We inspected Moorhaven Care Home on 23 and 25 May 2017. The inspection was unannounced. The service was last inspected in September 2016, when we found five regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to consent; safe care and treatment; staffing; recruitment and training, and good governance. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Moorhaven Care Home is a large property which consists of a Victorian main building with modern extensions. The service provides care and support for up to 33 older people and is accommodation for people who require personal care and nursing. At the time of our inspection there were 24 people living at Moorhaven.

The home had a registered manager in place. 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.

During this inspection, we found improvements had been made and there were no breaches.

The home had recently been redecorated and people told us that they liked the new décor. However, we saw that the outside of the building required some attention as we found rotting timber fasciae and broken guttering.

People who lived at Moorhaven told us they felt safe. Recruitment processes ensured only suitable staff were employed and staff had a good understanding of safeguarding procedures. Training records showed that staff were trained to the level required for them to carry out their work, and additional training was available to enhance the skills and knowledge of the staff. All staff received regular supervision and a yearly appraisal of their work.

There were systems in place to ensure that people received their medicines safely and in a timely way, and care records showed that risks to people’s health had been identified and were managed in a way that did not restrict independence. People had good access to healthcare and staff monitored their physical and mental health needs.

We saw that arrangements were in place to assess whether people were able to consent to care and treatment, and staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken. Where people were unable to consent to their care and treatment the appropriate authorisation to provide support had been sought.

People told us that they liked the food at Moorhaven. We saw that kitchen staff had a good understanding of people’s dietary requirements and people were supported to eat and drink in a way that met their nutritional and hydration needs.

There was a friendly and open atmosphere. The people who lived at Moorhaven were treated with respect by staff who recognised their differences and met their needs in a person centred way. Staff showed a good understanding of how people liked their care to be delivered. This was reflected in care plans, which were subject to regular review, and we saw staff were vigilant and recognised changes in need. Issues of concern, such as diet, weight and skin integrity were closely monitored.

There was a variety of activities and social stimulation available and people told us there was enough for them to do. Visitors and people who lived at Moorhaven told us that they had no complaints, and when we checked we saw that no complaints about the service had been made since before our last inspection.

Staff told us that they felt well directed and supported by the registered manager and providers, who monitored the quality of the service by carrying out checks on records, medicines and the environment, and systems were in place for people to prov

We inspected Moorhaven Care Home on 07 September 2016. The inspection was unannounced. The service was last inspected in August 2014 and met the regulations in force and inspected at that time.

Moorhaven Care Home is a large property which consists of a Victorian main building with modern extensions. The service provides care and support for up to 33 older people and is accommodation for people who require personal care and nursing. The service is close to all local amenities.

The home had a registered manager in place. 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.

Hazards within the home were not always recognised and safety management systems were not robust enough to ensure safety for people. This meant people were at risk of harm. Immediate risks identified during the inspection were rectified within an acceptable timeframe following the inspection.

Care plans did not contain all of the information around risks to people and staff, in particular those around challenging behaviour. Care plans did not contain all the knowledge staff had around people’s preferences, likes and dislikes. This meant the documentation was not person centred and there was a risk this would have a negative impact on people’s care.

We saw some documentation lacked detail staff needed to ensure people received their medicine as prescribed.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. However they were not formally assessing a person’s capacity and recording decisions made in people’s best interests which meant there was a risk people would not be fully protected in this area.

Systems in place to monitor and improve the quality and safety of the service provided were not effective or robust. We saw the views of the people using the service; their families and staff were not regularly sought or used to make changes following any feedback.

Staff told us they felt supported. Not all staff had received an appraisal to support them in their role and not all staff had up to date training. Staff with professional qualifications had not been assessed to ensure they were still fit to practice.

People told us there were enough staff on duty to meet people’s needs. We saw this was the case, however not enough staff were deployed within the team to ensure all tasks relating to the quality and safety of the service were carried out. We found not all appropriate checks had been undertaken or recorded before staff began work.

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. We saw the registered provider had not ensured one required statutory notification had been sent to the CQC when an incident of safeguarding had occurred.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and patient. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for. We saw there was a range of activities on offer for people who used the service to take part in.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. Peoples nutritional needs were monitored well my staff. People were supported to maintain good health and had access to healthcare professionals and services.

The registered provider had a system in place for responding to people’s concerns and complaints.

Multiple breache

Moorhaven Care Home Limited (Moorhaven) provides nursing and personal care for up to 33 people. The home is a large early 19 century house that has been extended to the rear of the building. There are 31 single bedrooms and one shared bedroom. En-suite toilets are provided in 11 bedrooms. At the time of our visit 28 people were using the service.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke to the registered manager and observed staff interactions with people who used the service. We looked at records and talked in private with one visiting relative, three people who used the service and five members of staff.

The full report contains the evidence to support this summary.

Is the service safe?

Overall the people we spoke with at the inspection visit were positive about the care provided by the home. The people we spoke with who used the service and the visitor we spoke with believed people were safe. This included observations made by people who used the service about staff relations with everyone in the home.

Staff who we spoke with told us they believed people who used the service were protected from abuse or exploitation. Comments from staff included “[there are] strong staff who would definitely confront poor practice”, “I trust my colleagues” and, “I would be mortified [if there was any abuse in the home], I really would”.

There was documentary evidence that staff had received training in the safeguarding of vulnerable adults. This was confirmed by staff who we asked. Staff also told us they understood the need to be vigilant and, to whistle blow if necessary.

While some aspects of the building looked a little ‘tired’ we saw no obvious threats to people’s safety or wellbeing.

Staff were provided with disposable gloves and aprons to help minimise the risk of cross infection.

Staff members spoke positively about the support they received from their colleagues and managers. They also told us they were not asked to undertake tasks they were not trained for or did not feel competent to do.

We saw that quality audits had been completed which included issues relating to health and safety in the building.

Is the service effective?

Each individual’s care needs were assessed and reviewed. A care plan was developed on the basis of the assessment, and updated when necessary. This would help to ensure that people received appropriate and consistent care.

Staff were made aware of the up to date needs of each individual. Staff told us that the ethos of team work was strong at the home.

People who used the service and where appropriate their relatives could contribute to decisions about the best way to meet their needs.

There were effective systems in place to monitor the quality and the safety of the service that people received. This meant that the service was able to identify and respond to any shortfalls in the service, as well as recognising the strengths of the service people received.

Is the service caring?

Observations of interactions between staff and people who used the service indicated a warm and caring atmosphere.

The people who used the service and the visitor we spoke with talked positively about the caring attitude and approach of the staff. Comments included: “[staff are] great to get on with”, “they look after you”, “they [staff] treat you properly. [For example] They help you to eat, and don’t just leave you to it” and “staff are very very nice”.

Staff demonstrated a caring attitude towards the people who used the service. Their comments included: “we are expected to treat people like human beings”, and “it’s a very homely home, with a nice family environment”.

Is the service responsive?

We did not look specifically at the service’s complaints procedure at this visit. However, people who used the service and the visitor who we asked during our visit said they believed they would be listened to if they made a complaint.

Staff were confident that the registered manager and service provider would respond positively to any issues which were raised.

People who used the service and a relative who we asked, said that they were comfortable talking to staff and believed that their views were listened to.

There were quality monitoring and quality assurance systems in place. These were overseen by the service provider.

Is the service well led?

There were clear lines of accountability between the registered manager, the nurses and the care staff. This did not detract staff from seeking support from any of their colleagues.

One staff member said there was good leadership from each nurse in charge of the shift. Another said that if an issue was taken to the registered manager she would sort it out.

The registered manager set clear expectations around best practice. Staff told us that good practice was an expectation of the service and not dependant on the motivation of individual staff.

The registered manager and service provider were supportive of staff training and support. Staff told us they were not asked to undertake any tasks they did not feel trained and supported to do.

At the time of our inspection visit 24 people were living at the home. The manager told us that about 80% of the people living at the home had complex health care needs such as dementia. This meant that they were unable to tell us about their experiences of receiving a service.

However, we spoke with five people who lived at the home. They told us that it was “alright” living at the home. One person said they liked living at the home. Another person said “The staff help me when I need it”. People told us that the staff were ‘nice’. We heard that the meals provided were “always nice” and we saw that people’s individual food preferences were respected. Two people said they felt they could voice a concern or complaint and were confident that it would be addressed.

We spoke with two visitors who told us they were satisfied with the service provided to their relative. They said their relative was “cared for” and “looked better” since living at the home.

People received respectful and supportive care from staff most of the time. Some staff interactions were task focused.

People’s health and nutritional needs were monitored and supported.

The management of medication and staff recruitment practices were appropriate.

The three care staff we spoke with demonstrated a good understanding of providing individual support to people.

At the time of our inspection visit 32 people were being cared for. Many of the people living in the home had complex health care needs. This meant that it was difficult for most people to tell us of their experiences of living at Moorhaven Care Home Limited. We did speak with three people who were living at the home and one visitor.

We heard that it was okay living at the home. Different comments included “Staff are very obliging, I like them”, “Staff, nurses and carers are good” and “Staff are okay, sometimes they talk down to me as though I have dementia”. This person qualified this by saying they thought it was understandable because several people did have dementia. People told us that they felt safe living at the home. We heard that the manager was approachable and people were confident that they received good care.

People told us that they were activities such as cards, bingo and a regular visit from a ‘pat’ dog. (A pat dog is trained to accept touch and patting from different people). We heard that people had a choice of a quieter music lounge or louder day time TV lounge.

We spoke with health care professionals who visited the home. They said “The care is very good”. They told us that they had no concerns and believed people received safe and appropriate care.

The manager had sent out feedback questionnaires in March 2012 to people who lived in the home, relatives and professionals. The majority of the returned responses were positive. One comment from a relatives’ feedback questionnaire included “I value the staff’s attitude to informing me about my mum’s ongoing care and her day to day well being”.