The Moors

Updated 16 December 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

The Moors is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 4 November 2020 and ended on 11 November 2020. We visited The Moors on 4 November 2020. We made telephone calls to staff members and relatives of people who use the service on 9 November 2020, 10 November 2020 and 11 November 2020.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, such as notifications from the provider and information from the local authority and the public. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with two relatives about their experience of the care provided. We observed staff supporting people who were unable to talk to us. We spoke with four members of staff including the family liaison officer, the quality lead and two care workers.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at a range of policies, records and information to support our judgements.

Updated 16 December 2020

About the service

The Moors is a residential care home providing personal care to 5 younger adults with learning disability and autism at the time of the inspection. The service can support up to 5 people across two adapted buildings. 4 people live in the main house and 1 person lives in an annexe.

The Moors is a family sized house in a residential area, similar in appearance to the other houses in the street.

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

Medicines were not always safely managed. Best practice guidance was not always followed and when people received their medicines 'as and when required' (PRN) the correct PRN protocols were not in place.

Health and safety audits were not always completed in line with best practice guidance. Several health and safety tasks were not completed in line with the provider’s policies.

Personal Emergency Evacuation Plan (PEEP) information was not in place. This meant people were at risk of not being appropriately supported to evacuate the premises in the event of an emergency.

Food hygiene standards were not always sufficiently met. We found several out of date items of food in the fridge.

The provider failed to have enough staff with the right skills deployed to provide people with their commissioned care. This placed people at risk of harm.

The provider had quality control systems in place, however they were not always effective as records were not always correct and audits had not always identified errors in records.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s individual risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Risk assessments were completed appropriately, for example around nutrition, equipment, personal care and behaviour.

Lessons were learnt when things went wrong. The provider identified trends and themes when issues occurred and developed strategies to mitigate the risk to people.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

The provider and management team had good links with the local communities within which people lived.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting maximises people’s choice, control and independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 15 January 2020).

Why we inspected

We received concerns in relation to staffing levels, staff training, medicines errors and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Moors 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, medicines, environment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The provider supplied us with an action plan to inform us of 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.