Moorland House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were abuse and avoidable harm. At our last ratings inspection we rated this key protected from question inadequate. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm. People told us there were enough staff to meet their needs. People knew how to raise concerns and felt action was taken to improve safety. The registered manager reviewed incidents and accidents to identify learning and to ensure changes were made that improved care for others. Safeguarding incidents were recorded and reported to the local authority in a timely way. The registered manager kept a log of all incidents with outcomes to make sure all the required actions had been completed. People had risk assessments and risk management plans, which set out the support they needed to stay safe. A number of improvements had been made to the internal environment which were positive. Staff demonstrated a good understanding of infection prevention and control processes. People received their medicines as prescribed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives knew how to raise concerns and told us action was taken to learn from incidents and make improvements. For example, 1 relative told us how following a series of falls, action had been taken to provide their family member with a pendant alarm. They said, “I spoke with the manager and that's why he now has an alarm around his neck so he can always alert staff if he has fallen it’s so much better.”

The registered manager told us staff were encouraged to share any concerns about ways of working. They described a range of systems which were used to update staff about new risks and to provide additional guidance to embed good practice. The registered manager told us about their review of incidents and accidents which had identified a higher rate of falls in a specific month. The information suggested this was linked to an outbreak of Covid-19 within the service. In response the registered manager had implemented additional drinks rounds to ensure people were staying hydrated. She said, “I and the deputy monitor this.” Staff told us they had regular meetings with the registered manager during which there were opportunities to reflect on their performance, what they had done well, and areas for development.

Since the last inspection, a more robust system of auditing had been implemented which enabled both the registered manager and provider to have improved oversight of shortfalls and enabled them to take action to address these. Staff meetings were held during which the leadership provided constructive feedback to staff. For example, following an observation the leadership worked with staff to ensure they provided an explanation prior to offering moving and handling support, to avoid the person becoming anxious or distressed. The registered manager reviewed incidents and accidents to identify learning and to ensure changes were made that improved care for others. For example, following a medicine’s related incident, the registered manager had met with the staff member concerned to ensure lessons were learnt. In this example, the staff member was retrained and had their competency to administer medicines reassessed. A local health care professional provided an example of how safety related incidents were being used as opportunities to learn and improve people’s care. They said, “Falls are reported to us via our falls assessment form which helps us to identify any causative factors and monitor the number of falls a resident has, thus triggering specialist assessments.” An area of improvement the provider was working on at the time of the assessment was developing staff’s knowledge in recognising safety related events and understanding their role in reporting them appropriately.

People and their relatives were confident that staff understood people’s needs and worked with agencies to ensure people remained safe as they moved through services. People confirmed they were involved in developing their care planning documentation and had contact with the service prior to their admission. One person told us, “They came out and met me. I gave them everything I knew about me, they listened.”

Staff told us they were kept informed about new admissions into the service; important information about the person was shared with staff, enabling them to support people from the start of their admission into the service. Staff confirmed information sheets were updated promptly when someone new was admitted into the service to ensure they had all the relevant information available and accessible. For example, the dietary information guidance which recorded people’s individual dietary preferences and requirements was kept easily accessible for reference in the kitchen. The registered manager described the pre-admissions process and how they shared relevant information with staff securely and effectively. They described their process for reviewing and updating people’s personalised care planning documentation post-admission to ensure it remained relevant to the person’s support needs and preferences.

Continuity of care was important to the provider. The registered manager told us about their processes for supporting people to engage with external health and social care services. This helped ensure all partners had the relevant information they needed to implement a collaborative approach and good outcomes for people. . To aid this approach, they promoted consistency in support to appointments, implemented relevant documentation to gather the information needed and had processes in place for sharing relevant information securely and effectively. This was confirmed by health and social care professionals’ feedback.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. This included referrals, admissions and discharge, and where people were moving between services. For example, a 'hospital pack' of essential information about a person could be shared with relevant professionals and services. For new admissions into the service, there was a robust pre-admissions process which promoted collaboration with people, their relatives and relevant professionals. This process included realistic timescales to enable care planning documentation and any required training to be put in place prior to admission. These systems and processes promoted safety and continuity of care for people. People's health conditions were documented, and people were supported to access a range of health care professionals.

People were not able to describe in any detail their feedback about how the service protected them from abuse, but they all told us they felt safe living at Moorland House. They and their relatives felt able to speak with staff or the registered manager if they had any concerns.

Staff told us they had completed safeguarding training. Those we spoke with told us about their responsibilities in relation to identifying and reporting concerns about abuse. One staff member said, “Safeguarding is neglect, we report it to the senior. If [Registered manager] or the director don’t take action, we call CQC or the social worker” and another said, “Safeguarding is to protect the residents and care for them from any harm. There are 6 principles of safeguarding.” The registered manager had implemented safeguarding audits, part of which included undertaking knowledge checks with the staff about their understanding of safeguarding and keeping people safe from abuse.

People were supported when they felt unsafe. One person was observed at intervals to get up from their chair or display distressed behaviours. We observed a staff member put her arm around the person and reassure them. We observed others being supported to use mobility aids and staff checking to ensure people’s mobility aids remained accessible to them when they were seated in their preferred seat.

Safeguarding incidents were recorded and reported to the local authority without delay. The registered manager kept a log of all incidents with outcomes to make sure all the required actions had been completed. The provider had a safeguarding policy which all staff had access to. Safeguarding training was provided, and staff had opportunities to discuss safeguarding at meetings and during supervision.

Where appropriate, relatives told us they were involved in decisions about their family member’s care. Relatives confirmed that care provision was safe and supportive. One relative told us, “[Person] is always included in things… I've seen [person’s] care plan. They have shown me what they were doing, and I am happy with it.”

Staff told us risks were assessed and documented in people’s care plans. One staff member said, “Care plans and risk assessments are good, they help me understand people.” The registered manager told us how they had worked with 1 person, their family and healthcare professionals to plan how staff should respond were the person to experience further falls. This helped to ensure the risks were being met in a balanced and proportionate way whilst at the same time respecting the choices of the person. Staff described how they supported people when they became distressed and how they recognised delirium and the action they needed to take to keep people safe.

We observed staff supporting people in line with their risk management plans. For example, when assisting people with their meals. One person required a puree diet to mitigate choking risks. We saw the correct diet was provided but was also well presented with each food item pureed separately so the person could taste individual flavours. One person had a sensor mat beside their bed to alert staff they were standing and might be at risk of falling. We observed staff responded promptly when this sensor mat was activated.

Risk assessment and management had improved since our previous inspection. People had risk assessments and risk management plans, which set out the support they needed to stay safe. For example, following a change in a person’s dietary needs, the registered manager had undertaken a choking risk assessment and reviewed the care plan to provide staff with updated guidance on how to support the person to eat and drink safely. We saw other similar examples where information about people’s risks was clearly recorded and accurate. This information was readily available to staff on handheld devices. There was evidence that staff worked effectively with a range of healthcare professionals to manage and respond to risks. This included the community nursing team and mental health professionals. Overall, plans had been regularly reviewed with people and their relatives to ensure these were up to date. The registered manager ensured detailed information was available for staff so they could respond to people’s distressed behaviours and recognise if a person might be experiencing delirium.

People and their relatives told us the service was clean and tidy.

Staff liaised with local professionals to make sure people had the equipment they needed.

A number of improvements had been made to the internal environment since our previous inspection. These included, redecoration of communal areas, updating and redecorating people’s rooms, making the dining room a more pleasant space for people to eat and replacement of flooring. The provider had a programme in place for improving the environment and we saw this programme in progress throughout the assessment. For example, during the assessment the flooring was replaced in the upstairs area.

Since our previous inspection the provider had implemented a ‘home improvement plan’, detailing an extensive refurbishment programme, which was in progress at the time of this assessment. This included redecorating people’s rooms as they became vacant and undertaking work to improve the gardens. A full time maintenance person had been employed. Checks were undertaken of the gas, electrical and water systems to ensure these were safe. Fire equipment and equipment used to deliver people’s care were also checked and maintained. There was some accessible signage to support people to recognise where the toilets or communal rooms were, but in general, whilst comfortable and homely, the environment was not fully adapted to meet the needs of those living with memory loss or dementia. To address this, the provider had commissioned a consultant to provide concept designs on how this might be improved.

People and relatives told us staff had the right skills and knowledge to meet their needs. Comments included, “The staff are very good, and I’m definitely well looked after” and “Always someone around to help us.”

The registered manager was confident there were sufficient numbers of staff to meet people’s needs. They told us, “I have a dependency tool, do observations…. I can look at the time staff spend doing tasks, I go out and do personal care, I see for myself, I can use this as a teaching moment if needed.” Staff raised no concerns with us about staffing levels. One staff member said, “We have a routine now, we have a system, we have breaks now and we make sure there are still staff on shift.” Staff said they had regular support meetings with their supervisor and an annual appraisal. Staff confirmed they completed employment checks before they started work and told us they had accessed training necessary for their role. The registered manager told us, “The online training is very interactive, there is a knowledge check throughout and an assessment at the end, there are interactive scenarios and staff can revisit the training at any time which is all available on a mobile friendly app.”

We observed people being supported safely and with dignity when they were being assisted to move from around the service. Overall, staff responded promptly when people requested help or when they used their call bell. One person who was at risk of falling was observed to get up often and walk around. Staff provided support, continually holding their hand and guiding the person towards a chair to sit down or walking with them around the service.

A dependency tool was in place to support judgements around staffing levels, and call bell response times were monitored. A recent provider weekly report showed the longest time a call bell had rang unanswered was just under 4 minutes. Since our previous inspection, recruitment practices had improved. Required pre-employment checks had been completed for staff before starting work. This included a check with the Disclosure and Barring Service (DBS). New staff received an induction, which included training and shadowing experienced staff. Records demonstrated staff received supervision every 3 months along with an annual performance review. Staff received training appropriate to their role which included subjects such as safeguarding, dementia care, end of life care and caring for people with diabetes and catheters. Competency assessments were in place for medicines. Moving and handling competence was checked as part of the annual training and covered areas such as use of equipment, and the use of hoists to assist people up from the floor.

People and their relatives told us staff followed good infection control measures. Comments included, “(Person) has a nice room which is always clean”, “[Person’s] room always appears to be clean and tidy and there is never a smell of urine.” Another relative told us their loved one was supported effectively to maintain their personal hygiene.

Staff demonstrated a comprehensive understanding of infection prevention and control processes they should follow and said they received training. Staff said they never had any problems obtaining the personal protective equipment they needed. Staff told us the service was kept clean and hygienic. For example, 1 staff member said, “The home is clean and tidy, we have reports to fill out for cleaning.” The registered manager told us about the positive feedback they had received from external health professionals about how they had effectively managed a Covid-19 outbreak.

Overall, we found the service tidy and clean. We observed domestic staff cleaning the service and staff wearing and disposing of PPE appropriately and hand sanitiser was available.

Since our previous inspection, infection prevention and control practices had improved. The provider had an infection prevention and control policy, which was regularly reviewed and updated to reflect current guidance. Cleaning schedules were in place for people’s rooms and the communal areas. Suitable cleaning products were used, and these were stored safely. Leaders completed spot checks of staff, to ensure they were putting the procedures and their training into practice. Where shortfalls had been identified, we saw from meeting minutes that staff were reminded by the leadership team of their role and responsibilities in relation to infection control. A health care professional told us a Covid-19 outbreak at the service had been dealt with very efficiently. The registered manager undertook infection control audits which they used effectively to improve the service.

People were not able to give us any detailed feedback about their medicines. A relative spoke positively about medicines management, saying “They have managed to bring [Person’s] medicines down from 5 tablets to 1.”

Staff told us they had been trained to administer medicines and demonstrated an understanding of medicines procedures. They described how they ensured best practice was followed when for example administering people's pain patches and how to identify when people were in pain and required additional pain relief.

Since our previous inspection, the management of people’s medicines had improved. The registered manager assessed the competency and knowledge of staff to administer medicines. Overall staff kept clear records of medicines administration. There were monthly audits of medicines records and weekly stock checks. People’s care plans contained clear information about the support they needed with medicines. It is good practice to put the date of opening on liquid medicines as expired medicines can be less effective. The registered manager had taken action to ensure this was consistently recorded. When staff applied a transdermal patch, they were now using the electronic body map to record the location of the patch