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Reports


Inspection carried out on 21 September 2017

During a routine inspection

The inspection took place on 21 and 26 September, 2 and 11 October, and 1 November 2017 and was unannounced.

Moorings Nursing Home is registered to provide care and accommodation with nursing care for up to 39 people some of whom may be living with dementia and/or mental health conditions. When we inspected there were 37 people living in the service.

Improvements were needed to staff training. Staff had not received training in subjects that specifically meet the needs of people who use the service. We have also made a recommendation about providing staff with regular support and development of their skills.

Although there was a registered manager in post, on the second day of our inspection they were not available. The provider appointed a new interim manager who, together with a senior care assistant provided as much information as they could for this inspection. 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 recruitment process was usually robust. However, the sudden changes in management and staff had caused staffing issues which the new interim manager was trying to sort out by quickly recruiting appropriate staff, to help keep people safe and to meet their needs.

People received a safe service and were protected from the risk of harm. The electronic medication system was good and people received their medication as prescribed.

The service supported people to have as much choice and control over their lives in the least restrictive way possible. People received sufficient food and drink to meet their needs and preferences. Their health was monitored and their healthcare needs were met.

Staff knew people well and they were kind, caring and empathetic in their approach. People were encouraged and supported to maintain their independence as much as they were able to. Staff ensured that people’s privacy was maintained and treated them with dignity and respect at all times.

People and their relatives were involved in the assessment and care planning process. The care plans and assessments had been regularly reviewed to reflect people’s changing needs. People were encouraged and supported to participate in activities of their choosing which suited their individual interests. Complaints were dealt with appropriately in a timely way.

People were positive about the quality of the service. The new interim manager and staff were committed to providing people with a good quality person centred service that met their needs and preferences. There were effective systems in place to monitor the quality of the service and to drive improvements.

Further information is in the detailed findings below.

Inspection carried out on 11 April 2016

During a routine inspection

The Inspection took place on 11 and 12 April 2016 and was unannounced.

Moorings Nursing Home is registered to provide accommodation and personal care with nursing for up to 39 persons who may be living with dementia or/and mental health issues. There were 36 people living in the service at the time of our inspection.

At our last inspection on 5 October 2015 we checked to see if the service had complied with the breaches found at the February 2015 inspection. We found that the provider had taken steps to mitigate the risks to people and address the shortfalls. This included implementing systems to monitor the quality and safety of the service. However, these measures needed to be embedded and sustained over time so we did not change the overall rating of the service at the 5 October 2015 inspection.

At this inspection we found that the improvements made in the October 2015 inspection had been sustained. People received their care and support in a way that ensured their safety and welfare. There were sufficient numbers of staff on duty who had been safely recruited, were well trained and supported to meet people’s assessed needs. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

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 2008 and associated Regulations about how the service is run.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed. Staff demonstrated a good understanding of how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure people were cared for safely.

People had sufficient amounts to eat and drink to meet their individual needs. Their healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed. People’s care needs had been assessed and their care plans provided staff with the information needed to meet their needs and preferences and to care for them safely.

Staff were kind and caring and knew the people they cared for well. They ensured that people’s privacy and dignity was maintained at all times. People expressed their views and opinions and they participated in activities of their choosing. People were able to receive their visitors at any time and their families and friends were made to feel welcome. There were advocacy services available when needed. People were confident that their concerns or complaints would be listened to and acted upon. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

Inspection carried out on 5 October 2015

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

This inspection took place on 5 October 2015 and was unannounced.

Moorings Nursing Home provides accommodation, personal and nursing care for up to 39 older people who may be living with dementia and/or mental health issues. On the day of our visit there were 29 people who lived in the service.

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 2008 and associated Regulations about how the service is run.

At our last inspection in February 2015 we had concerns about people’s care and support and the lack of information in their care plans, a nurse working against their condition of practice, staff training and support, the application of the Mental Capacity Act 2005 (MCA) and the quality assurance system and records.

You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Moorings Nursing Home on our website at www.cqc.org.uk

At this inspection we found that the service had improved in all of the areas we reviewed and were no longer in breach of the Regulations.

A registered manager was 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.

People were protected from abuse and harm because safeguarding procedures had been followed and medication was managed safely.

There were sufficient numbers of staff provided to meet people’s needs. Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs.

People were supported by staff that understood them. Staff had undertaken training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and demonstrated an awareness of the issues around people’s capacity and to consider people’s best interest when supporting them to make decisions. People’s capacity and ability to make informed decisions were assessed and recorded clearly. The service had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People’s care plans provided staff with sufficient information to meet their needs. Staff knew how to support people in ways that they wished to be supported. Risks to people’s care and welfare had been fully assessed and they had been involved in make decisions about their care and welfare.

The records were clear and provided staff with important information to protect people against risks to their health, safety and welfare.

People and their relatives were positive about the quality of the service. The registered manager had carried out checks on its systems and practices.

The provider had taken steps to mitigate the risks to people and address the shortfalls found at the last inspection. This included implementing systems to monitor the quality and safety of the service. However, these measures need to be embedded and sustained over time to ensure people are provided with a consistently safe quality service. The overall rating of the service will not change at this time.

Inspection carried out on 16 and 17 February 2015

During a routine inspection

This inspection took place on 16 and 17 February 2015 and was unannounced.

Moorings Nursing Home provides accommodation, personal and nursing care for up to 39 older people who may be living with dementia and/or mental health issues. On the day of our visit there were 32 people who lived in the service.

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 2008 and associated Regulations about how the service is run.

At our last inspection in July 2014 we had concerns about cleanliness and infection control, staffing, assessing and monitoring the quality of the service and records.

At this inspection we found that the service had improved in cleanliness and infection control but had further work to do to improve in assessing and monitoring the quality of the service and in records. The service also had shortfalls in safeguarding people, management of medicines and consent to care and treatment.

People may not always be protected from abuse and harm because safeguarding procedures had not been followed, medicines were not always being managed safely and effectively and the service had not fully complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Although people’s needs had been assessed and they were cared for by kind and caring staff who treated them with dignity and respect, the service was not consistently responsive to their personal healthcare needs. Risks to people’s care and welfare had not always been fully assessed and they had not always been involved in making decisions about their care and welfare.

The records were not clear and posed a risk to people’s health, safety and welfare because important information could be lost.

People who used the service and their relatives had been involved in meetings to discuss any issues about their care and support. Their complaints and concerns had been listened to and acted upon. The service had carried out checks on its systems and practices but they were not effective because they had not identified the issues raised in this report.

People told us they felt safe living in Moorings Nursing Home. The recruitment practice was thorough and staff were trained and supervised.

Although there were sufficient numbers of suitable care staff to meet people’s needs, people had been placed at risk of receiving unsafe care because a condition of practice was not being adhered to by a registered nurse.

People had been supported to have sufficient food and drink.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Previously the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

Inspection carried out on 29 July 2014

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

We spoke with 12 of the 29 people who were using the service at the time of our inspection. We also spoke with three visiting relatives and eight staff members. We looked at four people's care records. We looked at the computerised care planning system, infection control procedures and practices, staffing levels and the service’s quality checks.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that care records were complete, accurate and fit for purpose. This meant that care was planned for the individual to limit the risks to their safety and well-being.

People told us that they felt safe and happy living at Moorings Nursing Home.

We had concerns over the cleanliness of the service, infection control systems and practices and the amount of domestic and catering staff on duty at times and how this affected care and cleaning duties in the service.

Is the service effective?

The improvements to the care planning system ensure that the service was more effective in meeting people’s changing needs.

The service may not always be effective due to the lack of infection control and quality monitoring systems and practices.

Is the service caring?

We observed staff treating people respectfully. People told us that the staff were kind and caring and that they had time to talk with them.

We heard one member of staff talking to a person in their preferred language. This meant that the person was able to communicate in a way that was meaningful to them.

Is the service responsive?

People told us that the service was responsive to their needs. The care plans had been updated to reflect people’s changing needs.

The lack of quality checks meant that it was not always possible to know if the service had responded appropriately to issues raised.

Is the service well-led?

There was a new manager in post who had started to make improvements. They had concentrated on setting up the new computerised care planning system. They told us that the service had advertised for more staff, including domestic and kitchen staff.

Improvements needed to be made to ensure that the systems and processes in place were used for monitoring the quality of the service.

Inspection carried out on 13, 14 March 2014

During an inspection in response to concerns

We visited Moorings Nursing Home as we received some concerns about the health and welfare about people.

People using the service had complex needs which meant they were not always able to tell us directly about their experiences. One person told us, “I’m happy here. I like everything.” Another person told us, “It’s alright. They look after you well.” A relative told us, “We couldn’t wish for better care.”

We considered that some improvements were needed to maintain people’s dignity.

The provider had systems in place to ensure that people had sufficient food and refreshments and this was monitored. Improvements were needed to ensure the provider’s infection control systems were followed.

Staff seemed very busy and worked with people exhibiting challenging behaviour. We considered that staffing levels needed reviewing to ensure that they were sufficient to meet people’s needs.

Staff told us they enjoyed their work and felt supported. Improvements were needed to ensure that the quality of the service was properly monitored and that required records were properly maintained.