The Moorings

We found the following examples of good practice.

People, staff and visitors were protected from risks of infection by robust policies and procedures. Visitors completed a health questionnaire, had their temperature recorded and were asked to complete a rapid COVID-19 test, which provided a positive or negative test result within 30 minutes.

The home was visibly clean and hygienic. Staff used cleaning products known to be effective with COVID-19. Cleaning schedules included frequently touched surfaces such as handrails, light switches and door handles. Regular cleaning audits were conducted to ensure safety standards were maintained.

The home had a plentiful supply of Personal Protective Equipment (PPE). Staff were observed wearing this correctly and senior staff monitored this. Staff had received internal training in how to put on and take off PPE. This helped ensure a consistent approach and government guidelines were followed.

The home had supported people and staff to participate in the government’s COVID-19 testing and vaccination programme. Consent had been sought appropriately when required.

People and staff were encouraged to socially distance within the home. The interior layout and staff practice supported this. Only one staff member was allowed in the staff room at any one time and a one-way system had been introduced in the testing room. This helped reduce the risk of cross infection.

The home recognised the importance of supporting people’s mental wellbeing. For example, staff had created a social story for a person experiencing bereavement and wanting to attend the funeral safely. A social story explains a particular situation, event or activity, which includes specific information about what to expect in that situation.

The Moorings is a residential care home providing personal care to five people at the time of the inspection. The service can support up to six people.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

There was a very relaxed and welcoming atmosphere where people were supported by staff who were exceptionally kind and caring. Feedback about the compassionate and caring approach of staff was overwhelmingly positive. People were treated with dignity and respect in a way that truly valued them as individuals.

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 were placed at the centre of the service and were genuinely involved in relation to all decisions about their care and the service. The service had a proven track record of providing exceptionally responsive personalised care and support. There were also significant improvements in the outcomes for people that had enhanced their well-being and lives.

There was a person centred culture that was driven by a motivated and committed staff team. They constantly looked for ways to improve the service and ensure people received the outstanding care they deserved. This motivation resulted in a whole team who were totally supportive and committed to providing high quality, individualised care. The staff team told us they were truly valued and respected. They were highly skilled, motivated and knowledgeable.

The service was exceptional at helping people achieve positive outcomes, building confidence,

independence and helping develop people's life skills. There was an excellent range of activities and opportunities available to people. People had also been introduced to new activities which for those people were a significant achievement.

The service had provided exceptional and compassionate end of life care and took into consideration the needs of people who lived at The Moorings, staff and relatives.

The service was well-led. Since the last inspection, the registered and deputy manager had made many positive changes. The leadership and management were of high quality and there was an extremely committed and passionate staff team. The registered manager and staff team had a strong ethos and culture of delivering quality personalised care and support to people. Their systems to monitor, manage and improve service delivery and to improve the care and support provided to people were effective. Staff reported the strong commitment of the registered and deputy manager to the people and the service. They were always available, and they actively listened and promoted an open and learning culture.

The service was safe. Risks to people's health and safety were assessed and mitigated. There was a focus on positive risk taking. Medicines were managed in a safe way. The staffing levels were personalised to each individual and were flexible to support what people wanted to do at different times of the day.

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 (1 December 2016). At this inspection we found the service had improved to Outstanding overall.

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.

The Moorings is a care home without nursing for up to six people with learning disabilities in Poole. There were five people living at the home at the time of the inspection.

There was a registered manager who had been in post since December 2015. 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.

Three people were able to talk with us and one person used Makaton (a type of sign language) to communicate. One person used body language and sounds to communicate their needs. This person was very relaxed and crawled towards and reached out for staff, they gave staff eye contact and smiled and giggled. There was a calm and relaxed atmosphere at the home.

Relatives told us they felt their family members were safe at the home. Staff knew how to recognise and respond to any signs of abuse.

Risks to people’s safety were assessed and managed to minimise risks. Staff followed any risk management plans in place for people. Medicines were managed safely and stored securely. People received their medicines as prescribed by their GP. Staff knew when they should administer PRN ‘as needed’ medicines.

Staff knew people well and understood their needs and the way they communicated. People received care and support in a personalised way. This meant people were able to increase their independence, achieve and try new experiences. The impact this had on the individuals was outstanding and had resulted in them being settled, content and calm and helped them to lead full and active lives.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People were supported to take part in activities and try new experiences in the house and in the community.

People received the health, personal and social care support they needed. People’s health conditions were monitored to make sure they kept well.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. Staff were recruited safely and people were involved in the recruitment of staff. There were enough staff to meet people’s needs.

The culture within the service was personalised. There was a clear management structure and people, relatives and staff felt comfortable raising any issues. There were systems in place to monitor and drive improvements in the safety and quality of the service provided. There was an improvement plan in place.

We spoke briefly and Makaton signed (a type of sign language) with three people at the home. One person told us, 'Going to choose colour' when we asked about them having their bedroom decorated. One person smiled and another gave the 'thumbs up sign' when we spoke and signed with them to ask them what they thought of the home environment.

We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

One person Makaton signed 'thumbs up' and smiled when we asked about the home. Another person said 'like staff' and we observed someone else smiling at staff and reaching out to touch them.

People and or their representatives were involved in decision making. Their privacy, dignity and independence were respected and promoted. People experienced care and support that met their needs and protected their rights.

Medicines were managed, administered and stored safely.

People were cared for and supported by, suitably qualified, skilled and experienced staff. There were systems in place to regularly check and monitor the quality of the service and records were accurately maintained.

We found that the people who lived in the home, staff and visitors were not fully protected against the risks of unsafe or unsuitable premises.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of them had complex needs which meant they were unable to tell us about themselves. We spoke with four people and observed staff supporting all five people. We also spoke with four staff and the acting manager. The acting manager had only been acting up in the four weeks prior to the inspection.

One person told us 'like it here xxx is my key worker, comes in here and talks to me'. Another person Makaton signed (a type of sign language) 'like house' and 'happy here'.

People freely approached staff and sought their company. We saw that people were very relaxed with the staff that supported them.

People were supported to go out into the community. One person told us that there were 'meetings' and that they talked about the running of the house, food and activities.

Overall, people experienced care, treatment and support that met their needs. However, we identified shortfalls in involving people, assessing needs and care planning, medicines management and record keeping.