This inspection took place on 30 August 2017. This was an unannounced inspection which meant the staff and registered provider did not know we would be visiting. The service was last inspected on 16 April 2015.

Moorend Place is a nursing home that provides care for up to 58 older people. It is a purpose built care service. At the time of our inspection 53 people were living at the service.

There was a registered manager at the service. 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 told us they felt ‘safe’. Safeguarding procedures to protect people from abuse were robust and staff understood how to safeguard people they supported.

We found people’s care plans and risk assessments were reviewed regularly and in response to any change in needs.

The service had appropriate arrangements in place to manage medicines safely so people were protected from the risks associated with medicines.

People and relatives did not have any concerns about the staffing levels at the service. We saw there were sufficient staff to provide support to people living at the service.

The recruitment systems were designed to make sure new staff were only employed if they were suitable to work at the service.

We noticed that some staff had been working at the service for a significant amount of time with no further Disclosure and Barring Service (DBS) checks recorded. We recommend the registered provider considers requesting staff to complete an annual self-declaration relating to criminal convictions incurred since their previous criminal record check was provided.

During the inspection we did not find any concerns about infection control. The service was clean and smelt fresh.

People we spoke with told us they were satisfied with the quality of care they received. Their comments included: “I can’t fault it [care],” “They [staff] do their very best. I’m quite satisfied with the care given,” “Quite nice, big enough, it’s like a home from home,” “It is brilliant” and “It’s like one big family.”

All the relatives we spoke with were satisfied with the quality of care their family member received. Some of the relatives also told us they would recommend the service. Their comments included: “Such care taken, such concern shown, the staff are always smiling” and “Yes, I would recommend it, it’s well run and supervised.”

Some of the people and relatives we spoke with described how well staff supported people living at the service who became anxious or agitated. One relative said, “The staff are wonderful with them; they deal with them [people] calmly, professionally and affectionately.” A nurse we spoke with described how staff optimised engagement and distraction when people became anxious or worried.

All the people we spoke with made positive comments about the quality of the food at the service. People also told us there were snacks and drinks available between mealtimes.

Staff told us they felt supported and told us there was a good team working at the service. Staff had received appropriate supervision and appraisals to enable them to carry out the duties they were employed to perform.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

Staff enjoyed working at the service. They knew people well and were able to describe people’s individual likes and dislikes.

People were treated with dignity and respect and their privacy was protected. All the people we spoke with made positive comments about the staff. Their comments included: “I can’t fault them [staff], they a

This inspection took place on 16 April 2015. This was an unannounced inspection which meant the staff and registered provider did not know we would be visiting. The service was last inspected on 29 July 2014. At the last inspection we found the service was not meeting the requirements of the following three regulations: the care and welfare of people who use services, supporting workers and assessing and monitoring the quality of service provision. As a response to the last inspection the provider sent a report to the Care Quality Commission of the action they would take to become compliant with the regulations. The provider informed us they would be fully compliant by the end of November 2014. At this inspection we found that the required improvements had been made.

Moorend Place is a nursing service that provides care for up to 58 older people. It is a purpose built care service. At the time of our inspection 51 people were living at the service.

There was a registered manager at the service. 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 a and has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we observed domestic staff cleaning different parts of the service. However, we found there were malodours on one of the stairways and in the lounge areas of the home. We spoke with the registered manager who assured us that they would take action to address these concerns.

We saw that the system in place to ensure each person had access to a call bell on a lead unless it presented a risk to them needed to be more robust. A lead enables the call bell to be positioned so the person can call for staff assistance. We spoke with the registered manager; they assured us that a call bell lead would be available for people to use in their room unless it presented a risk and regular checks would be completed to ensure they were plugged in and left in reach for people to use.

People told us they felt safe and were treated with dignity and respect. Our discussions with staff told us they were fully aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen.

The service had appropriate arrangements in place to manage medicines so that people were protected from the risks associated with medicines.

Recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

Some people had personalised their rooms and they reflected their personalities and interests. We saw that the environment within the home could be improved to make it more dementia friendly. For example, some areas of decoration of the service could be improved, the signage and signs could be clearer and the clocks needed to be set at the right time.

People spoken with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Relatives spoken with also made positive comments about the care their family members had received and about the staff working at the service.

People had a written care plan in place. People’s records were updated on a daily basis.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. However, we found one person did not have a repositioning chart and another person did not have an observation chart in place. It is important that an accurate record of the care provided is recorded by staff. The person who required repositioning told us they received the support they needed from the night staff. We spoke with the registered manager; they assured us that these charts would be put in place.

People and/or their representatives were included in the completion of their care plans and they were reviewed regularly and in response to changes. There was evidence of involvement from other professionals such as doctors, optician, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required. Most people made positive comments about the food. People’s dietary needs were being met.

Staff told us they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, likes and dislikes and the name people preferred to be called by. Staff completed induction, training and received ongoing support. Staff received specialised training to meet the needs of people they supported.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities. There was a range of activities available which included: sing alongs, arts and crafts and games. However, we saw that some people living with dementia may benefit if they were provided with sensory and/or soft objects or items to stimulate memory for example, items to hold their attention and divert incidents of behaviour that challenged others.

The provider had a complaint’s process in place. We found the service had responded to people and/or their representative’s concerns, investigated them and had taken action to address their concerns.

There were regular meetings with people living at the service; this showed the service actively sought people’s view so they could share their experience of care.

There were regular relatives meeting held at the service. A copy of the latest relatives meeting minutes was available for people and visitors to the service to read in the reception area. There was a relative’s board where people’s relatives or representatives were kept informed about information relevant to them.

Accidents and untoward occurrences were monitored by the registered manager. We found that this monitoring could be improved by analysing occurrences in more detail to ensure any trends were identified.

On the day of the inspection two adult social care inspectors and a specialist advisor visited the service. At the time of the inspection, forty eight people were living at Moorend including two people who were in hospital. Twenty seven people were located on the residential unit primarily used for people living with dementia and twenty one people were located on the nursing unit. We observed the care people received; spoke with five people and five relatives. We also spoke with the manager, the deputy manager, one nurse, five care workers, one kitchen staff, two domestic staff and the activities coordinator. We also reviewed a range of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

People spoken with told us they felt “safe” and had no worries or concerns. Relatives felt their family member was in a safe place.

We observed individual staff members treating people with respect. Staff also explained their actions when they were assisting people and gained their consent prior to carrying out any tasks.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The home was aware of the need to submit applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

We found the arrangements in place to safeguard people using the service from financial abuse could be more robust.

Is the service effective?

At the last inspection in December 2013 we found the home was non-compliant in outcome 4, care and welfare of people who use the service. The home was asked to send us a report saying what action they were going to take to achieve compliance. During this inspection we checked to see whether the home had completed these actions. We found the home had not appropriately implemented the actions and not achieved compliance.

A few people’s personal hygiene records indicated they had been supported to have a daily body wash but they had not had a shower or bath during July. We spoke with the manager who assured us that people would be supported with their personal hygiene to maintain their dignity.

We found evidence that one person did not have a care plan in place. We also found some people’s risk assessment and care plans had not always been reviewed within the monthly timescale specified within the document or in response to a change in their needs. For example, one person’s urinary; bowel and oral assessment had not been reviewed since the 1st of April 2014. Another person’s challenging behaviour had not been reviewed since 1st April 2014.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people’s care and welfare.

We found some staff had not received a comprehensive induction and that was relevant to their role. This told us people were at risk of not receiving the care and treatment and support from staff who are knowledgeable and competent to carry out their roles.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to supporting staff.

Is the service caring?

People spoken with told us they were satisfied with the quality of care they had received. They also made positive comments about the staff. Their comments included: “very good food”, “the staff are okay” and “it’s very well organised”.

Relatives made mixed comments regarding the quality of the care being provided at the home. Positive comments included: “her [family member] care is okay”, “more than pleased with mums care” and “her [family member] mobility has improved since she has been here”. The negative comments included: “I have noticed smells in here and sometimes I have seen people wet the chair and then the staff don’t clean the chair cushion” and “I have also seen people wet themselves, they [staff] don’t always change them straightaway”.

Although an activity worker was employed we saw no activity to stimulate people and enhance their wellbeing on the nursing floor. People’s comments on the nursing floor regarding the level of activities included: “it’s very boring” and “I don’t do anything”.

Is the service responsive?

The provider's complaints process was displayed in different parts of the home.

We found in some people’s care plans there was no information on any action being taken as a consequence of the reviews.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people’s care and welfare.

Is the service well led?

There was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. However, our findings indicated the audits in place had not effectively identified the concerns we found during the inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to identifying, assessing and managing risks to health, safety and welfare of people who use the service and others.

People expressed their views and were involved in making decisions about their care and treatment. We observed people making comments to staff about their care needs and staff giving them choices. One person was not sure whether they wanted to join the others in the communal area or stay in their room. The care staff encouraged them to join the others and assured them if they wanted they could return to their room anytime.

People said they were confident that staff would respond and take action to make sure they were protected from any abuse or harm. A visiting relative and a professional visitor to the service confirmed the people were protected from harm or abuse, by caring and competent staff at the service.

There were enough qualified, skilled and experienced staff to meet people’s needs. The visitors to the service and people who lived at the service told us that there was a sufficient number of staff on duty. They told us that staff worked very hard and supported the people who lived at the service.

People who lived at the service, relatives and the visitors told us they had been involved in meetings where quality of service had been discussed. They said staff at the service were open to suggestions and always looking to improve.

Before people received any care consent was obtained and the provider acted in accordance with people’s wishes. Relatives said they were happy that their views had been considered when staff sought consent.

People’s experience of care did not always meet their needs and protect their rights. People’s care needs were not always reviewed as changes happened and plans of care were not updated. People were not sufficiently supervised to ensure their safety and welfare. Relatives said staff did not spend enough time interacting with people. They told us the same people attended activities and not all activities were meaningful to people.

Although people were cared for in a clean, hygienic environment, from time to time there had been concerns about unpleasant smells within the home.

People were cared for by staff who had been appropriately checked for their fitness.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. One relative said, “I am satisfied with the staff, they listen to me. They are considerate and take good care. But I would rather X was at home with me.”

Comments and complaints people made were responded to appropriately. Where people had not been fully satisfied with the outcome of their complaint they were not always made aware of the next step to take.