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We are carrying out a review of quality at Moorlands Nursing Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 20 December 2019

During a routine inspection

About the service

Moorlands Nursing Home is a care home providing accommodation and personal care to people. The home accommodates up to 41 people in one adapted building. People living in the home had a range of needs including those living with dementia and/or long-term health conditions. At the time of the inspection, 30 people were using the service.

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

Risks to people were managed effectively to reduce possible harm. Management plans provided guidance to staff to promote people’s safety. People were safeguarded from the risk of abuse. Staff had received safeguarding training and knew actions to take to report abuse. Incidents and accidents were managed in a way that lessons were learnt from them. People’s medicines were administered and managed safely. There were enough nursing and care staff available to support people. Staff were trained in infection control and followed procedures to reduce risks of infection.

Thorough needs assessment was conducted in line with best practice guidance before people were accepted to use the service. People were supported to eat a balanced diet and drink enough to keep hydrated. Staff were supported in their roles through effective induction, training and supervision. People had access to healthcare services they needed to maintain good health; and staff liaised effectively with other 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. People’s consent was sought for the care and support they received.

The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

Staff were kind and compassionate to people. People were treated with respect and dignity. People’s care and support was tailored to meet their individual needs. People’s end of life wishes were documented in their care plans and followed. People were supported and encouraged to participate in activities they enjoyed. The home was safe, well decorated and suitable to the needs of people.

People and their relatives knew how to raise complaints about the service. The registered manager responded to complaints appropriately, in line with the provider’s procedure. The registered manager engaged people, their relatives and external organisations to develop and improve the service. The service had effective systems to monitor the quality and safety of the service.

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 26 June 2017). At this inspection the service remained Good overall.

Why we inspected

This was a planned inspection based on the previous rating of the service.

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.

Inspection carried out on 10 May 2017

During a routine inspection

Moorlands Nursing Home provides nursing and residential care for a maximum of 41 older people, some of whom are living with dementia. There were 31 people living at the home at the time of our inspection.

The inspection took place on 10 May 2017 and was unannounced.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At our last inspection on 25 and 30 November 2015 we found the provider was breaching legal requirements in relation to safe care and treatment and person-centred care. People at risk of pressure damage, dehydration and unstable diabetes were not adequately protected from harm. Care was not always responsive to people’s individual needs and people did not have access to appropriate activities.

The provider sent us an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection the provider had taken action to address these concerns and meet the relevant regulations. Any risks involved in people’s care had been assessed and recorded. Where risks had been identified, staff had implemented appropriate measures to reduce the likelihood of harm. Care was responsive to people’s needs and people had access to appropriate activities. People’s needs were assessed when they moved into the home and kept under review. The care people received reflected their individual needs and preferences. People told us staff respected their choices about their care and staff had involved people and their relatives in developing their care plans.

People felt safe at the home and when staff provided their care. Relatives were confident that staff considered all available options to keep their family member safe. There were enough staff on each shift to meet people’s needs. Staff understood safeguarding procedures and were aware of their responsibilities should they suspect abuse was taking place. People were protected by the provider’s recruitment procedures. There were plans in place to ensure people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly to keep the premises and equipment safe for use. People’s medicines were managed safely.

People were supported by staff who had the skills and experience they needed to provide effective care. Staff attended all elements of core training during their induction and refresher training at regular intervals. Staff had access to further training relevant to the needs of the people they cared for and nursing staff had access to clinical training and ongoing professional development. All staff attended regular one-to-one supervision, which gave them the opportunity to discuss any support or further training they needed.

People enjoyed the food provided and were involved in developing the menu. People’s feedback about meals and mealtimes was encouraged and their suggestions were implemented. People’s nutritional needs had been assessed and were known by care and catering staff. The registered manager and staff had implemented measures that had improved the support people received to maintain adequate hydration.

People’s healthcare needs were monitored effectively and people were supported to obtain treatment if they needed it. Referrals were made to healthcare professionals if staff identified concerns about people’s health or well-being. Any guidance about people’s care issued by healthcare professionals was implemented and recorded in people’s care plans.

People were supported by caring and compassionate staff. People told us they had developed positive relationships with staff and enjoyed their company. Staff supported people to maintain rel

Inspection carried out on 25 and 30 November 2015

During a routine inspection

This inspection took place on 25 and 30 November 2015. It was unannounced. There were 30 people living at Moorlands Nursing Home when we visited. People cared for were mainly older people who needed nursing care. People had a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Many people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were living with dementia. The home also cared for people at the end of their lives.

Moorlands was a large house, which had been extended. Accommodation was provided over two floors, with a passenger lift in-between. There were sitting rooms and a dining room on the ground floor. Moorlands Nursing Home was situated in its own grounds. The provider for Moorlands Nursing Home was Caring Homes Healthcare Group Limited, who provide a range of services across the United Kingdom.

Moorlands Nursing Home did not have a registered manager in post when we inspected. The previous registered manager had left their post and a new manager had been appointed. This new manager came in post on 19 October 2015. They confirmed they would be applying for registration as manager with the CQC. 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.

The home was inspected on 17 December 2014 and was judged to be inadequate. At that inspection, issues were identified relating to consent for care and treatment, assessments and monitoring of the quality of the service, staff support and staffing. A further inspection was performed on 30 January 2015 to review progress towards making improvements in service provision. We found improvements had been progressed and the outcome areas reviewed were judged to be requiring improvement.

At this inspection, improvements had been made but some areas still required further improvement. Some people’s risks were not effectively managed. This included the care and treatment of people who were at risk of pressure damage, dehydration and the management of people’s diabetes. Some staff were unaware of the degree of people’s risk in these areas and the actions they should take to reduce them. Care plans did not clearly set out actions staff needed to take. They also did not follow relevant national guidelines on the care and treatment of people.

Where people were living with dementia, staff did not fully assess the extent of people’s behaviours which may challenge either themselves or others. Care plans were not drawn up to direct staff on how these people needed to be supported when they showed such behaviours. People’s individual needs for activities were not consistently assessed and the care plans for people were limited. The new manager and activities worker were taking action to develop and address such areas.

Where people needed medicines to be given in a disguised way (known as covert medication), systems for ensuring the consent of relevant persons were unclear and inconsistent. The new manager had taken action to ensure all other areas relating to consent to people’s care and treatment complied with the Mental Capacity Act (2005). They had also taken action to refer people to the local authority where they were at risk of being deprived of their liberties (DoLS).

Some areas of management had not yet been addressed by the new manager. This included ensuring effective deployment of staff to meet people’s needs. Also certain records, including records relating to people’s medicines and the monitoring of meeting people’s care and treatment needs were not in place, or did not accurately reflect what staff told us about.

Many people felt complaints and concerns had not been effectively managed in the past. They reported, now the new manager was in post, they were confident if they raised issues action would be taken to address their concerns. The new manager had ensured records of complaints and concerns raised by people were now fully documented.

The new manager had taken action to reduce risks to people by ensuring they had appropriate risk assessments. The systems for audit of accidents identified factors to reduce risk to people, and the new manager had taken action where relevant. They had also ordered relevant equipment such as new beds and pressure relieving equipment, to further reduce people’s risk.

Staff were caring and supported people in a kindly way, ensuring they offered them choice. Staff showed respect to the people they were caring for, including people from diverse backgrounds. These systems also ensured people who were at the end of their lives were supported in the way they wanted.

People were able to choose where they ate their meals and what they ate. People were assessed for nutritional risk and action were taken to reduce such risks. Staff provided people with support where they needed assistance with their meals.

The new manager had reviewed systems for staff support and training. They had developed a revised training programme. They had also set up systems for regular supervision of staff so they were supported in their roles. All staff had been trained in safeguarding adults from risk of abuse and were aware of actions they needed to take to ensure people were supported if they had been identified as being at risk of abuse.

People were safely supported in taking their medicines. There were appropriate systems for storage of medicines. People who needed external professional support, such speech and language therapists (SALT), were referred in a timely way. Advice from external professionals, like the SALTs, was followed by staff when providing care and treatment.

The new manager had ensured all of the home was well-maintained and clean. They had set up systems for regular audit of facilities and services. They had an action plan which showed the areas they had addressed and areas which they needed to address, with dates for completion of actions.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 15 June 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 17 December 2014 and a focused inspection on the 30 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to people’s consent to care and treatment, assessing and monitoring the quality of the service and how staff were supported.

We undertook this focused inspection to check that they had followed their plan and to confirm that they have now met legal requirements. This report covers our findings in relation to those requirements and additional concerns that were found on the inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moorlands Nursing Home on our website at www.cqc.org.uk.

There have not been sufficient improvements to the safety of the environment. On this inspection people continued to be at risk. The provider had not taken appropriate steps to minimise the risk of an unsafe environment. Rooms were in a state of disrepair and bathrooms and other rooms which were accessible to people were being used to store equipment.

We found that there were areas around the service that were not clean and posed an infection control. People’s rooms were dusty and areas around the home were not clean including hallways and the sluice rooms. The carpet throughout the service was stained and dirty. The service was not visibly clean or free from dust and dirt to be acceptable to people living at the service their visitors and staff. There was a strong smell of urine coming from some people’s rooms even after personal care had been given. Cleaning schedules showed that rooms were not always cleaned by staff.

Whilst we were at the inspection we were made aware of practice that suggested that restraint was being used inappropriately on a person whose behaviour could be challenging for staff. This has been reported to the local authority as a safeguarding alert.

Staff understood what their roles were and felt more supported by the registered manager. However there were still no systems to facilitate the registered manager meeting with staff on a one to one basis. The service policy stated that all records of clinical supervision with nurses and supervisions with care staff were to be kept confidential and stored appropriately in their personal files. There was no evidence of any of these supervisions on the day of the inspection. Supervisions were only taking place in the format of team meetings. Staff told us that they wanted to meet with their manager on a one to one basis to give them the opportunity to discuss any confidential concerns that they had.

On this inspection we found that people’s capacity was still not being assessed for specific decisions. This included decisions around the front door being locked from the inside and people having bed guards. The registered manager showed us that the only applications that had been made to the Local Authority was for people who did not choose to stay at the service and not where their liberties were restricted. We saw that where ‘Do not resuscitate’ (DNAR) forms had been completed for people who lacked capacity there was no evidence that capacity assessments had been completed. Staff did not have a good understanding of best interest meetings or the meaning of DoLS. This meant that people’s rights were not being protected.

Staff felt more supported as there was now a registered manager at the service. One person said that the manager was “Nice and friendly. They felt they could go to the registered manager if they were worried or concerned about anything. Staff felt that things are changed for the better since the manager had been in post. They felt they could go to the registered manager about any problems and one said things were “A lot more flexible now and not as rushed.”

Systems to assess the quality of the service were still not effective. Internal audits mentioned that supervisions should be undertaken with staff six times a year and we found that this was still not happening. An infection control audit had been carried out in May 2015 that did not identify the concerns with the cleanliness or the environment.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 30 January 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 17 December 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staffing and the care and welfare of people.

We undertook this focused inspection on the 30 January 2015 to check that the provider had followed their plan and to confirm that they have now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moorlands Nursing Home on our website at www.cqc.org.uk

At the time of inspection there was no 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 and associated Regulations about how the service is run.

Risk assessments for people had been reviewed and a plan for staff on how to reduce the risk was included in each person’s care plan.

People were being weighed regularly and where had a concern had been identified advice was being sought from health care professionals. Staff were recording the advice from the health care professionals and providing the most appropriate care to people.

Care plans had been completely re-written and reviews of care had been undertaken for the remaining eight that still needed to be done. Care plans detailed information people’s social and medical history, the person’s preferences and any identified risks. Staff understood people’s individual needs.

Staff had been re-deployed around the service and people were now getting their care in a timely way. People were being turned in bed by staff at regular intervals to reduce the risk of pressure sores and people received their medicines on time every day. People were able to get up and go to bed when they wanted.

A health care professional said that staff were happier and that the atmosphere in the service was a lot calmer. We found this to be the case on this inspection.

Inspection carried out on 16 December 2014

During a routine inspection

This was an unannounced inspection, which took place on the 16 December 2014. Moorlands Nursing Home provides residential and nursing care for up to 41 older people some of whom may be living with dementia. At the time of our inspection there were 33 people at the service.

At the time of inspection there was no 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 and associated Regulations about how the service is run.

People and their relatives said they felt they were safe with the staff. Not all staff had received updated safeguarding adults training but had knowledge of the safeguarding procedures and what to do if they suspected abuse.

There were not always enough staff to safely meet people’s needs. This meant that sometimes people did not receive personal care in a timely way. People did not always have their medicine on time and some had to sit in a wheelchair all day as there were not enough staff to transfer them into armchairs.

Some of the emergency equipment around the home needed to be updated for example the fire door guards. Some people’s bedroom doors were being propped open which was a fire risk.

Risk assessments for people were not up to date which meant that staff would not have the most up to date information for people.

There were gaps in the medicine records where a nurse should have signed to say that people’s medicines had been given. There was not always guidance for staff on when to give people their PRN (as needed) medicines. All of the medicine was administered and disposed of in a safe way.

Pre-employment checks for staff were completed. For example in relation to their full employment history and reasons why they had left previous employment. This meant that only suitable staff were employed.

Some people felt their health care needs were being met but others did not. Health care professionals said that some staff did not have the support and skills to deal with some people’s complex conditions.

Staff were not up to date with the service mandatory training and others had not had any training in some areas. This included first aid, fire training and infection control. This meant that staff would not have the most up to date guidance. Not at all staff had received a one to one supervision or appraisal with their manager.

Some staff knew about the Mental Capacity Act 2005. However we saw that mental capacity assessments had not taken place in relation to people where there was doubt about whether they could give consent. This related to people who were unable to access the front door or those people who had ‘Do not resuscitate’ (DNAR) forms.

People thought the food was good and felt that their nutritional needs were catered for. People were encouraged to make their own decisions about the food they wanted. We saw that there was a wide variety of fresh food and drinks available for people. However those people who needed additional support to eat were not always given that.

People had access to a range of health care professionals, such as chiropodist, community matron and doctor. A doctor visited regularly and people were referred when there were concerns with their health.

Some people thought that the staff were caring and that they were treated with dignity and respect. Other felt that they were left for long periods of time without any interaction from staff. People also felt that if they needed privacy then this would be given.

There was a strong smell of urine in the service which was present throughout the day. Staff were unable to identify where this smell was coming from.

Some activities were available and some people were out on a day trip on the day of the inspection. However there were no activities provided for people who remained in the service. There were not enough activities provided for people specific to their needs. Staff said that there was not enough for people to do.

People’s health needs were not being monitored consistently. One person needed to be weighed weekly and this was not happening. They had lost weight and there was no information on the care plan about how this was being managed.

People and relatives said they understood how to make a complaint and felt comfortable to do so. There was a copy of the complaints procedure for everyone to see in the reception area. All of the complaints were logged but there was no evidence of any learning from these complaints.

People, relatives and staff were asked for their opinion and feedback on what they thought of the service. We asked the interim manager for the analysis of the feedback that had been provided by people and relatives but this was not available. We were unable to establish if any improvements had been made from people’s feedback.

People and staff did not feel that the service was well managed. The audits that took place were not effective and improvements had not been made as a result of the audits. For example in relation to the infection control and care plans.

The last inspection of this home took place on 3 September 2013. During that inspection we found that the provider was in breach of the regulations that related to people’s care and welfare, meeting people’s nutritional needs and staffing levels. The provider sent us an action plan stating what steps they would take to address the issues identified. At this inspection we confirmed that the provider had not completed the actions needed.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 3 September 2014

During an inspection in response to concerns

We carried out this inspection because since the last inspection as we had received information of concern relating to the care people received, whether there were enough staff and whether people had enough food or a choice of food available to them.

We spoke with 11 people who used the service, six relatives and 11 members of staff including two acting managers and the provider's representative.

People and their relatives told us the regular permanent staff were kind and caring but the agency staff did not always know people or know how to meet their needs. Staff told us they were committed to providing a quality service but there were not always enough staff to meet everyone's needs at the time people required their help.

People's comments included; "The girls are lovely, there just aren't enough of them". "I can wait for up to 30 minutes to get help going to the toilet". "The staff are rushed and they don't always get time to help us".

One relative said the staff cared for their family member well. Other relatives said the staff were kind but there were not enough staff to help everyone. For example one relative said, "The carers are all very good, they all work very hard but there are times when they're very thin on the ground". Another relative said, "There have been times when I've heard people's call bells for ages and I've had to go and ask them [staff] what's going on".

We found people needs had been assessed but their care had not always been planned or delivered to meet those needs.

Because there were not enough staff people had not always been helped to have enough to eat and drink where they required this care.

Inspection carried out on 17 June 2014

During an inspection in response to concerns

This was a responsive inspection that was undertaken by two inspectors. We received information of concern in relation to care plans not being up to date or reviewed on a regular basis.

We looked at five outcomes that would help us to answer five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service safe?

People are treated with respect and dignity by the staff. People told us that they felt safe living at the service. One person told us, �Staff here are very good.�

We saw that safeguarding and whistle blowing procedures were available and staff understood their responsibilities around keeping people safe.

There were systems in place to record accidents and incidents, complaints, concerns, whistleblowing and investigations. We saw that changes had been made as a result of these events. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted.

Is the service effective?

People�s health and care needs were assessed and they and their relatives were involved in annual reviews of care plans. Records showed that people had access to healthcare professionals as and when required.

Staff received regular training that enabled them to carry out their roles. They had regular supervision and an annual appraisal with their line manager where training and support was discussed and planned.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when they supported people. People told us, �Staff were very good here.�

Staff were able to tell us about the people they supported. Staff were seen to take time to talk and listen to what people said. Staff encouraged people to be independent by involving them in activities around the house.

People�s likes, dislikes and religious needs had been recorded and care and support had been provided in accordance with people�s wishes.

Is the service responsive?

People were able to take part in a range of activities. People said they could make choices about the activities they wanted to do.

People and a relative knew how to make a complaint if they were unhappy. Information about how to do this was displayed in the entrance to the service and a copy was available in the service information pack that each person had in their bedrooms. The people we spoke with told us they would make a complaint to a member of staff if they needed to. One relative told us they had made a complaint and this was resolved to their satisfaction by the provider.

Is the service well-led?

The service has a system in place to monitor the quality of the service provided. The service maintained records of accidents and incidents. We saw that the registered manager had a book to record complaints received at the service.

The registered manager and staff told us that people who use the service, their relatives and associated professionals completed annual satisfaction surveys. One person who used the service told us they had completed a questionnaire. We reviewed the results of this feedback and saw the service had taken appropriate action.

Staff told us they were clear about their roles and responsibilities. Staff told us they felt supported by the register manager and that she promoted regular training for all staff.

Inspection carried out on 18 July 2013

During a routine inspection

People who used the service and their relatives confirmed that they were treated respectfully and had been provided with regular opportunities to speak to staff at all levels about aspects of their care.

Relatives that we spoke with were positive about the care being provided by the service. One relative told us, �We are very pleased with the standard of care that my relative receives. It has been a godsend. The staff have also helped us to understand my relative�s condition�.

We found staff to be trained and very aware of the safety of people. One member of staff said, �I�ve been here some time now and I have done some form of safeguarding training at least once a year. The company is very strong on this and rightly so�. Both people that we spoke with who used the service told us that they felt safe at Moorlands. One person said, �They look after me alright. Don�t worry�.

We found that there were sufficient care staff to meet the needs of people who used the service. One relative told us, �They can get quite busy at peak times but they manage and they find time to do the important things like talking to residents�.

We found that an effective system for monitoring and assessing care quality was in place and the service was responsive to changes in needs and the preferences of people who used the service.

We found that the provider had informed the Care Quality Commission of incidents required to notified, which had occurred while service was being provided.