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Inspection carried out on 21 and 22 July 2015

During a routine inspection

Moorhouse Farm is a residential care home, registered to provide accommodation and personal care for up to 24 people. At the time of the inspection six people were accommodated at the home.

This inspection took place on 21 and 22 July 2015. The inspection was unannounced. The last inspection we carried out at this service was in April 2014 when we found the provider was not

meeting one of the regulations that we inspected. This breach of regulation related to assessing and monitoring the quality of service provision. At this inspection we found improvements had been

made to the systems in place to monitor the quality of the service and this breach in regulation had been met.

The provider had two services on one site. Moorhouse Farm is a residential home and Ashington Grange is a nursing home. We inspected both services at the same time. The same staff were used across both services and the same management structure was in place. Our findings for Ashington Grange are discussed in a separate report.

A registered manager was in place. 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 we spoke with told us they felt comfortable and safe at the home. Staff had been trained in recognising and responding to potential abuse. Staff we spoke with were aware of how they should proceed if they had any concerns over people’s safety or wellbeing.

Areas of risk to people had been assessed. Action had been taken to mitigate risks wherever possible. Accidents and incidents records had been completed to a good level of detail They had been reviewed by the manager to ensure appropriate action had been taken and to determine if there were any trends where action could be taken to reduce the likelihood of accidents happening again.

During our inspection we saw there were enough staff to meet people’s needs. Staff were able to respond to any requests from people quickly, so people did not need to wait if they needed support. Staff recruitment procedures were in place to determine if potential employees were of good character before they started working at the home.

Processes were in place to manage medicines appropriately. Medicines were stored securely and any unused medicines were disposed of. Staff had received training in administering medicines and their competency to do so was regularly re-assessed.

Staff had received a range of training to equip them to carry out their roles. Staff training was up to date and monitored to ensure refresher courses were booked whenever training was due to expire. Staff regularly met with senior staff to discuss their role and the people they supported in supervision sessions. All staff had received an appraisal within the previous 12 months.

The manager was aware of the principles of Mental Capacity Act 2005 (MCA). The manager and staff told us that all of the people who used the service were able to make all of their own decisions about their care. Staff told us, and we observed, that they asked for people’s consent before delivering any care. The provider acted in accordance with the Deprivation of Liberty Safeguards (DoLS) and at the time of our inspection none of the people who used the service were subjected to any restrictions on their movement.

People told us they enjoyed the food and that the choice available to them was good. We saw food looked appetising and that mealtimes were relaxed with staff eating their lunch at the table with people after they had served people’s meals.

People told us staff respected their dignity and were caring towards them. We observed good staff practice staff knew people’s interests and we saw them engage them in conversations about their hobbies and families.

Activities had been planned to meet the individual needs of all of the people who used the service. People took part in a range of activities both inside and outside the home. A beach hut and caravan had been hired over the summer so people could visit it and enjoy their local area.

People had been involved in planning their own care. We saw care plans contained detailed information about people’s life histories. Care had been planned to meet people’s individual needs. When one person missed their morning medicines as they enjoyed a lie in on a morning, staff spoke with the person and their GP and were able to change the times of the medicine round for that person so that they could sleep in uninterrupted.

People had been asked to discuss their wishes as they approached the end of their lives. Staff had received training in end of life care and the manager made arrangements so that when needed families could stay at the home to be close to their relatives as they approached the end of their lives.

People told us they felt their needs were met. Care records were individual and personal to the person receiving care. Assessments had been carried out to determine people’s needs. Where people needed support from staff, specific care plans were in place. Staff were knowledgeable about people’s needs and about how they should care for them.

Meetings were planned regularly for people and their relatives. There had been no complaints within the previous 12 months.

Improvements had been made to systems in place to monitor the quality of the service since our last inspection.. People, relatives and staff spoke highly of the new registered manager and told us about the improvements she had made to the home.

Audits and checks of the service were carried out regularly. Both the manager and the care staff were involved in monitoring the quality of the service.

Inspection carried out on 29 April 2014

During a routine inspection

Moorhouse Farm is a residential home registered to accommodate up to 24 people. At the time of our inspection there were 13 people living at Moorhouse Farm.

Our inspection team was made up of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Below is a summary of what we found. The summary is based upon observations during the inspection, speaking to people who used the service and the staff supporting people.

At the time of our inspection there was no registered manager in post. However a manager had been recruited to the home and had been in post for number of weeks. The manager was in the process of applying to register with the Care Quality Commission.

The manager was responsible for two services on the same site; Moorhouse Farm and Ashington Grange. When looking at the accidents, incidents and complaints recorded we noted that this information was not recorded seperately for Moorhouse Farm and therefore it was difficult to distinguish which home the incidents or accidents had occurred in.

In addition we noted the records for complaints received in the past 12 months were not complete.

We saw that no documentation was available to show investigation or action had taken place and in seven cases the original complaint letter was not available to view.

This meant there had been a breach of the relevant legal regulation (Regulation 10) and the action we have asked the provider to take can be found at the back of the main report.

During our inspection staff we spoke with had a good understanding of safeguarding and could describe to us the training they had received and what they looked out for when working in the home. The manager had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We noted that in the lounge there was only one buzzer available and this was not located in a central area of the room. Due to people’s mobility needs we observed that they were unable to reach the buzzer and therefore would be unable to request assistance when required.

We saw medication within the home was stored appropriately and monitored on a regular basis.

When looking at care records we saw that people were involved regularly and where they could not express their views the service ensured that friends or family members were involved. We saw the activities at the home were varied in both ability required and location to try and engage as many of the people who used the service as possible.

Staff told us they had received training in all mandatory areas such as infection control and moving and handling. The manager told us they were aware supervisions had fallen behind prior to them starting in post. However, we noted 70% had been completed in the three months since they joined and they confirmed the remaining supervisions were planned to be completed by the end of the following month.

We saw staff were kind and caring and had developed positive relationships with the people who lived at Moorhouse Farm. People told us they were happy with the care they received at Moorhouse Farm. One person said, “This company is called HC, HC stands for High Class.” Another person said, “I feel very well looked after here.”

We saw staff knocked on peoples doors and asked permission before entering any rooms. We observed staff were discreet when talking to people about personal care requirements and made sure this was carried out in private.

Inspection carried out on 23 October 2013

During an inspection to make sure that the improvements required had been made

We spoke with people who told us they received a good service at Moorhouse Farm. One person said, "The staff are really good and they make time for us. I don't think we are short of staff. They always come when I ring for them and I don't have to wait. I am happy with the food. I have my meals here in the sitting room and that suits me really well." Another person told us, "The food is very good and I enjoy my meals. I think the staff are great. They are all really kind."

We found people's choices about where they had their meals were respected. People were supported to be able to eat and drink sufficient amounts to meet their needs.

People had their care needs met by staff who were qualified, skilled and experienced.

Inspection carried out on 4 September 2013

During a routine inspection

People told us they were happy with the care they received and staff made sure they were in agreement with it. We saw staff consulted people before they provided care and support.

We found people's needs were assessed and care was planned in line with their needs. One relative told us, “I have been satisfied with the care my relative receives.” Care plans were regularly updated and contained clear information about individuals' care.

People said they enjoyed the food provided. We were satisfied that staff provided effective support to protect people from the risks of inadequate nutrition and dehydration

We found there were occasions when there were not enough qualified, skilled and experienced staff available to meet people’s needs.

People were asked their views about the service provided and these were taken account of. People were aware of the complaints procedure. The provider had systems in place to monitor care delivery and the management of the home.

People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate format.

Inspection carried out on 15 March 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to follow up on concerns identified at the last inspection on 24 January 2013 about the standard of cleanliness.

During this inspection we spoke with two people who told us they were well cared for and liked living at Moorhouse Farm. They said the home was always clean.

We found people were protected from the risk of infection because appropriate guidance had been followed.

Inspection carried out on 24 January 2013

During a routine inspection

We spoke with two people about their experiences of the care and support they had received. They spoke positively about the support they received from staff at Moorhouse Farm. One person said, “I am very comfortable and happy here. I have the support I need and everyone is very friendly and nice.” The other person said, “It is nice living here, the staff are kind and support me. I like my room and I have everything I need.”

We saw there was a good rapport between the staff and people and there was a relaxed atmosphere. People told us staff asked them for their consent before they provided their care.

People’s needs were assessed and care and treatment delivered in line with their individual care plan.

We found that people were not protected from the risk of infection because appropriate guidance had not been followed.

People were protected by the systems in place for the recruitment of staff.

People were made aware of the complaints system. Their comments and complaints were listened to and acted upon.