Moat House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Moat House is registered to accommodate 101 older people; at the time of our inspection, there were 95 people living in the home.

At our last inspection in January 2016, we rated the service good, however, we rated responsive as requires improvement due to not all pre-admission information had been completed. At this inspection, we found that improvements had been made. The evidence continued to support the rating of good, and there was no information from our inspection and on-going monitoring that demonstrated any serious risks or concerns.

This inspection report is set out in a shorter format because our overall rating of the service has not changed since the last inspection.

The inspection took place on the 8 and 12 March 2018 and was unannounced.

People’s individuality was respected and they were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and staff and people were treated with empathy and kindness.

People's care and support needs was monitored and reviewed to ensure that care was provided in the way that they needed. People or their representative had been involved in planning and reviewing their care; plans of care were in place to guide staff in delivering consistent care and support in line with people’s personal preferences and choices. End of life wishes were discussed and plans put in place.

People received safe care. There were risk assessments in place, which ensured that any identified risks were mitigated, and people could live as independent a life as possible. Staff were appropriately recruited and there were sufficient staff to meet people’s needs.

People were protected from the risk of harm. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People's health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to.

The care that people received continued to be effective. Staff had access to the support, supervision and training that they required to work effectively in their roles. Development of staff knowledge and skills was encouraged. People were supported to maintain good health and nutrition.

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 home supported this practice. There was a variety of activities available for people to participate in if they wished to and family and friends were welcomed to take part in events at the home.

The service had a positive ethos and an open culture. People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored through the regular audits carried out by the management team and provider.

The service was well run by a registered manager who had the skills and experience to run the home so people received high quality person-centred care. The registered manager led a team of staff who shared their commitment to high standards of care and vision of the type of home they hoped to create for people.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

We carried out an unannounced inspection of the service on 13 January 2016.

Moat House provides care for 101 older people. At the time of our inspection 94 people were using the service. Accommodation is on three floors, all accessible by stairs and a lift. People’s rooms have an en-suite and are spacious. Facilities include a cinema, a working `pub’, a shop, a café and an enclosed landscaped sensory garden.

The service has 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 2008 and associated Regulations about how the service is run.

People were protected from abuse. Staff understood their responsibilities to identify and report any signs of abuse using the provider’s safeguarding procedures. People were protected from avoidable harm through risk assessments. These included information for staff about how to support people safely and without undue restrictions.

Staffing deployment was based on needs of people using the service. If people’s needs increased, additional staff were deployed. The provider’s recruitment procedures ensured as far as possible that only people suited to work at Moat House were employed.

The provider’s arrangements for the storage of medicines were safe. Only staff who successfully completed training in management of medicines supported people with their medicines.

People using the service were supported by staff with the right skills and knowledge. Staff were supported through effective training and supervision. Staff understood and practised their responsibilities under the Mental Capacity Act 2005. They sought people‘s consent before they provided care and support. No person had restrictions on their liberty unless it had been authorised under the Deprivation of Liberty Safeguards.

People were supported with their nutritional needs. They had a choice of nutritious food and were protected from the risks of malnutrition and dehydration. People were supported to access health services when they needed. The service arranged for health professionals to visit the service to attend to people’s health needs.

Staff developed caring relationships with people using the service. They were able to do this because they understood people’s needs and their life stories. Staff were attentive to people’s needs and supported them to be comfortable.

People using the service and their relatives had opportunities to be involved in decisions about their care and support. They had access to information about the service and their individual care plans.

Staff treated people with dignity and respect. People were able to spend their time the way they wanted and their choices were respected. People were able to spend private time alone or with relatives in their rooms.

Before people came to live at Moat House they had a pre-admission assessment of their needs. After six weeks, a more comprehensive care plan was developed. We identified a single instance of a pre-admission assessment not being thorough and a family not being kept informed about an aspect of the person’s care. This was the subject of a complaint made by the family which was under investigation at the time of our inspection.

People using the service and their relatives had access to a complaints procedure and other means of providing feedback about the service. Complaints were investigated and responded to, but not all written responses advised people where they could take their compliant if they were not satisfied with the response, although the complaints procedure did include that information. The provider told us that in future they would add that information to complaint response letters.

The service had a registered manager. They were supported by an operations director, a management team at the s

At our inspection we gathered evidence that helped answer our five questions.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with nine people who used the service and three relatives of other people who used the service. We spoke with staff and management and we looked at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at the home. Comments included, "It's very good here." One person told us, “When I use my call bell the staff respond pretty swiftly and I feel able to speak with staff about any concerns I may have.” People who used the service had been provided with pendant alarms that they used when they needed assistance. We looked at records of response times to calls for assistance and we found that staff had responded very quickly, usually in under three minutes. People also had call alarms in their bedrooms. This meant that people could feel safe and assured that they could summon help from anywhere inside the home. This also showed that enough staff were on duty to be able to respond promptly to people's needs.

Relatives told us that they felt people who used the service were safe at the home. They said they knew how to raise any concerns. They added they were confident that staff and the management at the home would take any concerns seriously. No relatives we spoke with had any concerns.

We saw that staff treated people with dignity and respect. Staff spoke politely to people and offered encouragement when they supported them. Care staff we spoke with knew the forms of abuse recognised in the Health and Social Care Act 2010. Staff knew how to identify and report concerns about people's safety internally within the home and with the relevant outside agencies.

Earlier in 2014, a series of errors in medications administration had occurred. These had been investigated. We found the provider had made changes and improvements to the way medications were managed and administered that reduced the risk of errors. No errors had been made since.

Care plans we looked at contained risk assessments of things that could potentially harm people. Care plans included plans of how to protect people from risk of falls and risk of injury whilst receiving personal care.

Senior staff we spoke with understood the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control.

The home was very clean. A relative told us, "The home is beautiful. There is no smell. It's always lovely."

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how they were supported with their needs. Care workers made daily records of how they had supported people. We looked at those records and we found that they showed that care workers had supported people in line with their care plans. We found care worker's daily notes varied in quality but noted that the provider had arranged training for care workers to help them improve their record keeping.

People who used the service told us that they had been well cared for and supported. One person told us, "I'm very satisfied. I get the support I need. The staff make sure I'm comfortable." Other people told us that staff supported them with their personal care routines. Relatives were complimentary about the care their family members had received. One relative told us, "The care is as good as it can get." All relatives we spoke with told us they were confident that care had been delivered in line with care plans.

All the people who used the service were registered with one of two GP surgeries. The provider had arranged weekly GP visits so that people's health could be checked.

We found from the evidence we gathered that the service had effectively planned and delivered care that met people's needs.

Is the service caring?

People told us they were well cared for. One person told us, "Staff treat me with respect and observe my dignity at all times." Another person told us, “Staff treat me with respect and dignity, I couldn’t wish for better people.” People who used the service told us that staff were "pleasant." Those comments were representative of what other people told us. Relatives described staff as "brilliant." We saw that staff spoke politely with people. Staff referred to people by their preferred name. We saw took time to have meaningful conversations with people.

People had been supported with their health and nursing needs because the service worked closely with health professionals, such as GPs, community nurses, physiotherapists and others. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People's preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches.

People took part in social activities that involved other people who used the service and had also been supported to enjoy activities that were of particular interest to them. We found that the provider was further developing a range of activities for people with dementia.

We found that the staff understood people's individual needs and had supported people with those needs in a caring way.

Is the service responsive?

People told us they were well looked after. Records we looked at showed that people had been supported with their personal care and welfare needs. People told us that they knew how they could make suggestions or raise concerns and that they were confident they would be listened to. The service organised residents and relatives meetings where people made suggestions and received feedback from the service about the results of satisfaction surveys. A relative told us they had been invited to those meetings. They added, "We always have opportunities to say what we think about the service."

We found that the service had been responsive to people's on-going and new needs.

Is the service well-led?

The provider had a system for monitoring the quality of service. This included checks of documentation and records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again.

The manager regularly sought the views of people who used the service and their relatives. That had been through one to one discussions with people and reviews of people's care plans. The provider also used a satisfaction surveys to obtain people's views. Four surveys took place over a 12 month period. Each survey focused on what people thought of particular aspects of the service such as food, activities and staff. We found that the surveys showed that people were satisfied with their experience of the service and that the provider had acted on what people had said.

It was evident that the owner of the home took an active interest in the quality of care provided. Staff we spoke with understood the aims of the home. A senior care worker told us, "It's a good team. Everyone pulls together."

People told us they were happy with the support they received. They said staff sought permission before they were helped. People’s care needs were assessed and the support provided was tailored to meet those needs. Comments received included: “They [staff] help me when I ask”; “The care is marvellous; you’d think I live in a hotel but its home for me” and “The staff are all very good; polite and they care.”

People were provided with a choice of meals to suit their dietary needs and preferences. One person said: “The portions are smaller, which is better for me. I’ve really enjoyed the soup today and the bread roll was awesome, it was warm, just the right size and cut properly.”

People received their medicines on time and were confident that staff were trained to administer medicines. One person said: “I know what I need to take; they [staff] always bring the tablets to me.”

People were supported by staff that had been screened to ensure they were suitable to work with vulnerable people and trained for the job.

The provider had effective quality assurance system in place to monitor and manage the quality of service provided. People had opportunities to make a comments or a complaint about the service, which was acted on. A system of audits, reviews and monitoring in place that ensured the overall service provision protected the health, safety and wellbeing of people using the service and others.

People told us they were well cared for and satisfied with the care received. People were treated with respect and involved to make sure their care and supports needs were provided in a manner that suited them. One person said: “The manager pops in to see me everyday to check whether everything is ok.”

People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly.

People lived in safe and accessible surroundings that promoted their independence and welfare. All areas of the service was well lit and decorated to a high standard. One person said: “I use to have ensuite facilities at the old place but this is much nicer.”

People were cared for and supported by trained staff that promoted their safety, independence and wellbeing. Staff maintained their knowledge and skills through regular training, updates, support and supervision.

People had opportunities to make comment or complain about the service. They were confident to raise concerns with the registered manager. One person said: “There’s nothing to complain about although I would if it was necessary.”

We spoke with five people who use the service, three visiting relatives and the visiting GP. Everyone told us that they were happy with the quality of care and support provided. They said staff were supportive, knowledgeable and confident to meet people’s needs. They told us:

“I’ve been here a week and you can’t fault it; not the staff, the help they give or the food – marvellous”

“The doctor comes here when we need to see him, which is always better for us”

“I would approach staff and the manager if there was a problem”

“The staff and the manager are very kind and caring, nothing’s too much”

“My observations about the home, it’s clean, tidy, décor and maintenance of the home is good”

“They let you know about events they are planning here and ask you what you think about the food, or if you have a complaint, etc”