The Moors

The Moors is a residential care home providing personal care to 5 younger adults with learning disability and autism at the time of the inspection. The service can support up to 5 people across two adapted buildings. 4 people live in the main house and 1 person lives in an annexe.

The Moors is a family sized house in a residential area, similar in appearance to the other houses in the street.

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

Medicines were not always safely managed. Best practice guidance was not always followed and when people received their medicines 'as and when required' (PRN) the correct PRN protocols were not in place.

Health and safety audits were not always completed in line with best practice guidance. Several health and safety tasks were not completed in line with the provider’s policies.

Personal Emergency Evacuation Plan (PEEP) information was not in place. This meant people were at risk of not being appropriately supported to evacuate the premises in the event of an emergency.

Food hygiene standards were not always sufficiently met. We found several out of date items of food in the fridge.

The provider failed to have enough staff with the right skills deployed to provide people with their commissioned care. This placed people at risk of harm.

The provider had quality control systems in place, however they were not always effective as records were not always correct and audits had not always identified errors in records.

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.

People’s individual risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Risk assessments were completed appropriately, for example around nutrition, equipment, personal care and behaviour.

Lessons were learnt when things went wrong. The provider identified trends and themes when issues occurred and developed strategies to mitigate the risk to people.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

The provider and management team had good links with the local communities within which people lived.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting maximises people’s choice, control and independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 15 January 2020).

Why we inspected

We received concerns in relation to staffing levels, staff training, medicines errors and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, medicines, environment and governance at this inspection.

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

Follow up

The provider supplied us with an action plan to inform us of 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.

The Moors is a small residential home providing care and support for people with a learning disability or autistic spectrum disorder. The provider’s ethos is based on the philosophy of Rudolf Steiner. This focusses on providing support to people with learning disabilities that promotes their ability to continually develop. At the time of inspection, they were providing personal care to four people.

At the time of inspection, the home was divided into two separate living spaces. In one area three people lived and shared communal space such as the lounge, kitchen and bathrooms. The other part of the home had been specially designed for one person to receive support from staff in their own private space comprising of a bedroom, bathroom, kitchen and lounge.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service had a positive ethos and an open culture. The management team were approachable, understood the needs of people, and listened to staff. There was sufficient oversight in place to ensure people received a good service that met their needs and any improvements identified were made promptly.

Sufficient staff were available to meet people's needs. Improvements had recently been made to the deployment of staff, to ensure sufficient staff were employed to meet people's needs without staff working excessive hours. New staff had been recruited and were in their induction period at the time of inspection.

People were cared for safely and received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

Staff were appropriately recruited and had access to the support and supervision they required to work effectively in their roles. Staff had mostly received the training they needed to meet people’s needs. People told us staff were well trained.

Staff were friendly, caring and passionate about their work; they treated people with respect and maintained their dignity.

Information was provided to people in an accessible format to enable them to make decisions about their care and support. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

There was no end of life care being delivered at the time of the inspection. People were given the opportunity to discuss their wishes for the end of their life.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 27 November 2018, and this is the first inspection.

Why we inspected

This was a planned inspection.