Archived: The Moat House

Updated 3 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The team consisted of two inspectors, two assistant inspectors and a specialist advisor who was a nurse, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 12 people who used the service, six relatives and one GP who regularly visits the service about their experience of the care provided. We spoke with representatives of the provider, which included the assistant director and the area quality director. We also spoke with an interim manager, deputy and clinical managers, as well as six agency staff, 13 permanent staff including seniors, care assistants, an activities coordinator and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included 18 people’s care records and multiple medication records. We looked at five staff files and agency records in relation to recruitment and staff supervision and a variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 3 December 2019

About the service

The Moat House is a residential and nursing home registered to provide accommodation for up to 72 people in one adapted building, comprising of five suites known as Willow, Oak, Aspen, Maple and Thistle.

People residing in Willow require support to manage their dementia and nursing needs. Oak provides nursing care. Aspen accommodates people living with dementia. Maple is the residential unit and Thistle is currently closed. At the time of our inspection, there were 41 people using the service.

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

Changes within the provider’s management team, and frequent changes of manager at The Moat House have led to a lack of leadership, management and oversight of the service. This, combined with high use of agency staff, has impacted on the quality of the service provided and has resulted in a failure to identify, assess and manage risks to the health, safety and welfare of people using the service.

At this inspection there was no registered manager in post. The last of a succession of registered managers cancelled their registration with us, the Commission on 10 September 2019. Since that date, there have been two interim managers, one being the providers area quality director. A new manager has been appointed and due to commence employment at the end of October 2019. People, their relatives and staff told us this has impacted on the culture in the service and the quality of the care people have received. Staff did not feel valued and did not have a clear understanding of what was expected of them.

The providers governance framework and home improvement plan had identified where improvements were needed, but the lack of management oversight has failed to drive the required improvements. Safety concerns and risks to people, such as security of the premises, unidentified bruising and choking were not consistently identified or addressed quickly enough to keep people safe. People were at risk of harm because staff did not order, store and administer medicines safely, or follow current national guidance and standards in relation to infection control.

Safeguarding policies and procedures were not fully imbedded into practice. Staff were not clear of safeguarding and whistle blowing process, when and how to raise concerns and are wary of doing so, which meant there were times when people’s safety had not been protected.

The workforce in the service has been made up almost entirely of agency staff. Whilst some agency had worked at the service on a consistent basis, a high proportion had not. This inconsistency in staff who are unfamiliar with people’s needs had placed people at risk of harm. Staff recruitment checks, including agency needed to improve to ensure employees were safe to work with people using the service.

Staff had received training to give them the skills, knowledge and experience to carry out their roles, however not all training was up to date. People who ate little and often were not routinely offered snacks or being prompted to eat and drink. There were no visual aids, to help people living with dementia to choose and remember what they had ordered for their meals.

The facilities and premises were not designed to enhance the wellbeing of people living with dementia. The environment needed maintenance throughout, carpets were stained, and doors and woodwork were chipped.

Staff interactions were kind and caring. However, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans were not always up to date where changes in people’s care, support and treatment had been made. Where people had known behavioural issues, there was minimal guidance for staff on how to support them at times of agitation and distress. The requirements of the Accessible Information Standards were not being met. There was minimal information available to support the communication needs of people with a disability or sensory loss.

Incidents where people had complained about staff actions or been party to verbal aggression by staff have not been addressed in a timely manner. There was little recognition for people wishes and preferred priorities at the end of their life. No end of life care plans was in place to guide staff on how to provide care to a person who was at the end stages of their life.

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 January 2019) and there was a breach of regulation, good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of the regulations.

The service is rated inadequate. At the last two consecutive inspections, this service has been rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about a lack of safeguards being raised by the service in relation to falls, unexplained bruising, weight loss, poor recording and high use of agency staff. A decision was made for us to inspect and examine those risks.

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

You can see what action we have asked the provider to take at the end of this full report. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The provider sent us an updated service improvement plan on 30 October 2019 outlining how they intend to address the concerns we have raised at this inspection. Immediate action had been taken to make the premises safe and protect people at risk of choking.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment, meeting people’s nutritional needs and good governance.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.