Moorgate Croft

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. We saw staff were thoughtful in how they interacted with people and knowledgeable about people's needs and wishes. The care plans we saw were written in a person centred way and incorporated people’s wishes, preferences and life histories. People's rooms were personalised and people had access to personal possessions that meant a lot to them.

The team were proactive and creative in their approach to supporting people’s emotional wellbeing and we saw evidence of an exceptional level of personalisation in 1 person’s care. Using a strengths-based approach the team had adapted the person’s care based on their faith and unique personal history, employing music as a therapeutic tool. This helped maintain the person’s quality of life and helped to manage their distress related to dementia. The person had been a member of their church choir, and had sung with their young relative, who regularly visited the home to sing with their family member. Recognising the person found singing calming, the registered manager had asked their family for a recording of their young relative singing. When the person became upset, staff played the recording for them, and this helped them to settle, reducing their distress without the need for medication and providing emotional comfort. The team had also supported the person to attend a local carol service at Christmas to further reconnect them with their faith and love for choir music.

Another person had previously enjoyed attending pantomimes but felt there was “no point” in going after losing their sight. Staff encouraged the person to attend a pantomime with audio description, with a staff member describing stage settings and movements. The provider’s records showed the person had said, “It was very good going to the pantomime. It was nice and it made me feel that life doesn’t have to stop just because I have lost my eyesight. I never give in; I still have two hands and two feet, and I definitely want to go again.”

People and their relatives were complimentary about how people’s possessions and clothing were cared for. People praised the activities that were provided. People’s comments included, “I think they [staff] try very hard with the activities. They couldn’t do much more.”, “There are plenty of trips and activities” and “The activities are fine. I like them all.” A relative said, “Yes, there are enough activities and [my family member] goes in the garden.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Staff helped people to stay in touch with their family and friends, who were free to visit the home without undue restrictions. Relatives told us staff were friendly, welcoming and supportive of them. For instance, a relative said, “They [staff] support me as well.” Relatives were involved in escorting their loved ones for outings and appointments and felt involved in their care and support.

People and their relatives told us they felt informed about what was happening at the service. Staff told us they understood people’s communication needs and knew people well. People had individual assessments which accounted for their specific communication requirements. For people who did not communicate in conventional ways, staff said they were able to tell by a person’s facial expression or change in their body language if they needed support. At lunchtime we saw staff knew who needed support to choose their meal, showing them the food on offer on the plate, to help people to decide.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service could provide information in a variety of formats and languages if required by a particular person. Signage was very clear making it easier for people to find their way around the home. Information about upcoming events such as activities, events and meetings were clearly displayed in the home.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. The provider had a complaints process which supported people in raising concerns about the service. Members of the management team told us complaints were welcomed and used to develop the service and improve practice.

When complaints were made, systems were in place to make sure investigations were completed, responses given within a reasonable timescale and improvements implemented when necessary. People were confident about sharing their views. One person said, “Yes, it is well run and yes I would recommend it. I know who the manager is, and I would know who to complain to.” Another person said, “Everything is nice. I have not thought about if I needed to complain. I have not needed to.”

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. People’s equality and human rights were protected and promoted. The management team were aware of people who were likely to experience inequality and actively listened to make sure people’s diversity was valued and respected. One relative said, “The best thing here is they try to make it home from home. They do parties and cover all events.”

Care plans considered people’s needs, and any reasonable adjustments were made in relation to any protected characteristics people may have to make sure people were comfortable and in receipt of support which fully met their needs. Protected characteristics are specific attributes safeguarded against discrimination under the Equality Act 2010. The staff team were very alert to discrimination and inequality. Staff told us they were provided with training on equality and diversity, and this had helped to raise their awareness of people’s rights.

The provider promoted a culture of empowering people to live their life as they chose, whilst ensuring their safety. We saw evidence of the personalised care provided to a person who had experienced sudden sight loss. The team recognised the emotional and psychological impact of the person’s loss of vision, and provided both, practical support and meaningful engagement, seeking external expertise to enhance the person’s quality of life. The person also experienced distressing hallucinations following the loss of their sight. The team contacted the Royal National Institute of Blind People (RNIB) who recommended additional lighting for the person’s room to reduce hallucinations. This was installed, leading to the person experiencing fewer hallucinations and reducing their distress. The involvement of RNIB helped made sure the person’s care was evidence-based and guided by best practice, in addition to improving the person’s health and sensory wellbeing.

The team had linked another person with relevant healthcare specialists such as neurological services, had arranged medicines reviews and supported the person with strength and balance exercises. The provider had made environmental

modifications and provided staff training on managing risks related to the person’s specific and complex needs, including their ongoing neurological and health issues. Over time, the person had experienced significant reductions in the number of falls they experienced, and as a result, a reduction in hospital admissions. They had subsequently engaged in activities in the home, formed friendships, and mobilised independently, with the support of appropriate equipment, maintaining their dignity and freedom of movement. The provider’s records showed how these improvements had enhanced the person’s quality of life, the person said, “I am relieved I am not falling as much, it feels very good that I do not have to go to hospital. I feel very happy and safe.”

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this. People’s human rights were protected and the provider had procedures in place regarding equality and diversity. People’s care plans included preferences and information about their cultural and religious needs.

We saw evidence of action staff and leaders had taken to improve outcomes for people. For example, very good rehabilitation support had been provided to a person who, prior to moving to the home, had lived in bed because of fears related to falling. Staff and leaders had used a holistic, rehabilitative approach that combined physical, social, and nutritional care, allowing the person to regain independence and improve their well-being. Additionally, risk factors around falls and muscle deterioration had been addressed, and tailored interventions enabled the person to regain confidence and willingness to engage socially. Staff and leaders supported the person with a gradual mobilisation programme, from chair exercise, building to mobilising around the home and building their strength through structured movement exercises. Planned, nutritional support was introduced, which had aided the person’s recovery and staff had encouraged the person to eat in the dining room with others and socialise. The person had gained weight, improving their strength and overall health. They had also become more independent, mobilising around the home, engaging in daily activities and forming friendships.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life. Staff and leaders supported people to plan for the future and contribute to their care plan. Staff worked as a team to make sure people’s care and support was seamless. Staff were extremely considerate when planning care interventions to make sure people were as comfortable as possible.

The management team told us they were working towards achieving the ‘gold standard framework’ for end of life care. This is a model of good practice that enables a “gold standard” of care for people who are nearing the end of their lives.

Staff and leaders worked well with the local hospice to make sure people received the right care and the right time in an environment of their choosing.

Some people had requested to stay at the home rather than move into the hospice and their care was supported by the hospice at home team, and staff at the home. We saw evidence of a holistic, compassionate, culturally and spiritually sensitive care for 1 person. This integrated physical, emotional, and spiritual support including sensory therapy, spiritual engagement, and psychological comfort to create a peaceful and dignified experience.