Archived: Morris Grange Care Home

When we completed our previous inspection on 5 January 2017, we found concerns relating to medicines administration, staff supervision and the provider's quality and assurance systems. At this inspection, improvements had been made to meet the relevant requirements.

Morris Grange 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.

Morris Grange accommodates 71 people across three separate units, each of which has separate adapted facilities. At the time of our inspection, there were 55 people who used the service. One of the units specialises in providing care to people living with dementia who have behaviours that need to be managed. The other units provide residential and nursing care.

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 safe, effective, responsive and well-led to at least good. During this inspection we found the provider had made improvements in all these areas.

At the time of inspection the registered provider was in administration and a management company was overseeing the operation of the home on behalf of the administrators. The management company were providing regular updates to CQC regarding the home for our monitoring purposes. Where we refer to the provider in this report we are referring to the administrator.

The service had a registered manager. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. They were confident that the registered manager would address any concerns.

Medicines were stored and administered safely and the premises were well maintained to keep people safe. Some areas were in need of renovation, but essential repairs to keep people safe were completed.

Risk assessments were completed to reduce the risk of harm. Accidents and incidents were analysed to reduce the risk of reoccurrence.

Staffing levels were sufficient to meet people's needs. There were safe recruitment and selection procedures in place and appropriate checks had been undertaken before staff began work. Staff received the support and training they needed to give them the necessary skills and knowledge to meet people's assessed needs. Staff had requested more practical training and this had been organised.

People were provided with sufficient food and drink to maintain their health and wellbeing. Staff supported people to access healthcare professionals and services.

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.

There were positive interactions between people and staff. Staff knew people well and promoted their independence. Care was person-centred and people were provided with choice. Staff were kind and treated people with dignity and respect. People told us they were happy and felt well cared for.

Care records contained information about people's needs, preferences, likes and dislikes. Staff understood people were individuals and would not tolerate discrimination.

Complaints and feedback were taken seriously and action was taken to address any concerns. The registered manager and provider monitored the quality of service provided to ensure that people received a safe and effective service which met their needs.

Morris Grange provides personal and nursing care and accommodation for up to 71 people, who have nursing and/or dementia care needs. The home also provides care for people who may display behaviours that can be challenging. Care is provided in three separate units, with each unit specialising in providing a different type of care. The home is located in a rural setting close to Scotch Corner, with gardens and car parking available. At the time of our inspection 50 people were living at Morris Grange.

At the time of inspection the registered provider was in administration and a management company was overseeing the operation of the home on behalf of the administrators. The management company were providing regular updated to the Care Quality Commission regarding the home for our monitoring purposes.

The service had a registered manager. 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.

Medicines were not always managed safely for people and records had not been completed correctly.

Staff could easily demonstrate a person centred approach to care, they knew people and their life history’s well. However, we found this detailed staff knowledge was not adequately recorded in people’s care plans and records.

Audits were taking place, however the in house audits were mainly tick boxes and were not robust enough to highlight the issues we found during our visit.

Staff did not receive supervision or a yearly appraisal in line with the home’s supervision policy.

Risks to people arising from their health and support needs and the premises were assessed, and plans were in place to minimise them. Risk assessments were regularly reviewed to ensure they met people’s current needs. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

There were enough staff to meet people's needs. Due to the rural nature of the service it was difficult to recruit staff and there were staff vacancies, but the registered provider had covered these with the consistent use of agency staff.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff received training to ensure that they could appropriately support people, and the registered provider used the Care Certificate as the framework for its training.

Staff understood safeguarding issues and felt confident in raising any concerns they had, in order to keep people safe.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and clearly understood the requirements of the Act. This meant they were working within the law to support people who may lack capacity to make their own decisions. The registered manager understood their responsibilities in relation to the DoLS.

People were supported to maintain a healthy diet and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service and that they enjoyed it.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, care home liaison nurse and other professionals. Feedback we received from health professionals was positive?

The interactions between people and staff were cheerful and supportive. Staff were kind and respectful. We saw that they were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received.

Procedures were in place to support people to access advocacy services should the need arise. At the time of inspection three people had independent mental capacity advocates (IMCA’s). IMCA’s support people who lack capacity to make specific important decisions.

People’s care plans contained a record of assessment, care planning, reviews and evaluations, daily records and external healthcare professional input. However, we found that different people’s care plans were very similar, with some containing duplicated and generic information, with only the person’s name changed. This meant they were not always individual and person centred.

People had access to a range of activities, which they enjoyed. The service employed three activity coordinators, one of which worked solely on a weekend.

The registered provider had a clear complaints policy that was applied when any concerns were raised. People and their relatives knew how to raise any issues they had. Complaints were documented, with a full outcome recorded to show if the complainant was satisfied.

The registered manager was a visible presence at the service, spending time out of the office. Feedback was sought from people, relatives, external professionals and staff to help monitor and improve the service.

We identified 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Overall we found that staffing levels at the home were being maintained at safe levels, which were suitable to the needs of the people using the service. However, we found that maintaining these staffing levels did involve staff covering extra shifts and the frequent use of agency staff to cover vacancies and sickness. Some of the staff, relatives and visiting professionals we spoke with were concerned about the effect this could potentially have on people's care, if the levels of agency staff usage continued or increased. However, the home's manager was able to demonstrate that they were in the process of recruiting new permanent staff and explained how they tried to use the same agency staff where possible to increase continuity of care.

Staff at the service told us that they did not feel adequately supported by the service's management. The majority of staff spoken with told us that they did not feel listened to and some said that they felt bullied by management. These concerns were also shared by some of the relatives and visiting professionals we spoke with. We were informed that there was the perception that staff who raised concerns would be victimised and staff told us that they had little confidence in the service's whistleblowing procedures.

People looked well cared for and relatives told us they thought people were treated well and that their experiences in the home were positive.

We saw records that showed some people were involved in developing their care plans and that some people's representatives had been involved, if the person was unable to give their consent.

We observed the care staff being kind and respectful to people. One visitor said 'It is Fathers home now.'

We saw that the provider had a robust recruitment and selection process which meant that people who used the service were cared for by staff who were suitably qualified.

The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service. One visitor said they were very satisfied with everything, and that they 'would have said if they were not.'