Moulsham Home

About the service

Moulsham Home is a residential care home providing the regulated activity of accommodation and personal care to up to 23 people. The service provides support to people with learning disabilities and dementia. At the time of our inspection 22 people were using the service.

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

The service was not always meeting the underpinning principles of Right support, Right care, Right culture. Improvements were needed to the systems and governance of the service to ensure people received safe care. We found concerns with the providers lack of oversight and poor recruitment practice.

Right Support:

Care and support were provided in a safe, homely, well equipped, well-furnished environment which met people's physical and sensory needs. People living at the service had adapted their bedrooms to their likings. People's independence was promoted.

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.

Right Care:

There was limited information in the support plans we reviewed relating to people's end of life wishes. We have made a recommendation about end of life wishes.

Care was planned and delivered in a way which was intended to ensure people's safety and welfare. There were enough staff to meet people's needs. There were systems in place to minimise the risk of infection. Medication was dispensed by staff who had received training to do so and assessed as competent.

Right Culture:

Support focused on quality of life and followed best practice. Staff involved people, their family and other professionals as appropriate to evaluate the quality of support given and obtain feedback to improve people's day to day quality of life.

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

Rating at last inspection

The rating at the last inspection was good (published 22 August 2017).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Moulsham Home on our website at www.cqc.org.uk.

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.

Enforcement and Recommendations

We have made a recommendation in relation to recruitment practices, management of when required (PRN) medicines, risk assessments, end of life wishes and quality assurances.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Moulsham Home is a care home providing accommodation for up to 23 older people, including people living with dementia. At the time of the inspection there were 18 people living at the home.

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

We received information raising concerns about staffing and how people using the service were being kept safe. We wrote to the provider and asked for information around their systems and processes. This included policies staffing rota’s, assessment of needs, the preferred times people wanted to get up and the current policy and procedure for managing people’s safety (safeguards).

We inspected the home from 06.00am to see how care was being provided against the information the provider had shared with us. During the inspection call bells were answered in a timely manner and staff were knowledgeable about people’s needs and how they wanted to be cared for. This included what time they wanted to get up and when/what they had for breakfast.

We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was readily available to staff and all staff were following the latest guidance.

Prior to the inspection we received information that safeguarding processes were not being followed. Whilst we did not identify any additional concerns in relation to Moulsham Home, we found that the provider’s policy needed further clarity, to reflect best practice, ensure staff were aware of the escalation processes required, to share information and ensure people were safe from harm. We have made a recommendation about this. The registered manager was working closely with the local safeguarding team to reflect on the current practice within the service to ensure that lessons were learned and to make improvements where needed.

Rating at last inspection

The last rating for this service was Good (published 22 September 2017).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, safeguarding concerns and infection control risks. A decision was made for us to inspect and examine those risks.

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 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 Moulsham Home 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Moulsham home provides residential care for up to 23 people, some of whom may be living with dementia. There were 23 people living at the service at the time of our inspection two of these people were in hospital.

When we last visited the service it was rated good. At this inspection we found the service remained good.

The service has a registered manager in post. 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 were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were appropriate arrangements in place for medication to be stored and administered safely, and there were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated codes of practice.

People had access to healthcare professionals. A choice of food and drink was available that reflected their nutritional needs, and took into account their personal lifestyle preferences and health care needs.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support.

People were treated with kindness and respect by staff who knew them well and who listened to their views and preferences.

People were encouraged to follow their interests and hobbies. They were supported to keep in contact with their family and friends.

There was a strong management team who encouraged an open culture and who led by example. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided.

For a more comprehensive report regarding this service, please refer to the report of our last visit which was published on 6 August 2015.

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

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

This was an unannounced inspection. We spoke with six people who lived at the home and two relatives who were visiting. We could not speak with some people due to their needs. We also spoke with the manager and three other members of staff. We looked at written records, which included copies of people's care records, medication systems, staff personnel files and quality assurance documentation.

Is the service safe?

We found the home to be warm and clean. The accommodation was adapted to meet the needs of people living there, was suited to caring for people with limited mobility and was appropriately maintained.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. People were protected by safe recruitment practices. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents and understood people's needs, which enabled them to deliver appropriate and safe care. People were cared for by staff who were properly trained and supported to develop professionally.

People we spoke with were satisfied with the care and support they received.

Is the service caring?

We spoke with six people who used the service. One person said to us, "All the staff here are very kind. I am very well looked after." Another person said to us, "I have no complaints, but I could easily speak to any of the staff if I did." Another person said, "Everything is good. I love it here." One relative said to us, "This is a fantastic home." Everyone we spoke with told us that the food was good and echoed the sentiments expressed in the quotations above. Nobody we spoke with raised any concerns with us.

We observed a good rapport between staff and the people who lived at the home. We witnessed the care and attention people received from staff. Staff were friendly, were attentive to people's needs and people were treated with dignity and respect.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Care plans and risk assessments were regularly reviewed. Activities took place, both planned and spontaneous, that were appropriate to people's needs.

Three staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns.

Is the service well led?

Three staff members said that they felt well supported by the manager and senior staff and they were able do their jobs safely. The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

During our inspection we saw a homely and clean environment. Staff knew people well and they were friendly and approachable. We saw staff were able to meet people's individual needs and treated people with dignity and respect. One person told us: 'All the staff are fine' and 'I like the food.' The visitor told us that staff looked after their relative well.

We saw people were given a choice of activities during the day. We observed staff engaging with people in activities such as bingo, dancing and sitting and talking with them. There was also a visiting hairdresser and we saw many people having their hair styled during the morning. People told us they had trips out and some had recently been Christmas shopping and others for a Chinese meal.

We saw people's nutritional needs were being met and there was a wide range of food available. However we found that people's care and support was not planned and delivered in a way that was intended to meet their individual needs and ensure their safety and welfare.

We saw the provider followed appropriate recruitment processes that ensured new staff were suitable for the role. Records showed us that staff received training that was appropriate to their role and that they were supported well through regular supervision.

We saw that all staff were given guidance on how to safeguard people and received training in this area.

People told us how they felt that their needs were met in the home and that they were happy living in the home. They told us that the liked the food and they felt they were, 'Looked after.'

People also told us that they liked the staff and felt safe in the home, they said that if they had any concerns they felt able to raise them.

When we spoke with a visitor they told us that they felt there were always adequate staff on duty within the home and they were happy that their relative was living in the home. They described the home as, 'Nice' and said that they were kept up to date about their relatives needs. They also told us that they would approach the manager if they had any concerns regarding the home.