Moorhouse Care Home

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• 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

Risk assessments detailed individual risks known to people and how staff should support people to mitigate these. We observed staff following the risk assessments during our site visits. There were sufficient numbers of suitably trained and experienced staff to meet people’s needs. There was a consistent staffing team who knew people and their needs well, with any use of agency staff being in long term blocks to ensure familiarity. The safety and hygiene of the premises, environment and equipment was maintained by staff. This led to good infection prevention and control practices. Medicine management and administration practices were safe.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives felt the service had improved since our last inspection. One relative said, “There have been significant improvements in many areas including general cleanliness of the property, better food, and most significantly increased numbers of directly employed care staff.” Another relative told us, “The manager clearly understands the need to make all previous and ongoing improvements, and is proactive in that regard, as well as in engaging with family members regarding in our case Mother’s care and well-being.” A further relative said, “All staff that we encounter are friendly, attentive and caring looking out for mum's best interests and pick up any problems quickly and deal with them promptly, advising us along the way of any actions taken.”

Staff echoed the feeling of improvement within the service. A staff member told us, “The home is improving since the new manager started. I feel that staff are better and patient care is improving.” Another staff member said, “A year ago, lots of things were out of stock: chairs, pads, wheelchairs, bedsheets. We used to share wheelchairs among residents but now that is no longer taking place. [Manager] allocated some staff members to deal with it and action has been taken.” The manager was transparent on the issues the service had faced and how they had resolved these. For example, she informed us she had had to move some staff on as she had observed poor moving and handling practice and a lack of engagement with people. There had also been issues with continence pad stock management. The operations manager said, “The incontinence pad issue has been resolved now. That was entirely our fault and we held our hands up.”

Processes were in place to support learning opportunities to improve the service. For example, a complaints policy was in place to ensure concerns raised by people, relatives and staff were addressed appropriately and in a timely manner. People and relatives had fed back in a recent survey that they knew how to raise concerns and that the service would address them to make improvements.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Risks related to people had been identified and they were supported and guided by staff to remain safe, whilst being encouraged in their independence. One relative informed us their loved one was chair and bed bound. Staff were aware of the risk of pressure sores that can occur from periods of not moving and had prevented this from happening by regular repositioning. Another relative told us, “'I would say it is safe. He is checked on every hour during the night. He has an in-house review every month”.

Staff felt confident in managing risks to people through regular communication amongst staff and up to date care plans. One staff member told us, “Everyone’s care plan is up to date. We made sure all referrals were made if necessary. We improved the information given to staff; any falls any deterioration in people, any new guidance. That has improved communication and quality. Any urgent actions are discussed in daily flash meetings.” Another staff member said, “We have a handheld [device]. We read [people’s care plans] from there. Each day we have a quick handover at 3pm to discuss people’s needs.”

Staff followed safe clinical and care practices. For example, one person’s care plan stated they required bed rails due to a risk of falls. We observed these were in place during our onsite assessment. We also observed people receiving their meals in their required modified texture where needed to ensure they could safely swallow their meal.

Care plans were comprehensive and obtained information and guidance for staff around managing individual risks to people. This included health care plans for conditions such as diabetes. There were also daily clinical and non-clinical staff meetings to discuss any individual issues identified during the day and how to resolve these.

People and relatives felt the environment was safe to deliver care in. One person said, “I’m not worried about anything.” One relative told us, “I would say it is safe.” Feedback gathered from people and their relatives in a recent quality survey demonstrated a strong feeling of the environment and equipment being safe and well maintained.

Staff were able to confirm checks that were in place to ensure the environment was safe people. One staff member said, “We do daily environmental checks, such as lights and footpaths. We also check the equipment too, things like hoists, slings and gas.” Staff told us the lift had been out of order for a month in 2022 due to a mechanical fault, but generally the efficiency of equipment in the service was good.

During our onsite assessment we observed the environment was safe. The lift had not been working the day before our assessment but the issue had been resolved.

Regular checks were undertaken on the environment. This included fire equipment checks and fire drills. People living at the service had personal evacuation plans in place. Checks were carried out by external bodies, such as environmental health and the fire services. Equipment was annually serviced and improvements to the environment had been made, such as replacing beds and flooring in some rooms.

People and relatives felt there were enough well trained staff to support people. In relation to staff response to their call bell being pushed, one person said, “They come as quickly as you’d expect them to.” Another person told us, “I like the staff both day and night.” One relative told us, “The staff before [manager] came were not very happy. Now when I come and visit, the staff always greet me and they are much more present with the residents. They engage with them more. Staffing is more consistent than previously, which is beneficial for residents. There does not seem to be the same turnover of staff as there was previously. I have definitely noticed that.” Another relative said “I think that [manager] has put together a great team and is providing an excellent home for the residents. Not to mention a nice environment for those of us visiting.”

Staff echoed this. One staff member said 'We are well-staffed now. Before we relied on agency; now we have our own staff, we hardly have agency.” Another staff member told us, “Sometimes it is busy, but mostly it is OK.” A further staff member said, “I get the right training and supervision.”

Staff were available when people needed them. Staff were available in communal areas and responded promptly when people used their call bells. All staff worked well as a team to ensure people received their meals in good time and had support and encouragement to eat if required. This created a positive mealtime experience for people. Staff engagement with people was proactive and positive, such as engaging people in conversation and asking whether they were comfortable.

Safe recruitment processes were in place. These included ensuring all staff had two references from previous employers, an identity check and a Disclosure and Barring Service (DBS) check.

Relatives felt the service was clean and tidy. One relative told us, “Housekeeping standards have improved dramatically.” Another said, “Mum's room is always clean and fresh and so is she.” A further relative told us they saw housekeeping staff cleaning when they visited and that the home was kept clean and hygienic. They had never had concerns about the cleanliness of communal areas or of their family member's bedroom.

Staff were able to explain to us how they maintained a good level of cleanliness in the service. One staff member explained there is a resident of the day scheme. As part of this, a staff member records whether they had cleaned the person’s room and checked any moving and handling equipment is clean. Staff also confirmed they had received training in infection prevention and control.

There was a slight odour of urine on the ground floor during the morning of our assessment which is when most people were receiving personal care. However, all the areas of the home we observed and the equipment used in people's care was clean and hygienic. This included hoists and adapted bathroom equipment. There were separate labelled disposal facilities for clinical and non-clinical waste.

The clinical lead regularly made visual checks on standards of hygiene in the home and of equipment used in people's care. The clinical lead also advised infection prevention and control areas were audited regularly. We found evidence of this in the audits the manager provided to us for review. The cleaning staff ensured that touch surfaces were cleaned every two hours, that deep cleaning was done, and that the right cleaning products were used. This makes it less likely that an infection will spread to people who are at risk of complications developing.

Relatives felt confident their loved one’s medicines were administered and managed safely. One relative said, “Staff manage [family member's] medicines. I would not have any concerns about that.' A recent survey in which people were able to feedback their care experience had scored highly in the area ‘I am supported with my medication as much as I need to be, and if staff manage my medication, this is done in a safe and competent way.’

Staff also shared this belief. One staff member said, “Medicine are administered safely, and I have had training to do this.” The clinical lead described the nursing element of the service 'dysfunctional when she first arrived in post'. Given this, the clinical lead felt it was the right thing to do to replace the nurses in post and this had led to improvements in this area.

In line with the National Institute of Health and Care Excellence (NICE) guidelines, medicines were stored securely in a lockable cupboard, with only authorised staff having access to this. Medicine Administration Records (MAR) contained sufficient information such as photographs and allergies of each person to ensure safe administration of their medicines. There was guidance in place for staff around ‘when required’ medicines. Medicines were managed by staff who had received the relevant training and who underwent annual assessments of their competency. There were checks of medicines and audits to identify any concerns and address any shortfalls.