Archived: Moorside

Updated 29 October 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 and 26 July 2016 and was unannounced. The inspection was carried out by one adult social care inspector.

Before the inspection we spoke with a team manager from adult services in Winchester to gather their views on the service. We reviewed the information we held about the service, which included previous inspection reports and statutory notifications. A notification is information about important events which providers are required to notify us by law. We requested a Provider Information Return (PIR) and this was completed by the provider before our visit. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us. We carried out observations on each of the three clusters to see how people were being cared for and we observed lunchtimes. During the inspection we spoke with five people and three people’s relatives. We reviewed recently completed written feedback on the quality of the service from four people and five people’s relatives. We spoke with the registered manager, the assistant director, deputy matron, the chef, two activities staff, three care staff, a volunteer and two nurses.

We reviewed records which included four people’s care plans and monitoring records relating to people’s care, people’s medicine administration records, three staff recruitment and supervision records and records relating to the management of the service. These included staff training records, quality assurance records, the annual development plan, policies and procedures. The record of complaints, accident and incident reports and staffing rotas for the period 30 May to 17 July 2016.

This service was last inspected on 6 December 2013 and no concerns were identified.

Updated 29 October 2016

This inspection took place on the 25 and 26 July 2016 and was unannounced. Moorside is a care home registered to provide accommodation for up to 27 older people who require nursing or personal care and the treatment of disorder, disease or injury. The home provides care for people living with dementia and includes a day centre facility and short stay respite care for people living in the community. Moorside is located close to the centre of Winchester and the accommodation is arranged into three ‘clusters’ for up to eight people. Each cluster has a separate dining room, lounge and kitchenette. This provides people with a small and homely environment within the larger home. There is an attractive garden to the rear of the home which backs onto the river and a large day centre and activities room on the ground floor. At the time of our inspection there were 25 people living in the service.

A registered manager was in post at the time of our 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.

People told us they felt ‘safe’ living at Moorside. Staff had completed training in safeguarding people from abuse and understood how to report their concerns. The registered manager acted on concerns to keep people safe and used learning from incidents to prevent a reoccurrence. People were cared for safely.

People were supported to be as independent as possible and risks to their health and wellbeing were assessed. This included risks to people from falls and behaviours which may challenge others. Staff understood how to support people to manage risks and acted to prevent people from experiencing harm.

Staffing levels were sufficient to meet people’s needs. People were supported by nursing and care staff on each cluster to ensure the appropriate mix of staff skills were available to meet their needs. We observed staff had enough time to spend with people to meet their needs in a patient and meaningful way. The provider carried out the appropriate pre-employment checks to confirm people were supported by staff who were suitable for their role.

People’s medicines were managed safely. Nursing staff administered people medicines and were regularly assessed as competent to do so by the deputy matron. When a medication error had occurred the registered manager reviewed procedures with the nursing staff to enable them to learn from the incident. Prompt action was taken with staff to rectify some recording errors we found and a procedure put in place to prevent a reoccurrence. Guidance was available and used by staff to ensure people had medicines prescribed ‘as required’ when they needed them. This included pain relief when people may not be able to verbalise their need for this.

Staff completed an induction and on-going training in their role to enable them to meet people’s needs effectively. Staff communicated well during daily handovers to keep each other informed about changes to people’s needs, their progress and any concerns. The registered manager attended handover and facilitated discussion to help staff think through their responses to meeting people’s needs. Staff shared their skills and experience to support each other’s learning and provide effective care for the people they supported.

Decisions about people’s care when they lacked mental capacity were guided by the principles of the Mental Capacity Act 2005 (MCA). When it was deemed to be in people’s best interest to restrict their freedom to keep them safe their rights were protected by an application for a Deprivation of Liberty (DoLS) safeguard. Not all decisions made in people’s best interests had been recorded; however the registered manager took immediate steps to implement this process during our inspection. We found people’s rights under the MCA were protected.

People told us the food was good and they were satisfied with the choices available to them. We observed that people received the appropriate support from staff to eat when this was required. People living with dementia can benefit from a flexible approach to eating because they may not always choose to eat at mealtimes. We saw snacks were available to people throughout the day and staff used opportunities as they presented to encourage people to eat. Risks to people from malnutrition or other risks associated with eating such as difficulties in swallowing were assessed. Guidance was in place and acted on to ensure these risks were managed appropriately to support people with their eating and drinking needs.

People had access to a range of healthcare professionals including; nurses on site, GP’s tissue viability nurses, speech and language therapists (SALT’s), community mental health teams, physiotherapists, dentists and opticians. People received appropriate care to meet their specific healthcare needs.

People told us staff were caring and compassionate. We observed that staff knew, understood and responded to people in a caring way. Staff had information available to them about people likes, dislikes and history and staff were able to describe these to us. People told us they were involved in making decisions and we saw staff enabled people to participate in decisions about their day to day care.

People were treated with dignity and respect by staff. People and their relatives were cared for and comforted when people were at the end of their lives. A person’s family told us how well they and their relative had been cared for in these circumstances. People’s decisions for their end of life care were recorded, known by staff and respected.

Care and treatment plans were personalised. The examples seen were thorough and reflected people’s needs and choices. People’s needs were reviewed regularly and as required. Monitoring records were kept to enable staff to evaluate people’s needs and adjust their care accordingly. For example; health observations, weight and bowel monitoring. People received care in line with their assessed needs.

The needs of people living with dementia were central to the design and delivery of care and treatment at Moorside. This included; the environment, activities, staff skills and staff behaviours. The registered manager and staff were committed to providing care that was responsive to people’s needs. Their approach was informed by best practice dementia themed research and organisations leading in dementia care. People were engaged in meaningful interaction with staff and enjoyed a variety of individual and group activities supported by dedicated activities staff and volunteers. People living with dementia received person-centred care that promoted their well-being.

The registered manager provided positive leadership aimed at creating an open and empowering culture within the home. Staff spoke positively about the registered manager and told us they ‘led by example’. Staff were supported in their learning and development and to understand their roles and responsibilities. Staff told us they were well supported by the management team.

There was a positive atmosphere in the home and comments from people and their relatives about the home included ‘homely, welcoming and comfortable with excellent caring and kind staff’. Feedback from people and their relatives was sought through an annual questionnaire and regular residents and relatives meetings. Feedback was acted on for example; to provide activities of interest to people and to improve the quality of care delivered. An effective quality assurance system was in place which enabled the provider and registered manager to assess, monitor and improve the quality and safety of the service people received.