Peel Moat

Peel Moat is a residential care home providing accommodation with personal care to up to 31 people. The service provides support to older people with dementia. At the time of our inspection there were 28 people using the service.

All communal areas are located on the ground floor. People’s bedrooms are across 3 floors.

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

The provider had not followed guidance and did not have appropriate checks in place to maintain the safety of the passenger lift at the service. Some improvements to the environment at the service had been made however; overall improvements were slow and took significant time to implement. Audits and management meetings did not always recognise areas for improvement or drive those improvements.

Staff were recruited safely. Medicines were not always managed safely. The home appeared clean throughout. We found a cleaning product in an unlocked cupboard. This was moved during the inspection. Staff had completed training to support them in their role.

Staff supported people to maintain their independence, particularly around their mobility. Staff supported people in a kind and caring way.

The service had engaged with people and their families around concerns raised about the lift. Care plans showed personalisation however they lacked detail in end of life care planning. People were supported and encouraged to engage in activities within and outside the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 29 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. You can see what action we have asked the provider to take at the end of this full report. The provider addressed the concerns around the lift following the inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to provider oversight, health and safety and the safe management of medicines.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Peel Moat is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. Peel Moat accommodates up to 31 people in one adapted building.

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

People felt safe at Peel Moat and told us staff were kind to them. People had personal items in their bedrooms. Bedrooms were individually decorated to each person’s taste. People were supported with bathing and personal care as they wished.

Staff supported people to remain in contact with their families by phone and video calls during the pandemic. There was a visiting policy to support safe visiting that reflected the latest government guidance. This included individual risk assessments for each designated visitor along with a lateral flow device test (LFT) before each visit, and the wearing of appropriate PPE.

Peel Moat was clean and hygienic and there was a designated housekeeping team. The cleaning schedule included cleaning of frequently touched surfaces and there were infection control posters throughout the premises to promote good practice.

Staff were provided with adequate supplies of PPE . Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. Hand sanitiser was readily available throughout the home.

The general manager undertook spot checks on staff practice. The general manager also did daily walk rounds to observe practice and support staff and people.

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 29 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about person centred-care. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and responsive sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Peel Moat on our website at www.cqc.org.uk.

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.

Peel Moat is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Peel Moat provides accommodation for up to 31 people who require personal care, some of whom are living with dementia. At the time of the inspection, 28 people were living in the service.

At the last inspection undertaken on 1 August 2016, the registered provider had breached Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the lack of risk assessments relating to the premises, risk assessments in relation to people at risk of choking, medicines management, staff training was not up to date and the registered provider’s quality assurance systems had not identified the areas of concern we found. We also made a recommendation because the home did not have features to support people living with dementia, such as reminiscence material, items of visual or tactile interest, or dementia-friendly signage. The overall rating for the service was requires improvement.

Following the last inspection we asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions, is the service safe, effective, responsive and well led to at least good. At this inspection, we found that improvements had been made in all areas and plans were in place to make further improvements.

The service had 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 was absent and the deputy manager was available throughout this inspection. We were informed that the registered manager left the service shortly after our inspection and plans were in place to recruit a suitable replacement.

We raised concerns during the first day of this inspection about the recruitment process for a new member of staff. There were also concerns about a person’s deteriorating health and behaviour which had resulted in an incident. The deputy manager took prompt action to address both matters.

We saw that improvements had been made to the management of medicines and risk assessments were now in place for the premises. This included a risk assessment for the new alarm system, which had been introduced following feedback from the Coroner in relation to an incident at another of the registered provider’s services.

Risk assessments were in place for people who had identified problems with swallowing which meant they were at risk of choking.

Staff training was not up to date. However, this was because there had been a number of staff who had recently come to work at the home who were undertaking induction training. We recommended that the outstanding staff training is completed as soon as possible.

We saw that the service had created a dementia friendly lounge, which had reminiscence materials such as visual items including 1950’s ornaments and furnishings. Further improvements had been made to the environment with ‘dementia friendly corridors’ to help people make their way around the home.

Staff we spoke with told us they would have no hesitation in reporting any poor practice they witnessed from colleagues and were confident they would be listened to by the deputy manager and action would be taken.

There were enough staff available to meet people’s needs.

People were supported to maintain their general health and wellbeing.

Staff received training in the Mental Capacity Act 2005 (MCA) about their responsibilities when caring for people who lacked capacity to make a decision. The registered manager also understood the need to apply for Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.

People were offered a choice of food and had access to drinks.

People had their own rooms, which allowed privacy. Rooms were furnished in accordance with people’s choices and preferences. The home was clean, comfortable and homely.

People and relatives were complimentary about the service and made positive comments about the staff. They were happy with the care and support they received at Peel Moat.

Care plans were personalised and reviewed regularly. Staff were knowledgeable about people’s needs and preferences.

A new activities co-ordinator had been employed at the home. There had been an improvement in the activities available to people and the activities co-ordinator had had a positive impact on the atmosphere at the home.

There was a complaints procedure in place. In the absence of the registered manager people, relatives and staff told us that the deputy manager was approachable and always willing to listen and help.

Managers used a variety of methods to assess and monitor the quality of the service. These included regular audits as well as, staff, relative and resident meetings to seek their views about the service provided.

The service had been working hard to recruit the right staff and reduce the need for agency staff. This included promoting teamwork and confidence of staff through increasing their responsibilities and skills. This had led to a recent positive impact of staff morale at the home.

Peel Moat is a care home with accommodation for up to 31 people who require personal care, some of whom are living with dementia. At the time of the inspection 25 people were living in the service.

The service had 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 provider had breached Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service did not have features to support people living with dementia, such as reminiscence material, items of visual or tactile interest, or dementia-friendly signage.

We have made a recommendation that the service seek advice and guidance about the adaptation, design and decoration of the service.

We found some risk assessments for people who were at risk of choking were not reviewed. This meant we could not be sure those people’s care was appropriate or person-centred as their needs were not properly assessed.

We found that medicines were not being managed safely. Medicine records did not always give clear information for staff to follow. Some medicine administration records (MAR) showed gaps in recording. Temperatures for storing medicines were not always at a safe level.

We found the service did not have risk assessments relating to the building and work practices for staff to refer to.

The provider’s quality assurance process did not pick up shortfalls in medicine audits in relation to the safe storage of medicines. We found the audit document was not fully completed.

Staff training was not up to date. Staff told us and records showed they were not receiving regular supervision. The registered manager advised that only four staff members had received an appraisal in the last year.

People and relatives were complimentary about the service and made positive comments. They were happy with the care and support they received at Peel Moat. One person said, “I’m delighted with the care here. The girls are brilliant.” One relative said, “I’m happy because I know [family member] is safe and well looked after.”

Recruitment practices at the service were thorough and safe. The service obtained necessary checks before employing staff. For example, checks had been made with the disclosure and barring service (DBS) before new staff were employed. This was to confirm whether applicants had a criminal record and were barred from working with vulnerable people.

The registered manager used a dependency tool to ascertain safe staffing levels. They told us, “I also use common sense to increase staffing when activities are on.” There were enough staff employed to make sure people were supported. One person told us, “I have a buzzer, I press it and they come, they are pretty quick.” Another commented, “There is always staff about.”

Staff had an understanding of safeguarding and whistleblowing and told us they would speak to

management if they had any concerns. They felt confident that management would listen and act on any concerns they raised.

Systems were in place for recording and managing safeguarding concerns, accidents and incidents these identified trends or patterns. People and relatives told us they knew how to make a complaint. One person told us, “I would speak to the manager if I was not happy.” We found records to show complaints were responded to in a timely manner.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people are not restricted unnecessarily.

People were supported to maintain their general health and wellbeing. We saw that referrals had been made to healthcare professionals when needed, and people had been assessed by the GP, dietician and speech and language therapist.

Care plans were personalised and reviewed regularly. Changes in need were acknowledged and care plans updated. Relatives felt involved in their family member’s care and were able to speak with staff. For example one relative commented, “They always let me know if [relative] is not well.” Staff were knowledgeable about people’s care. For example, one staff member was able to describe how they supported a person with their nutrition.

People, relatives and staff gave us positive feedback about the registered manager. They told us the registered manager was approachable and always willing to listen and help. One relative told us, “He’s laid back and nice but also efficient. If you want something sorting he’ll do it.”

People had accommodation which allowed privacy. Rooms were furnished in accordance with people’s choices and preferences. The home was clean with communal areas for people to sit and relax.