Morven House

Morven House is a residential care home providing personal care to up to 40 people. The service provides support to older people requiring residential support. The service does not provide nursing care. At the time of our inspection there were 26 people using the service.

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

People were not always protected by the provider’s planning and safety checks. The service had not updated its fire evacuation plan as directed by fire services and failed to deploy enough staff over night to be able to implement the evacuation plans in place. Daily health and safety checks failed to detect hazards we found which included risks of tripping and falling from height.

People’s individual risk assessments did not always contain enough information to support staff to mitigate risks. Checks were not made of the temperatures at which medicines were stored and we found the temperatures on both medicines’ trollies exceeded permitted levels.

The service did not have a registered manager in post. The new manager had been in post for only 2 weeks at the time of our inspection. People, relatives and staff expressed confidence in the new manager and noted a number of improvements they had made already.

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.

The care home was clean. Staff followed an enhanced cleaning programme and wore appropriate personal protective equipment to reduce people’s risks and spread of infection. Food was stored and prepared safely, and good hygiene practices were followed in the laundering of clothing and bedding.

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 requires improvement (published 12 May 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted in part due to concerns received about fire safety, staffing, medicines and the management at the service. 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 and well-led sections of this full report. The provider has taken action to mitigate the risks we found.

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

Enforcement

We have identified breaches in relation to people’s safe care and treatment and the provider’s leadership of the service.

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 have requested further action plans from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Morven House is a residential care home providing personal care to up to 40 people. The service provides support to older people requiring residential support. The service does not provide nursing care. At the time of our inspection there were 17 people using the service.

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

People felt safe at the service and around staff. Staff were knowledgeable in safeguarding adults’ procedures and any concerns were reported. Risk assessments had been reviewed and staff knew how to support people safely. However, we found that some environmental risks remained, including in relation to fire safety. The director and manager were aware of these risks and had arranged for work to be undertaken to address these risks, but these had not been completed by the time of our inspection.

There were sufficient numbers of staff at the service. Since our last inspection in June 2021 there was a new staff team. There was good team working with high morale. There was less reliance on agency staff. Staff had completed the provider’s mandatory training and continued to complete training courses to ensure they had the knowledge and skills to meet people’s needs.

People’s needs had been assessed and continued to be assessed to ensure Morven house was the right place for people to live and staff were able to support people to achieve good outcomes. People were treated well and with dignity and respect. Staff supported people to access healthcare services and they were regularly visited by healthcare professionals. Staff understood and supported people with their nutritional needs. Safe medicines management practices were in place.

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. Where people did not have the capacity to make certain decisions, staff ensured this was done in their best interests and in liaison with their relatives. Staff also organised for advocacy services to visit people.

A new manager had been appointed since our last inspection who had a commitment to continuous improvement. They had reinitiated systems to obtain people’s, relative’s and staff’s views and ensure they felt involved in service delivery and development. Staff felt supported by the manager and supported the changes they had implemented. The manager had introduced a programme of audits to regularly review the quality of service delivery and where improvements were required, these were actioned.

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 requires improvement (published 2 August 2021).

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 many of the regulations we identified at our previous inspection, however the provider remained in breach of regulation 12.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to check they 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 Safe, Effective and Well-led which contain those requirements.

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 remains requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified a continued breach of regulation relating to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Morven House is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

People told us they did not feel safe at the service and we could not be assured that people were protected from the risk of abuse. There were insufficient staff on duty to meet people’s needs and this impacted on the quality of service people received. People were not protected from risks to their health and safety and a clean, hygienic environment was not provided. Comprehensive risk assessments were not in place and people were not protected from all environmental risks. People were not protected from the risk of infection and were not adequately supported to maintain good personal hygiene. The staff were not consistently following current government guidance regarding protecting people from the COVID-19 virus. Safe medicines management practices were not being followed.

People’s needs had not been adequately assessed to enable staff to provide the level of care and support they required. We could not be assured that people had timely access to other healthcare professionals to ensure all of their needs were being met. People’s dignity was not always maintained and people were not always treated with respect. Staff were not up to date with their mandatory training and staff were not being adequately supported through regular supervision. An appropriate, well maintained environment was not provided.

There were ineffective systems in place to review and improve the quality of the service. Audits were undertaken but these had not been completed correctly and in the manner they were intended. They had not identified the concerns we found during inspection and were not being used to ensure the service was provided in line with best practice guidance. There were not appropriate systems in place to ensure peoples, relatives and staff views and opinions were gathered and used to ensure continuous improvement of service delivery. There was a lack of clarity of staff’s roles and responsibilities, and who took accountability for certain aspects of service delivery. This was causing tension within the staff team and there was not a cohesive team approach to service delivery, impacting on the outcomes people experienced.

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 did have access to a balanced diet which met their nutritional needs and any specific dietary requirements. People were able to get support from their GP and the district nursing service.

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 (report published 31 January 2020)

Why we inspected

We received concerns in relation to staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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 Morven House 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 person-centred care, safe care and treatment, dignity and respect, safeguarding, premises, good governance and staffing at this inspection.

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 meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. 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 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.

Morven House is a residential care home providing personal care for up to 40 older people who are living with dementia. Some people use the service for respite care breaks. Accommodation is arranged over three floors and there is passenger lift access. There were 28 people using the service at the time of our inspection.

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

People told us they felt safe and happy. There were positive and caring relationships between staff and people, and this extended to relatives and other visitors.

People needs were fully assessed before moving to the home so the provider knew whether they could meet the person's needs. Care plans were individual and representative of people’s needs, preferences, values and beliefs. Risks to people’s health and wellbeing were assessed and reviewed when needed.

Staff knew how to recognise and report any concerns they had about people’s welfare and how to protect them from abuse. The registered manager responded appropriately to any allegations of abuse and worked in partnership with the local authority and other agencies to keep people safe.

There were enough staff, day and night, to support people’s needs. The provider recruited staff safely to ensure they were suitable for their role. Staff continued to receive ongoing training and support to keep their knowledge, skills and practice up to date.

Morven House was clean, tidy and staff carried out health and safety checks to make sure people lived in a safe environment. People had the equipment they needed to meet their assessed needs.

People were supported to maintain good health and to eat and drink well. Staff involved other professionals when people became unwell or required additional services. People received their medicines when they should. The provider followed safe practice for the management of medicines.

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's diversity was respected and embraced. Staff were respectful and open to all cultures, faiths and beliefs and people's individuality. People's end of life preferences and wishes had been considered and these were supported.

People enjoyed a wide variety of group and one to one activity that also considered the needs of people living with dementia. Staff took time to find out about people's individual hobbies and interests and arranged meaningful activities. Staff understood the importance of social interaction and ensured they offered people support and companionship when needed.

People knew how to raise a concern or make a complaint and felt confident this would be dealt with appropriately. People and their families were regularly asked for their feedback and this was used to determine what the home was doing well and what could be improved.

There was an open and inclusive atmosphere in the service and the registered manager showed effective leadership. Established quality assurance systems and processes enabled the registered manager to quickly identify any areas for further improvement.

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 (11 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Morven House is registered to provide residential care for up to 40 older people who are living with dementia. Some people use the service for respite care breaks. Accommodation is arranged over three floors and there is passenger lift access. There were 22 people using the service at the time of our inspection.

At our comprehensive inspection in February 2015, we found the provider was not meeting a number of regulations. We therefore asked the provider to take action in relation to staff training and support, providing safe care for people at risk of pressure ulcers, person centred care and good governance. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations. At our next inspection in November 2015 we found improvements although we identified a continued breach in relation to good governance and a new breach in respect of medicines management. We also asked the provider to review people’s mental capacity assessments as they did not fully meet the principles of the Mental Capacity Act. We took enforcement action and issued a warning notice for the continued breach. When we checked for compliance with this notice on 12 July 2016, the provider had taken the required action.

The aim of this inspection was to carry out a comprehensive review of the service and to follow-up on the requirement action made in relation to the management of medicines. At this inspection we found the provider had followed their action plan and improvements had been made.

The manager in post at the time of our previous inspection left employment shortly afterwards and a new manager was appointed in November 2016. The new manager had begun the process of applying for registration. 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 2008 and associated Regulations about how the service is run.

Improved arrangements were in place for the recording, safe keeping and administration of medicines. New audit systems had been introduced and regular checks were being carried out. People received their medicines as prescribed and when needed.

At this inspection we found improvements in care planning. Care plans were up to date and reflected people’s needs. Individual health, care and support needs were assessed and reviewed in a timely manner. Referrals were made to other professionals as necessary to help keep people safe and well.

People felt safe and the staff took action to assess and minimise risks to people’s health and well-being. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. The service responded appropriately to allegations or suspicions of abuse.

People’s rights were protected because staff were aware of their responsibilities under the Mental Capacity Act 2005. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Conditions on authorisations to deprive a person of their liberty were being met.

Appropriate recruitment checks were followed to make sure staff were suitable to work at the home. Staff received an induction and essential training at the beginning of their employment. This was followed by ongoing refresher training to update and develop their knowledge and skills.

At the time of our inspection there were enough staff to meet people’s needs and keep them safe. Management were aware that staffing levels would need review should the number of people using the service increase. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff maintained people’s privacy and dignity at all times and treated individuals with respect and courtesy.

More activities were provided for people that met their needs and choices. The home had employed an activity coordinator who supported people to take part in activities either individually or in groups.

Morven House had undergone refurbishment and redecoration and further home improvements were taking place at the time of this inspection. We found that areas within the home could be decorated and equipped more suitably for people living with dementia. We have made a recommendation about improving the environment to provide more engagement and stimulation.

People and their relatives were comfortable to raise any issues and felt they were listened to. The provider had a complaints procedure to support this.

Management had oversight of how the home was performing and was aware of its strengths and weaknesses. Arrangements to assess and monitor the quality of the service had been strengthened and included feedback from people, their relatives and staff. The new manager knew what was required to develop the service and was working to an action plan. This showed us there was an upward trend towards improvement in the service.

The provider worked in partnership with other agencies and professionals to support care provision and service development. Management had been working with the local authority safeguarding team and commissioners to improve standards. This helped ensure that lessons were learnt and similar incidents were less likely to happen again.

Morven House provides residential care for a maximum of 20 people who may be living with dementia.

The service had recruited a new manager who was in the process of registering with CQC. 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 2008 and associated Regulations about how the service is run.

At our previous inspections in February and November 2015 we found the service was not well-led because the provider did not effectively assess and monitor services provided to people to identify where improvements were needed. We found existing audit systems were ineffective and inaccurate.

At this inspection, we found the service had made improvements through the introduction of a wide ranging system of checks, reviews and audits to improve service provision. We will be carrying out a further inspection to address other breaches and concerns identified in our previous inspection in November 2015.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspections, looking at records and speaking with people using the service, their relatives, and members of staff.

Please read the full report for evidence that supports our summary.

Is the service safe?

We found the provider had not ensured that people using the service were in safe, accessible surroundings that promoted their wellbeing. The building of a large extension to improve the facilities for people using the service had significantly overrun its completion date. As a result, the existing building had not been redecorated or refurbished for some time. There were large, plywood panels reinforcing decorative ceilings, there was no outside space that people using the service could access and the condition of the driveway had deteriorated.

We were initially concerned about certain issues in relation to the building works that we passed on to another regulatory body, which were promptly addressed by the provider and builders. The considerations of that regulatory body have delayed the publication of our report.

Although the extension was scheduled for completion in the next few months building work has been ongoing for 18 months. We have issued the provider with a compliance action for failing to ensure that people who use the service, staff and visitors were protected against the risks associated with unsafe or unsuitable premises. .

We looked at a random selection of care plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We found that care plans were regularly reviewed and up to date which supported staff to deliver safe and appropriate care.

The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that there were policies, procedures and training in place in relation to DoLS. The policy and procedures did not reflect recent changes brought about by a judgement at the Supreme Court in March 2014. It was our opinion that a number of people at the home required DoLS applications as a result of the Supreme Court ruling and we asked the manager to ensure that reviews took place to identify anybody falling into the new guidance.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We were told that an assessment of people's needs was carried before people came to the home and where possible they were invited to spend some time there before moving in.

Staff received appropriate professional development. We were provided with information and records to show that staff received regular training and supervision meetings. Members of staff treated people with respect and dignity. One person told us, 'I find it very good, very caring and friendly.' Another person told us, 'The manager and the staff are very helpful. I just turn up whenever I want to and always feel welcome.'

One member of staff was the activities coordinator for two afternoons a week. At other times staff were expected to fulfil the activities timetable and interact with people using the service.

Is the service caring?

We saw that there were regular interactions between staff and people using the service that were positive and friendly. People and staff referred to each other on first name terms. Care was delivered in a kind and caring manner.

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. We saw that care plans were person centred and recorded how people preferred their care and treatment to be delivered.

We saw that there were yearly surveys for people using the service. We were told by people using the service and visitors that if they had any issues or concerns they would inform the manger or a member of staff.

Is the service well led?

We spoke with people using the service, visitors and members of staff who told us that the manager operated an 'open door' policy and was approachable. The manager was appropriately qualified and experienced. There were efective systems in place to assess and monitor service provision.