as falls, mobility, nutrition and skin integrity. However, some care records we looked at required updating and there was evidence staff did not always follow recommendations made by other healthcare professionals.

Appropriate recruitment checks were carried out to make sure only people suitable to work in the caring profession were employed. However, we recommended the provider reviewed the staffing levels on the evening shift to ensure there are sufficient staff on duty to meet people’s needs.

Staff told us there were now clear lines of communication and accountability within the home and they were kept informed of any changes in policies and procedures or anything that might affect people’s care and treatment.

Private accommodation and communal areas of the home were generally well maintained and there was a planned programme of refurbishment in place.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA). This helped to make sure people’s rights were protected.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services and systems were in place to ensure people received their medicines safely and as prescribed.

There was a range of leisure activities for people to participate in, including both activities in the home and in the local community. However, people's views differed regarding the activities available on a daily basis.

We saw the complaints policy was available. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. However, we found some concerns highlighted in the body of this report had not been identified through the quality assurance monitoring system.

Morton Close provides accommodation and personal care for up to 40 older people. There were 30 people using the service when we visited. Accommodation is provided over three floors with lift access to each level. There are twenty-five single bedrooms and five double rooms. There are two separate lounges and a large dining area with a kitchenette on the top floor.

The home has a registered manager who has been in post for several years. 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 present on both days of this inspection.

People told us they felt safe, as did relatives we met. Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the Commission. Risks to people were assessed and managed to ensure people’s safety and well-being.

Medicines management had improved which ensured people received their medicines when they needed them.

People told us there were enough staff to keep them safe and meet their needs and this was confirmed in our observations during the inspection. People’s dependencies were assessed and staffing levels were increased as and when required. Staff recruitment processes were robust and ensured staff were suitable to work in the care service. We found staff received the induction, training and support they required to carry out their roles.

The home was clean and well maintained and records showed systems were in place to make sure the premises and equipment was safe and in good working order. However, we found some hot water temperatures were exceeding the maximum temperature recommended by the Health and Safety Executive which put people at risk of scalding. Following the inspection the registered manager confirmed thermostatic valves were being fitted to mitigate the risks to people.

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.

We saw improvements in the care records which were up to date and provided more detailed information about people’s care needs. People had access to healthcare services and this was reflected in their care records.

People told us they enjoyed the food. We saw mealtimes were managed in a way that ensured people had a pleasant and relaxed dining experience. People were offered choices and given the support they required from staff. People’s weights were monitored to ensure they received enough to eat and drink.

People praised the staff who they described as ‘excellent’, ‘lovely’ and ‘friendly’. People spoke positively of the care they received and we saw staff treated people with respect and ensured their privacy and dignity was maintained.

A range of activities were provided and we saw people were able to move freely around the home. There was a relaxed and happy atmosphere as people occupied themselves chatting with one another, meeting with visitors, looking at magazines, watching television or following their own particular interests.

The complaints procedure was displayed and records showed complaints had been investigated and dealt with appropriately, with feedback provided to the complainant.

Effective quality assurance systems were in place with an ongoing action plan to ensure continued improvement of the service. Staff praised the registered manager who we saw provided strong and supportive leadership. It was evident from our observations and feedback from people, relatives and staff that many improvements had been made since the last inspection.

We last inspected this service in January 2014 and found it was meeting all of the regulations inspected at that time.

Morton Close Care Home is a large detached property situated approximately two miles from Bingley town centre. The home is registered to provide residential care for up 40 people. Most of the people who use the service are older people, some of whom live with dementia. On the day of our inspection 25 people lived at Morton Close. Accommodation is on three floors with single and some double rooms available. The communal lounges and dining areas are all situated on the top floor. The home is well served by public transport. There is level access into the home and one passenger lift to all floors.

There was a registered manager who had been in post for a number of years. 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.

We reviewed the medicines management systems in place and although we saw some good practice we also identified areas where improvements were needed to ensure medicines were managed in a safe and proper way.

We saw mealtimes were a positive and relaxed experience. Overall we found people were provided with appropriate encouragement and assistance to eat. People told us the food was good and plentiful.

We found care records did not always contain accurate and complete information. We also found a lack of information within care records to demonstrate that risks were being appropriately assessed, monitored and mitigated.

People told us they felt safe and we saw robust procedures were in place to protect people from the risk of abuse.

Staff received appropriate training and development to enable them to deliver effective care.

Staff sought consent at the point of care delivery and worked in line with the requirements of relevant legislation such as the Deprivation of Liberty Safeguards (DoLS).

The majority of people we spoke with told us staff provided them with timely support. Our observations during the inspection confirmed this. However, we concluded minor improvements were needed to ensure staffing levels were consistently sufficient.

People told us staff were kind and caring and treated them with respect. Despite the limited information within people’s care records we saw staff knew people well and used this knowledge to deliver person centred care. Staff adapted the running of the service to respond to people’s changing needs and preferences.

People who used the service and their relatives were asked for their views and were listened to. Where people raised concerns or complaints these were promptly investigated and resolved.

Where quality assurance systems were in place these were not sufficiently robust and did not always prompt improvements to be made. There were some areas where comprehensive audits were not in place but were required to ensure appropriate action was taken to monitor and improve the service. Despite this, people spoke positively about how the service was run and told us the registered manager provided good leadership and generated positive staff morale.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three people who used the service and they told us they enjoyed living at the home and were very complementary about the care and support provided by the manager and staff.

We spoke with a relative of a person who used the service and they told us about the standard of care their relatives received. They said "I have no concerns at all."

We found staff were well supported in their role and were provided with an appropriate level of support and training in order for them to carry out their role effectively.

We also found the provider had an accurate Statement of Purpose (SoP) and it contained the necessary information including aim and objectives, the kinds of services provided, names of key individuals working for the service, legal status of the provider and details of the office address.