We carried out a review of the data available to us about Moreland House Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Moreland House Care Home, you can give feedback on this service.
Moreland House is a residential care home providing personal and nursing care to older people. The service is an adapted building with facilities over three floors, with rooms including en-suite bathrooms. The service was registered to provide support to up to 50 people and there were 48 people using the service at the time of our inspection.
People’s experience of using this service and what we found
People were protected from abuse as the provider had robust procedures and processes in place and staff had received training in this area. Risk assessments were in place which included information about how to manage and reduce risks to ensure people’s safety. The provider had a safe recruitment and selection processes in place. There were enough staff on duty to care for people. People’s medicines were managed safely. The provider had systems to ensure people, staff and visitors were safe regarding the spread of infection. There was a system in place to record and monitor accidents and incidents.
There were quality assurance and governance systems in place to drive continuous improvement. The provider sought feedback from people who used the service and their relatives about the service. Regular audits and checks were undertaken to ensure the service was run well. The management team worked with a number of health and social care professionals and this helped to ensure people’s needs were fully met.
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 03 April 2020).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Moreland House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
At the time of our inspection, pandemic lockdown measures were being lessened and national guidance advised reinstating visits to people living at residential services. Moreland House had recently started permitting visits to people in their own room. Visitors could also meet people at the service via a specially created social distanced visiting pod, where infection transmission risk was lessened as people and visitors were separated via a window. All visitors attended the service through reception where there was ample signage around keeping people safe through the use of Personal Protective Equipment (PPE), washing hands and social distancing. Visitors' temperatures were checked upon entry and those entering the service were supported with Lateral Flow Tests (LFT) or rapid testing and putting on and taking off PPE. People at the service were also supported to use video calls to people outside the service. All visits and calls were pre-booked. Visitors and people outside the service were provided instructions around visit protocols and service policy. At the present time only one person per family was permitted enter the service as per national guidance. Visitors were not permitted to meet or see any other residents so as to lessen the risk of infection.
All staff wore appropriate PPE and had been trained how to put it on and take it off correctly. There was ample supply of PPE and the provider told us there was no issues with supply presently. We saw staff were continually reminded about the importance of good infection prevention and control. We also saw management and discussed the recent changes to visiting with staff so they knew what to expect and how best to work with people around this. Similarly, staff had been trained how to use LFT, so they could support people and visitors with this. All staff were tested weekly, and residents monthly, as per national guidance. If people presented with symptoms they were tested, isolated and barrier nursed to lessen the risk of infection to others at the service. Staff wore visors where required to support people who might be anxious or had difficulty working with staff wearing masks.
The service was a designated setting scheme, which is where people who have had tested positive for COVID-19 are discharged from hospital to recover in isolation before returning home or to care settings. This scheme supports the freeing up of hospital beds to further support the national effort to combat the pandemic. At the time of the inspection the designated setting was not in use. We saw the measures in place to ensure infection transmission was lessened through isolation, zoning and cohorting of staff. We have signposted the provider around providing information to agency staff before coming to work at the service; so as to ensure they have a better understanding of work practices before working at the service.
The were procedures in place to support new admissions to the service. Both COVID-19 positive admissions to the designated setting and COVID-19 negative admission to the service were tested and isolated from others as per national guidance. Enhanced cleaning was in place to support admissions and visits, with access routes cleaned after admissions and rooms cleaned following visits. We found the service in a clean and hygienic state during inspection. Infection control audits were completed regularly to ensure measures in place to prevent infection were being effectively followed by staff.
We found the following examples of good practice.
Where visiting was permitted, this was done safely. Routine visiting had been suspended at the time of our inspection, to reduce the risk of the spread of COVID-19. However, exceptions had been made for some healthcare professionals and for relatives visiting people at end of life. Reception staff checked visitors’ temperatures and recorded their contact details should they need to be contacted. Staffs’ temperatures were also monitored.
Signs were displayed at the entrance to the premises and throughout the building, requesting people be mindful of infection transmission, reminding people to socially distance from one another and to comply with government guidance to wear the correct personal protective equipment (PPE). The provider had ensured an ample supply of PPE for visitors and staff to use. Hand sanitiser was readily available around the building and signs were displayed to remind people to wash their hands. Instructions for putting on and taking off PPE were provided in the bathrooms where staff and visitors did this. Staff had received training on the correct use of PPE and we observed staff wearing it appropriately during our inspection.
The provider routinely tested people and staff for COVID-19. Staff had access to rapid response lateral flow tests (LFT) as well as standard Polymerase Chain Reaction (PCR) tests, to test visitors, once routine visiting resumed. The provider was in the process of having a bespoke pod built in the garden. to provide a safe environment for visiting friends and relatives. Staff supported people to communicate with relatives through video conferencing applications on portable tablets or by telephone.
New admissions to the service were supported in line with best practice guidance. Admissions were expected to provide recent COVID-19 test results, were further tested by the service following admission and isolated upon arrival to minimise risk of potential infection to existing residents.
Staff had access to face shields, for use when supporting people living with dementia. This allowed people to see staffs’ faces which enhanced communication and lessened anxiety. The provider had a proven record of managing a COVID-19 outbreak in the home and had put robust procedures in place to ensure people received safe care.
The risk of infection transmission was minimised through enhanced cleaning schedules and regular infection control and prevention auditing.
The provider had made adaptations to the building to act as a designated care setting. A designated care setting provides temporary accommodation for people discharged from hospital who have a COVID-19 positive status. We were assured this service operated good infection prevention and control process.
Moreland House is a residential care home providing personal care to older people. The home is an adapted three floor building with facilities, including en-suite bathrooms. The service was registered to provide support to up to 50 people and there were 30 people using the service at the time of our inspection.
People’s experience of using this service and what we found
People were protected from the risks associated with the spread of infection. They received care and support in accordance with their preferences, interests and diverse needs. Care plans contained information about people's needs and were reviewed to ensure people received the care and support they needed. Staff encouraged people to take part in activities of their choice and this helped to ensure they were not socially isolated. The provider had policies and procedures for dealing with any concerns or complaints.
The manager operated an open and inclusive culture where people, relatives, staff and other professionals were encouraged to help improve the service provided to people. Staff had access to a range of policies and procedures and this helped them to carry out their role. The manager worked in partnership with other organisations to support and care for people.
Rating at last inspection and update
The last rating was requires improvement (published 3 April 2020) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Responsive and Well-led. We also looked at infection prevention and control measures and this is reported in the safe section. 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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Moreland House Care Home 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. If we receive any concerning information we may inspect sooner.
Moreland House Care Home is a residential care home providing personal and nursing care to people.
The service can support up to 50 people. At the time of our inspection there were 43 people living there. The service is purpose built and care is provided to people on the upper three floors.
People’s experience of using this service and what we found
Care plans were not always person-centred, and people were at risk of social isolation and did not engage in meaningful or relevant activities. There were systems in place to make sure people received their medicines safely. We recommended the service ensure PRN protocols are consistent. The service was purpose built but not always adapted with people’s needs in mind. We recommended the service considers the design and adaptation for people living with dementia or other sensory and communication related support needs.
Systems were in place to keep people safe from harm and risk assessments were designed to keep people safe. Recruitment practices were safe, and people received consistent care in a timely manner. The service was clean and well maintained. Accidents and incidents were analysed to prevent reoccurrence and keep people safe from harm.
Staff were supported through training and supervisions to provide effective care and support. People were supported to have their nutritional needs met and the service worked well with other health and social care professionals to provide holistic care and support and keep people well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People told us they found staff were kind and caring and they were involved in their care and support. People felt they were encouraged to be as independent as possible and treated with respect and dignity.
Information was provided to people in an accessible format. People and relatives told us they felt able to make a complaint and were confident that complaints would be listened to and acted on. The service was good quality end of life care for people and their views and wishes had been considered.
People, relatives and staff spoke positively about the service and said it was managed well by the deputy manager who was applying to be the registered manager. There were systems in place to manage and monitor the quality of the service provided and the provider planned to audit the provisions and monitoring of activities for people. The management team had regular contact with people using the service, their relatives and the staff. The deputy manager liaised with other health and social care professionals to ensure a high-quality service was being delivered.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating was requires improvement (published 21 August 2019) and there were three breaches of regulation. 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/ sustained, and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about end of life care; allegations of abuse and the management of falls. 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 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Moreland House Care Home on our website at www.cqc.org.uk.
Enforcement
We have identified a breach in relation to person centred care.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
Moreland House Care Home is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 50 people. The service is purpose built and care is provided to people on the upper three floors.
People’s experience of using this service and what we found
The service was not always safe because medicines were not stored securely, records indicated people did not always receive enough fluids and pressure relieving mattresses were set incorrectly. Staff did not always undertake all required training. The service had failed to notify the Care Quality Commission when a Deprivation of Liberty Safeguard (DoLS) authorisation was in place for a person and quality assurance systems had failed to identify and address shortfalls within the service.
Systems were in place to protect people from the risk of abuse. There were enough staff working at the service and checks were carried out on prospective staff. Measures were in place to reduce the risk of the spread of infection. Steps were taken to learn lessons if things went wrong.
Assessments were carried out of people’s needs before they started using the service. Staff received regular one to one supervision. People had enough to eat and drink and told us they enjoyed the food. The service worked with other agencies to help meet people’s health care needs. 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.
People told us they were treated well by staff. Staff understood how to support people in a way that promoted their dignity, privacy and independence. The service sought to meet people’s needs in relation to equality and diversity.
Care plans were in place which set out how to meet people’s needs. People and their relatives were involved in developing these plans. People had access to a range of social activities and we saw people enjoying these on the day of our inspection. Complaints procedures were in place and records showed complaints were handled in line with the procedures.
Staff spoke positively about the leadership group and said there was a good working atmosphere. The service had links with other agencies to help develop best practice. Systems were in place for seeking the views of people who used the service and their relatives.
Rating at last inspection
The last rating for this service was good (published 12 October 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to medicines and unsafe care, staff training, quality assurance and monitoring processes and notifications of DoLS authorisations.
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 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.
Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 45 people were using the service.
The service had a registered manager. 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 and associated Regulations about how the service is run.
At the last inspection on 7and 8 September 2016, we found one breach of the Health and Social Care Act 2014. Medicines were not safely managed and we asked the provider to take action to make improvements to ensure that people who received their medicines without their knowing (covertly) or who had their medicines crushed were appropriately managed. The provider sent us an action plan detailing the action they were taking to meet these requirements. At this inspection we found that the actions had been completed and that people who received their medicines without their knowing (covertly) or who had their medicines crushed were now appropriately managed. People received their medicines safely.
Staff knew people and their needs well but some care plans were not sufficiently detailed or person centred. This was an area of ongoing development.
An activities worker was employed and social and recreational activities and events were available.
Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.
Staff received the training and support they needed to carry out their duties. They provided people with the support they needed and wanted.
People were supported to receive the healthcare that they needed. They told us they felt safe at Moreland House and were supported by kind and caring staff.
We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.
The provider’s recruitment process ensured staff were suitable to work with people who needed support.
Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.
Complaints were taken seriously and action was taken to address any concerns.
Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People’s nutritional needs were met and if there were concerns about their eating, drinking or their weight, this was discussed with the GP. Support and advice were sought from the relevant healthcare professional, for example, a dietitian.
Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.
The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided.
Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 47 people were using the service.
The service did not have a registered manager. 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 and associated Regulations about how the service is run.The current manager was in the process of registering with CQC.
At the last inspection on 23 and 24 September 2015 we asked the provider to take action to make improvements with regard to medicines storage and recording, taking action when possible abuse had occurred and dealing with emergencies. The provider sent us an action plan detailing the action they were taking to meet these requirements. At this inspection we found that the actions had been completed.
The arrangements for administering medicines were not always safe. People who received their medicines without their knowledge (covertly) were not managed safely. However, the issues found at the previous inspection had now been addressed.
Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.
Staff received the training and support they needed to carry out their duties and to provide people with the support they needed and wanted.
People were supported to receive the healthcare that they needed. They told us they felt safe at Moreland House and were supported by kind and caring staff.
We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.
The provider’s recruitment process ensured staff were suitable to work with people who need support.
Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs. We have recommended that the floor cleaning system be reviewed to ensure that people are not placed at risk of falls due to wet floors. We have also recommended that further consideration be given to make the internal environment more dementia friendly.
Complaints were taken seriously and concerns addressed but some people were not aware of how to complain or whom to complain to. We have recommended that action be taken to remedy this.
Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People told us that the food was good and that they could have a drink when they wanted. People’s nutritional needs were met and if there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.
We have recommended that lunchtime arrangements and support be reviewed to ensure that people have a more pleasurable meal time experience at a pace that suits them.
Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.
An activities worker was employed and social and recreational activities and events were available. People told us that they particularly enjoyed the exercise activity.
People’s care plans were being reviewed and updated to ensure that they were clear and sufficiently detailed to enable staff to support them safely and effectively.
The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
This inspection took place on 23 and 24 September 2015 and was unannounced on 23 September 2015.
Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 26 people were using the service. This was because in December 2014, when building work had been completed, Moreland House changed its registration from a 20 bed home providing personal care and accommodation for older people to a 50 bed home providing nursing and personal care or older people. The provider limited admissions to the service during the transition period.
We found that the arrangements for administering medicines were not always safe. Medicines records were not always accurate and we could not be confident that people received all of their prescribed medicines safely.
The systems in place to safeguard people from abuse and improper treatment were not effectively implemented.
People were supported to receive the healthcare that they needed. A healthcare professional told us, “From a medical point of view they are getting good support.”
People told us they felt safe at Moreland House and that they were supported by kind, caring staff. One person said, “Girls are marvellous. Make sure we’re safe.”
We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs and provided care in a respectful way.
The provider’s recruitment process ensured that staff were suitable to work with people who need support.
Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.
Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People told us that the food was good and that they had a choice of food and drinks. We saw that people’s nutritional needs were met. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.
Staff received the training they needed to meet people’s overall needs. However they were not clear as to the action to take in the event of a person choking.
Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.
The arrangements to meet people's social and recreational needs were limited. However this had been recognised by the provider and an activities worker had been recruited.
People’s care plans were being reviewed and updated to ensure that they contained all of the necessary information to enable staff to support them safely and effectively.
The service did not have registered manager but appropriate interim arrangements were in place. The service had not been consistently well managed but people were positive about the changes and improvements that were now taking place.
The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided. However we recommend that the provider monitoring reports clearly indicate any action required along with timescales for completion. Also that subsequent visits check and report on the progress made to complete the actions.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
There were systems in place in place for obtaining informed consent from people who use the service. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. A relative of a person told us, "my father's care plan is reviewed quarterly and they ask for my feedback and I sign it."
We saw that all areas, including bedrooms and communal areas, were clean. No odours were evident. Staff had access to, and we saw they used personal protective equipment such as gloves, alcohol gel for cleaning hands and disposable plastic aprons. One person told us, "always clean here. The staff wear protective clothing."
We found that the provider had taken action to ensure all staff received regular supervision and ensuring training needs were identified since our last inspection. The provider had addressed the concerns we raised at the previous inspection.
People using the service said they could talk to staff or the manager if they had any concerns or complaints. They also felt confident that staff members would resolve their problem. One person told us, "I would go to the office and complain. They would deal with it."
People felt that they were treated with dignity and respect. A relative commented 'staff are respectful and kind to her.' We saw that staff maintained people's dignity. For example by discreetly asking them if they wanted to use the toilet. We also saw that staff asked people what they wanted or liked. They offered choices of drinks at lunch time and asked people if they wanted something to protect their clothing whilst they were eating.
Although staff received training to carry out their duties and to support people who used the service there was not a consistent or organised approach for identifying staff training needs and ensuring that staff attended training. We also found that staff were not receiving regular supervision or feedback about their work practice. This limited their opportunity to discuss work practice and issues relating to the operation and development of the service.
The manager and the provider monitored the quality of the service via visits and audits. People who used the service and their relatives were asked for their opinions about the service provided. Action was taken to address any issues that were identified.