We carried out a review of the data available to us about Moorside Hall on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Moorside Hall, you can give feedback on this service.
Moorside Hall is a nursing home providing accommodation and nursing care for up to 22 people. At the time of our inspection there were 15 people living in the home. The home is an extended adapted property with bedrooms on two floors, near Williamson's Park in Lancaster. There is a lift and a stair lift.
People's experience of using this service and what we found
People told us, and their relatives confirmed, they felt safe in the home. People were protected from abuse and avoidable harm because the providers' safeguarding policies were understood and followed by staff. People were supported by enough staff who told us they had time to care for people in person-centred ways. People received their medicines as prescribed from trained and qualified staff.
People were protected from environmental risks, including fire and legionella because the provider ensured safe systems were maintained and equipment had been checked and serviced regularly.
People living in the home and their relatives praised the person-centred culture of the home. Staff and leaders were committed to achieving high-quality care. People received care which promoted their independence from staff who were proud to work in the home.
The management team had robust governance systems in place to monitor the quality of care and care practice.
People and their relatives felt fully engaged with things going on the home and were able to raise anything they wished with the staff and leaders.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rated inspection for this service was good. (Published 17 April 2018). The rating at this inspection has remained the same.
Why we inspected
This inspection was prompted by a review of the information we held about this service. This was a focused inspection looking at the key questions of Safe and Well-Led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Moorside Hall is a residential care home providing personal care and support to 15 people aged over 65, at the time of the inspection. The service can support up to 22 people. The service can also provide support to people who are living with dementia.
People's experience of using this service and what we found
There were sufficient numbers of staff to meet people's needs. People looked settled and we observed good interactions between staff and people living in the home.
Some pre-employment processes had not been completed. Although these had not put people at risk, the provider completed them prior to this report being published. Where appropriate, the provider implemented disciplinary processes to ensure staff were always suitable to work with vulnerable people.
We noted there had been recent changes to the management structure and a deputy manager/clinical lead was to be appointed.
Staff, management and the provider's directors were known to people. They interacted well with people and people told us they were happy with the level of staffing.
All areas of the home that we looked at, were clean, well maintained and odour free. Safe processes were in place to support effective infection prevention and control. We also observed management and staff using personal protective equipment (PPE) safely.
The provider was accessing regular COVID-19 testing and all staff and people living in the home had been vaccinated. Safe visiting processes were due to commence in accordance with the current guidance.
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 'good' (published 17 April 2018).
Why we inspected
This targeted inspection was prompted, in part, due to specific concerns received about the availability and level of staff and unsuitable infection control processes . A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains 'Good'.
The Care Quality Commission (CQC) have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous
inspection. This is because they do not assess all areas of a key question.
We also 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 found no evidence during this inspection that people were at risk of harm from these concerns. Please see the 'Safe' section of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moorside Hall on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Moorside Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Set in its own grounds, and close to Lancaster City Centre, the home consists of mainly single bedrooms with en-suite facilities with a toilet and a hand-wash basin. There is a large conservatory with a dining room and a lounge adjacent to it.
At our last inspection in September 2015 the service was rated ‘Good.’ At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Staff were able to explain the support individuals required and the way in which they supported people who lived at the home. Relatives told us they were consulted and involved in their family members care.
Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found two care records required updating. Prior to the inspection concluding we were informed this had been carried out. Staff were knowledgeable of people’s needs and the support they required to maintain their safety. People who lived at Moorside Hall told us they felt safe.
Medicines were managed safely. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required.
We found people had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Moorside Hall.
We found people who received support were able to raise their views on the service. ‘Residents and relatives meetings’ were held to gain the views of people who used the service.
During the inspection we observed people being supported to eat and drink in accordance with their assessed needs. People told us they were happy with the meals provided.
The registered manager completed a series of checks to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these.
We found the environment was clean and staff wore protective clothing when required. This minimised the risk and spread of infection.
Staff told us they were aware of the procedures to follow if they suspected someone was at risk of harm or abuse. Staff told us they would report any concerns to the registered manager or the Lancashire Safeguarding Authorities so people were protected.
There was a complaints procedure which was displayed within the service. People told us they had no complaints, but they were confident the registered manager and registered provider would respond to any complaints made.
Recruitment checks were carried out to ensure suitable people were employed to work at the service. We found staff were caring. We observed warm and respectful interactions between staff and people and who lived at the home. We saw staff had time to spend with people and staffing was arranged to ensure people received support when they needed or wanted it.
We observed activities taking place and these were enjoyed by people who lived at Moorside Hall. People also said if they did not wish to take part in activities, their wishes were respected.
The registered manager demonstrated their understanding of the Mental Capacity Act 2005. Staff were able to give examples of how they supported people to make decisions. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
Further information is in the detailed findings below.
We carried out an unannounced inspection of Moorside Hall on 08 and 09 September 2015.
Moorside Hall is a care home registered to accommodate up to 22 people with dementia, and to provide nursing care. Set in its own grounds, and close to Lancaster City Centre, the home consists of mainly single bedrooms with en-suite facilities with a toilet and a hand-wash basin. There is a large conservatory with a dining room and a lounge adjacent to it. There is also a small lounge on the first floor. The first floor is accessible by a passenger lift.
There was no registered manager at the time of our inspection. We saw evidence that an application had been sent and was being processed by the Care Quality Commission [CQC]. The provider was overseeing the day-to-day management of the home and people and staff told us they were accessible, supportive and visible within the service. 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 last inspected the service on 24 September 2014. We found a breach of legal requirement relating to records, Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.
The provider responded by sending CQC an action plan of how they had addressed the breach identified. We found the improvements the provider told us they had made had been maintained during this inspection.
The manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. Staff spoken with told us they were aware of the procedure. They said they wouldn’t hesitate to use this if they had any issues or concerns about other staff members care practice or conduct. People who lived at the home told us they felt safe and their rights and dignity were respected. One person who lived at the home told us, “I’ve never had any problems living here. I feel safe.”
We found recruitment procedures were safe. Required checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff. Recruitment records examined contained a Disclosure and Barring Service check (DBS). These checks can include information about any criminal convictions recorded. Staff spoken with and records seen confirmed a structured induction training and development programme was in place. This included mentoring and shadowing experienced staff members.
Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. We found staffing levels were sufficient with an appropriate skill mix to meet the needs of people. The deployment of staff was well managed and provided people with support to meet their needs.
People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.
We found people who lived at the home and were living with dementia were supported to be as independent as possible. At lunch time we observed staff encouraging people to eat their meal independently.
Care plans we looked at confirmed the manager had completed an assessment of people’s support needs before they moved into the home. We saw people or a family member had been involved in the assessment and had consented to the support being provided. People we spoke with said they were happy with their care and they liked living at the home.
We observed staff demonstrated an effective understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussion with the manager confirmed she understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required. Systems were in place to protect people’s human rights and we observed staff followed their recorded preferences and diverse needs.
The environment was well maintained clean and hygienic when we visited. No offensive odours were observed by the inspection team. The people we spoke with said they were happy with the standard of hygiene in place.
We found medicine procedures in place were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place. People told us they received their medicines at the times they needed them.
People’s health needs were being met and any changes in health managed well. The people we spoke with said they had access to healthcare professionals when they needed them.
People told us they were happy with the activities arranged to keep them entertained. One person said, “It’s a nice place, staff do an incredible job and we do singing, baking and play board games.”
The manager used a variety of methods to assess and monitor the quality of the service. These included surveys which were issued to people to encourage feedback about the service they had received. We noted responses to surveys in meeting minutes and changes actioned due to feedback received. The people we spoke with during our inspection visit told us they were satisfied with the service they were receiving.
Areas of non-compliance found at the last inspection related to the care and welfare of people, the lack of staff support to meet people`s dietary needs and there were no suitable arrangements in place to respond appropriately to allegations of abuse. There was a lack of suitably qualified and experienced staff to meet people`s needs and there was a lack of effective quality monitoring systems in place to protect people from the risks of unsafe care. Also of concern was the management of medication.
We asked the registered provider to provide us with an action plan demonstrating what they were doing to address the issues of non-compliance. We received their action plan in May 2014. This detailed the procedures put in place to address the shortfalls. We used this inspection to see what actions had been taken to address the areas of non-compliance.
In August 2014 the registered provider notified the Commission there had been a recent change in the management of the home. He told us he had appointed a new manager, who was currently applying to the Commission to become the registered manager at the home. The previous manager had submitted an application to be removed from Moorside Hall as their registered manager. At the time of our inspection the newly appointed manager had only been in post seven weeks.
Information we gathered during the inspection helped 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. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
There was a copy of the Local Authority safeguarding guidance clearly displayed in the office downstairs. Our discussions with staff confirmed they were aware of what actions to take should they have any concerns for the people they cared for. The manager told us she would not hesitate to take action should she have any concerns regarding any poor practice witnessed in the home.
We found there had been generally some improvements made with the management of medicines. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.
Is the service effective?
We found concerns that some records were not being completed accurately.
Is the service caring?
We observed staff to treat people with respect and dignity. Staff were patient, kind and caring with people.
Is the service responsive?
Records of accidents, incidents and behavioural incidents within the home were being reported. Action was taken to protect people from the risks posed to them.
Is the service well led?
We saw evidence to show that a range of monthly audits were being implemented on a regular basis. The manager was submitting Notifications and reporting safeguarding concerns to the appropriate bodies. Staff were undertaking Dementia Awareness training.
The Local Authority had undertaken an independent inspection visit in July 2014 and the provider was given an action plan to assist them to make improvements in some areas. The Local Authority planned to return in October 2014 to see if those improvements had been made.
The inspection was led by one inspector and a specialist adviser. Information we gathered during the inspection helped 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. The summary is based on our observations during the inspection, speaking with people who live at Moorside Hall, relatives, visitors, other professionals, and staff. We looked at care plan records.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
At this inspection we found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and detailed care plan records were not always maintained.
We looked at the staffing levels. Despite there being an recent increase in the staffing levels in the afternoon we still found a lack of adequate staff support was available to meet people`s assessed needs. We observed the lunchtime period; there were times when people waited for long periods for assistance for their meal, food and for cutlery. People were left unsupported to eat their meals. We noted the least experienced member of the staff team was left to support 16 residents in the dining rooms and conservatory areas on her own for lengthy periods. This showed us the staffing levels in the home were inadequate to meet the needs of people and keep them safe and well. Visitors we spoke with told us they had concerns regarding the staffing levels in the home.
The home used assistive technology to help reduce the risks posed to people. There was the use of bed sensors, infra-red beams, and exit alarms in some people`s bedrooms. However there had been several incidents indicating a history of faults with this technology. Whilst faults had been remedied quickly by the maintenance member of staff there seems to be an issue in how the technology is used. Without the safe use of this equipment in place, would mean that some significant risks posed to people would not be managed safely.
Is the service effective?
During our observations we saw people were sat for long periods without any stimulation or activities provided to meet their needs. We noted one person who slept for most of the day had very limited interaction with others. A second person remained alone throughout the day in the smaller lounge either talking to the television or sleeping. This person was unable to leave their chair without staff assistance and they had no means of summoning staff as there was no call button. Staff and other residents rarely used the room.
Is the service caring?
We observed at times that some of the carers were very kind and patient with people they were caring for. Some staff we saw tried to respond to people`s care needs when requested or anticipated needs as they passed by. However it was a busy home and staff were not always available to support people when they requested assistance. On occasions we saw some staff ignored people`s requests. We saw one staff member asking a colleague if they could go on their dinner break rather than respond to a person`s request for support. There were other occasions when we saw poor practice such as moving and handling. On occasions the care being provided was not acceptable. We saw staff discuss people`s care needs in front of them and others. We saw that people were not always treated with respect and dignity. We reported our concerns to the registered manager and the provider.
Is the service responsive?
We noted that in one person`s daily notes there was a request from the community mental health team (CMHT) requesting a blood sample to be taken on the day of our inspection. However neither the nurse on duty nor the registered manager had any knowledge of this. The information had not been communicated through their systems and therefore the blood sample was not taken. This showed us that people did not always receive care and treatment to support their needs.
Records of accidents, incidents and behavioural incidents within the home were not being accurately recorded. There was no analysis of these incidents being undertaken. The records we looked at indicated a high level of falls taking place in the home between January 2014 and the date of our inspection. Information we looked at indicated there were serious injuries sustained by people. There was no records to indicate what actions had been taken to minimise the risks posed to people. We read of four incidents when people had injured themselves and there was no adequate explanations for these in the records we looked at.
Is the service well-led?
Although the management team had a range of systems in place to monitor the quality of the service, we did not see evidence that they were being effective. At a senior level, there was no evidence that quality audits were taking place to identify the shortfalls in the care planning system. This meant there was no action taken to ensure that care plan records were completed correctly, completed at the appropriate time or met the needs of the people being supported. This situation put people at risk of harm.
Records of accidents, incidents and behavioural incidents within the home were not being accurately recorded. There was no analysis of these incidents being undertaken. This showed us the risks posed to people were not being effectively managed.
Notifications regarding serious injuries to people and reporting safeguarding concerns were not being completed and reported to the appropriate authorities including the Commission.
This home cares for people with a range of dementia conditions and conversation with some residents was limited. We therefore spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.
We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.
The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "It's homely here. The staff are excellent and I am very happy.'
Several people had contacted us before the inspection to express a range of concerns. In particular that there was insufficient staff for management of behaviour that challenged. On the inspection, there were enough staff on duty and they were deployed around the home.
We were able to speak with people during the day of the inspection about their care and support. We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.
We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.
People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. We spoke with people about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.