Moorlands Grange

Moorlands Grange is a residential care home providing personal care for up to 40 people who require short-term or intermediate care. People are supported by a core team of staff and an on-site health care team which includes; pharmacists, physiotherapists, occupational therapist, nurses and other health care professionals. At the time of our inspection there were 28 people using the service.

The service is a purpose-built building and is set out across 2 floors, each divided into 2 units, with adapted facilities. Each unit has a kitchen, lounge and dining area. Each bedroom has an en-suite facility.

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

People’s medicines were at risk of not being administered safely. We found no evidence of harm to people and the provider was working to address staff’s performance around medicines. We have made a recommendation about embedding safe medicines practices.

Risks associated with people’s care were appropriately assessed and staff were aware of said risks. Improvements had been made to records associated with risks to people’s care. We found risk assessments and care plans to be detailed and person-centred.

People told us they felt safe. Staff were trained in and aware of their safeguarding responsibilities. Infection, prevention and control measures were followed to ensure staff protected people from the risk of infection.

Sufficient numbers of staff were available in line with people’s needs. People and relatives mostly spoke positively about the care received from the staff team. One person said, “Yes I feel safe here, the staff are so good.”

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.

Effective quality and governance processes were in place and the registered manager worked proactively to drive service improvement. Any concerns were promptly investigated, and lessons learnt were shared with staff. The service worked with the on-site health care team and other health and social care professionals to ensure people’s care was effective.

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 for this service was requires improvement (published 01 May 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider took action to update their medicines practice. At this inspection we found the provider had taken action to address their medicines practice, but required a further recommendation to ensure newer governance processes were embedded for managing medicines safely.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Why we inspected

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

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 Moorlands Grange on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about embedding newer quality assurance processes to address staff performance in relation to safe medicines management.

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.

The service was clean, hygienic and well maintained. There were cleaning schedules in place which identified high touch areas for enhanced cleaning.

There were robust procedures in place to support visiting and prevent the spread of COVID-19. Testing procedures were in place and appropriate details were obtained from visitors.

Isolation, zoning and cohorting had been effectively implemented at the service to reduce the risk of cross infection. One to one support and activities were in place for people to prevent social isolation.

Personal Protective Equipment (PPE) was being utilised in line with government guidance to keep people safe and prevent the spread of COVID-19.

People’s experience of using this service:

Risk assessments were in place but were not specific to the needs of the individual. They did not consider person specific reduction measures to guide staff to manage the risk of harm.

People told us staff provided a service that made them feel safe, promoted their independence and had a positive impact in their lives. Staff knew how to report potential abuse and to take immediate action to protect people.

Medicines management did not always follow evidence-based practice. We have made a recommendation about the management of some medicines.

Maintenance checks on the environment were robust and the service had an onsite maintenance person to coordinate any response required.

There were enough staff to meet people's needs and keep them safe. Due to the increasing complexity of people’s needs, the provider had identified the need for night staffing levels to increase.

People were supported by staff who received appropriate training and support to carry out their roles and responsibilities. Staff felt supported by the management team.

People received support to eat and drink if this was part of their care plan. Staff knew how to access relevant healthcare professionals, and this was evidenced in people’s care records.

The service worked in partnership with other organisations and healthcare professionals to improve people's outcomes.

People's care and support had been planned in partnership with them, and regularly reviewed to ensure they achieved their goals. 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.

A range of audits and checks were undertaken to help monitor the quality of the service. Some of these needed to be more robust to ensure that the service consistently met CQC standards. Management were keen to make improvements to ensure they improved their service and sought advice to support this aim.

Rating at last inspection: Good (published 3 September 2016)

Why we inspected: This was a scheduled inspection based on the service previous rating.

Enforcement: We found one breach in the regulation. Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

We previously inspected Moorlands Grange on 21 March 2014, at which time the service was compliant with all regulatory standards inspected.

Moorlands Grange is a residential care home in Netherton, Huddersfield, providing accommodation and personal care for up to 40 older people. There were 36 people using the service at the time of our inspection. Moorlands Grange also provides short-term residential care for older people who need support with personal care after being in hospital or have had a change in circumstances whilst appropriate care packages are reviewed and implemented. People using this aspect of the service stay on the ‘Hawthorn Suite’, which is made up of 16 ground floor bedrooms. Moorlands Grange also has 24 bedrooms which are used to provide intermediate care for people who have been assessed as needing additional support before returning home. Most people using this aspect of the service stay on the ‘Oakmoor Suite’ and had access to an externally employed, on-site health care team who provided nursing, physiotherapy and occupational therapy support where required.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

There were sufficient numbers of staff on duty in order to safely meet the needs of people who used the service and to maintain the premises. We observed call bells responded to promptly throughout the inspection. All areas of the building were clean and well maintained, including external areas.

Staff were trained in safeguarding and displayed a good knowledge of safeguarding principles and what they would do should they have any concerns. People who used the service and their relatives expressed confidence in the ability of staff to protect people from harm.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service (DBS) checks, references and identity checks.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE).

Risk assessments took into account people’s individual needs and staff displayed a good knowledge of the risks people faced and how to reduce these risks.

People received the treatment they needed through prompt and regular liaison with nursing, physiotherapy and occupational therapy staff.

Mandatory staff training was regularly updated to ensure staff had a good working knowledge of people’s needs, whilst the Care Certificate modules were used to help refresh staff knowledge.

Staff received regular supervision and appraisal processes as well as regular team meetings.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. Staff displayed a good understanding of capacity and consent and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was homely and welcoming. People who used the service, relatives and external stakeholders told us staff were caring and we observed this in practice.

Detailed care plans were in place and staff had ensured sufficient information about each person was readily accessible and appropriately shared with health care staff to ensure people’s needs were met. Daily records, handover documents and weekly multi-disciplinary team (MDT) meetings were used to ensure staff and partner agencies were aware of changes to people’s needs. We saw regular reviews took place with the involvement of people and their family members.

One-to-one time was offered to people by volunteers and some people were content with the level of activities provision. More could be done however to improve the planning and provision of social and recreational activities for people who used the service.

People who used the service, relatives and external professionals we spoke with had confidence in the staff team and the registered manager. We found the culture to be consistently focussed on ensuring people were supported to regain and maintain their independence as they returned home.

We went back on this inspection to check whether improvements had been made.

On the day of our inspection 39 people were living at the home. We looked at the care records of five people and found they all contained documentation to show each person had given their consent to the care and treatment they received at the home.

We looked at four staff personnel records and saw they all contained evidence to show effective recruitment processes had been followed.

We looked at the rotas in place which showed the staffing levels for a two week period prior to our inspection. We saw staffing at night had been increased. This meant there were four members of staff to care for people at night.

We looked at nutritional charts for people living at the home and saw these were accurate and up to date.