About the service Moorleigh Nursing Home is a nursing home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 36 people.
People’s experience of using this service and what we found
During the inspection, we identified many concerns relating to people's safety. This included the service not having appropriate fire evacuation plans in place. Also, a lack of training and guidance for staff on how to support people in the event of a fire. There were insufficient staffing levels during the day and at night which all put people at significant risk of harm.
We found areas of the premises were not safe. This included windows on the first floor with no restrictors.
There were not enough staff on duty to meet people’s needs which meant people did not have their needs met in a timely manner. They did not receive care that was person-centred or individualised.
Medicines were not managed safely. Staff did not always have guidance to ensure they administered 'as required' medicines to people. Topical cream administration records were not always completed by staff.
Risks to people were not always properly assessed. This included moving and handling, nutritional needs, use of equipment and falls risks. The provider had failed to address this which meant people were at risk of harm.
Assessments of people's needs were not up to date which resulted in people's needs not being met.
Staff demonstrated a limited understanding of safeguarding and records showed they had not received appropriate training in this area. During our inspection, we reported our concerns to the local safeguarding team. This means external professionals will look into our concerns.
The provider did not always maintain appropriate records relating to the requirements of the Mental Capacity Act 2005 (MCA). There was a failure to properly oversee and make applications for authorisations under the Deprivation of Liberty Safeguards (DoLS). People had not been included in decisions about their care.
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 nutritional needs were not always met.
Staff did not always complete mandatory training to ensure they had the skills they required for their roles. Staff did not always receive supervision and appraisal of their performance.
The governance of the service was poor. The provider did not have an awareness of the issues we identified and therefore had not mitigated the risks we identified within the service.
After the first day of the inspection, we requested an urgent action plan from the provider to tell us how they would address the concerns we found. They responded with a plan which gave timescales for the completion of works. We visited the service again to follow this up and found that not all of the actions had been completed. We found there were plans in place as to how these would be met. We continued to monitor the service regarding the improvements they were making.
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 20 December 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
This service was registered with us under the new provider on 15/01/2019 and this was the first inspection since the new registration.
Why we inspected
The inspection was prompted in part due to concerns received about staffing, medicines management and management of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.
Since our inspection, the provider has worked with other agencies including the fire service to make the necessary improvements.
Enforcement
We have identified breaches in relation to staffing, people’s safety, protecting people from harm, protecting people’s rights and overall management of the service at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.