The inspection took place on 4 December 2017. The inspection was unannounced.

Moordale Court was last inspected by CQC on 15, 16 and 19 October 2015 and was rated ‘good’ overall and in all areas. At this inspection we found the service remained Good overall and in all areas.

Moordale Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Moordale Court provides personal care for up to three people with learning disabilities. At the time of our inspection there were three people living at the home. Moordale is located in a village called Lingdale near Saltburn. The home is situated within walking distance to the local high street and shops.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The atmosphere of the home was very homely, warm and welcoming. People who used the service were relaxed in their own home environment.

People were supported to have choice and control over their own lives from being supported by person centred approaches. Person centred care is when the person is central to their support and their preferences are respected.

People were supported to forward plan and were also supported to achieve personal goals in their lives.

People were always respected by staff and treated with kindness. We saw staff being respectful, considerate and communicating exceptionally well with people who don’t use words to communicate.

People’s support plans were person centred. They included outcomes that people wanted to achieve and a ‘one page profile’ that referenced people’s personal histories and described their individual support needs. These were regularly reviewed.

People were supported to play an active role within their local community by making regular use of local resources including the local shops and local activities.

Support plans contained person centred risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. This supported people do the things they wanted to live their lives fully. The support plans we viewed also showed us that people’s health was monitored and referrals were made to other health support professionals where necessary, for example their GP or epilepsy nurse.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes 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; the policies and systems in the service supported this practice.

Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. The service was truly reflective of what people liked and people were in control of this and chose what they would like to eat.

People had their rights respected and access to advocacy services was available.

People were supported to main

Our inspection team was made up of one inspector. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We looked at a range of records, spoke with the manager and three staff. We observed the interactions between staff and people living at Moordale Court and engaged with people who used the service. We also spoke with the relatives of one person who lives at Moordale Court.

Below is a summary of what we found. The summary is based on our observations during the inspection and from speaking with manager and staff. Also from our observation of how staff supporting people lived at Moordale Court.

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

Is the service safe?

We saw that there were systems in place to keep people safe. People were provided with appropriate levels of staffing and observation to keep them safe.

There were effective systems in place for the ongoing maintenance and servicing of equipment. There were also good systems in place in respect of fire safety and fire training. We saw that Moordale Court was well maintained, clean and homely.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager had received training in regard to this and understood the action that needed to be taken should the need arise. Staff had also completed safeguarding of vulnerable adults training which incorporated information about the Mental Capacity Act.

Is it effective?

People all had their needs assessed and had individual care, which set out their care needs. We observed how aspects of care detailed within people’s care plan were delivered by staff. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people’s care records

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement. We saw them involving people in individual activities and give encouragement and praise.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided comprehensive information to staff on what care and support people who lived at Moordale Court needed.

People's preferences, interests, aspirations and diverse needs had been recorded in their care records. Care and support had been provided in accordance with people’s needs.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals. We saw lots of evidence of multi-agency working and also of annual health checks.

It is well led?

The service worked well with other agencies and services, to make sure people received their care in a joined up way.

The home had a registered manager. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed, although this was not always formally recorded.

Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people told us.

During this inspection we were unable to engage people in any detailed verbal communication. We did however carry out some observations while people were in the service. We saw that staff treated people with dignity and respect. We saw that there was a real sense of well-being, with lots of smiles, singing and positive non-verbal communication. One person we spoke with indicated they were settled and happy in the home and told us about the music they liked to listen to.

One relative we spoke with said, “They are well cared for, we are kept well informed and have a good rapport with the staff.”

We saw that staff had a good understanding of people’s non-verbal cues and were very quick to respond to them.

Staff told us about the various activities available. These included attendance at a local day centre, going out for walks and outings. Staff said, “We provide person centred care, there is a loose routine but it is flexible, based around individual needs.”

We also saw within the home that people accessed activities suitable for them. Their individual bedrooms were well personalised. One person was engaged in arts and crafts, while another was using musical instruments.

The people we met had very limited verbal communication skills and were unable to share their experiences of the service with us. We observed staff practice in the communal areas and saw that staff were very attentive; consistently attempted to gain people’s views; and were able to communicate with individuals. We found that staff understood people’s needs and responded to their requests and needs in a timely and effective manner.

We inspected Moordale Court on 15, 16 and 19 October 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Moordale Court is a three bedded care home providing personal care to people with a learning disability. It is a purpose built house situated close to local shops and amenities.

The home had a registered manager in place and they have run the home for over 20 years. 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 the time of the inspection three people lived at the home and we met all of the people who used the service. Two of the people who used the service were unable communicate verbally and the other person did not like meeting strangers but they did tell us that they liked the staff and the home met all of their needs. We observed staff practices and saw that the people were treated with compassion and respect. We saw that people were very comfortable with each other and staff presence and there was lots of laughter.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

We saw that staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight..

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities. Staff had also received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The staff we spoke with fully understood the requirements of this Act and were ensuring that where appropriate this legislation was used.

Staff shared with us a range of information about how they as a team worked very closely with people to make sure the service enabled each person to reach their potential.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs and we observed that were sufficient staff on duty to meet people’s needs. We saw that two staff were on duty when people were at home and one person was on duty overnight. We found that the registered manager was on duty during the weekdays.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. We saw that there was an accessible complaints policy and relatives were regularly contacted and knew how to complain. We found that relatives felt confident that staff would respond and take action to support them.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home.

The registered provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service