This inspection visit took place on 5 April 2018 and was unannounced.

Moorland House is a care home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Moorland House is registered to provide care and accommodation for 48 older people. On the day of our inspection there were 44 people living there. Moorland House, changed from a nursing home to a care home in November 2017, and no longer provides care and accommodation to people who require nursing care.

The registered manager had been in post since November 2017. 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.

The service was safe. Appropriate checks and assessments of staff were completed to ensure they were safe to care for people. Staff understood their duty to protect people from abuse and the policies in place supported this. Risk assessments were in place and identified people who required additional support for some or all of their daily living activities. Medicines were mostly managed safely; and there were processes in place that prevented the spread of infection.

The service was effective. People’s needs were assessed and used to develop personalised care plans. 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 support this practice. Staff had relevant training, skills and knowledge to care for people’s individual needs; and teams worked together across the service to ensure people received safe and effective care. People were supported to live healthy lifestyles and had sufficient to eat and drink. The building was designed to provide a safe living environment with a variety of private and communal spaces, both indoors and outside; where people were able to spend time alone, with friends or with family.

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

The service was caring. Staff were kind, compassionate and caring and they developed positive and professional relationships with people. They cared for people with respect and promoted their dignity and independence. Family and visitors were made to feel welcome and were encouraged to spend time with their loved ones. People were encouraged to express their views about their daily care and preferences for daily living.

The service was responsive. Staff took time to get to know people, their histories and their aspirations and used this to promote their wellbeing and emotional health. Staff understood people’s individual care needs, preferences and responded positively, when people needed assistance. People felt able to make comments, complaints and suggestions and we found these were acted upon by the staff and registered manager. People received dignified care and support at the end of their life, where families were encouraged to visit and spend time with loved ones.

We found aspects of the service that were not always well led.

The provider, Methodist Homes had not always consulted with staff or people when it made changes to how the service was delivered. Recent changes to the rota had taken place without prior consultation with staff or discussion about impact on people. The service had also recently stopped providing nursing care and had only consulted the four people who were receiving nursing care at that time. It had not consulted all the people in the home, whose needs may change in th

This inspection took place on the 30 November 2016 and was unannounced. The service was last inspected in April 2014 when it was compliant in the areas inspected. The service is registered to provide care for 48 people. There were 45 people living there on the day of our inspection.

There was a registered manager in post. 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 safe at Moorland House. Staff had the skills and knowledge to keep people safe from harm and abuse and policies were in place to support this. Risks to people were identified and managed, whilst continuing to promote independence. Medicines were generally managed well, errors were identified and staff supported to improve their practice.

Staff had the skills and knowledge to care for people effectively. New staff completed a thorough induction and all staff received on-going training and support. People were supported to make their own decisions about their care. Where they lacked capacity to do so, appropriate arrangements were in place for staff, family and appropriate professionals if necessary, to make decisions in their best interest. People were supported to access community health services and appropriate referrals were made. Meals were nutritionally balanced and special diets were catered for. However, we found the lunchtime service was poorly managed and people waited a long time for their meal.

People were cared for by staff who were kind and compassionate. There were good relationships between people, staff and families. Staff clearly knew the people they cared for and were aware of their interests, wishes and preferences.

There was a comprehensive activities programme for people from Monday to Friday. The activities available were based on individual interests; and included group and individual activities, within and outside the home. A minibus was used to take people on trips in the local area. This enabled people to maintain their sense of identity and remain part of the local community. There was a complaints policy in place and people and their families were consulted about service improvements and encouraged to make suggestions. People told us they knew who to complain to and most people were happy with the response they received. However, some people told us they felt the response depended on how busy the staff were.

There was a positive and welcoming atmosphere in the home. The registered manager was available, approachable and was supported in their role by a team of regional managers. Staff we spoke with were motivated and supported in their personal development. However, we found that at times of staff shortage, staff did not always feel supported or valued by the provider as they felt their concerns regarding the quality of care, were not always acknowledged or acted upon.

Our inspection team was made up of a lead inspector and we aimed to answer our five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at the records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe. Staff had received training in safeguarding and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risk to people and helped the service to continually improve. People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual care plans in relation to activities of daily living.

Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living in the home.

Medicines were stored and administered appropriately and there were clear procedures for recording. Staff who administered medicines were trained to do so.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. One person told us, "I'm extremely happy, everybody looks after you".

Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People's needs were taken into consideration in the layout and design of the service enabling people to move around freely and there was seating available throughout the home for them. Visitors told us that there were able to see people in private and visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. One visitor we spoke with told us, "The staff here are very friendly, positive people".

People using the service were invited to complete a survey. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People completed a range of activities inside and outside the service regularly. The home supported people to attend local activities within the local community and invited people from the local community into the home. People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with and found that the responses had been open, thorough and timely.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. Records seen by us showed that identified shortfalls were addressed promptly and as a result the service was constantly improving.

There were 46 people using the service at the time of this inspection, including 16 people who required nursing care. We spoke with six people, five staff and the manager.

People we spoke with were satisfied with the care provided at the home. One person said, “It’s clean, it’s safe and the food is good – can’t ask for any more than that!” People had a choice of suitable food and were given the support they needed to eat and drink. They told us, “The food is excellent and we always have a choice.”, and, “They know what I can and can’t eat and there’s always something for me”.

The home was clean and hygienic with effective systems in place to prevent and control the spread of infection.

There were usually enough staff available to ensure people’s needs could be met. People told us, “Staff are there when you need them. They come at the drop of a hat.”, and, “They could do with one or two more staff sometimes. I’d like them to have more time to sit and talk.”

Staff received appropriate training and support to ensure they could meet the needs of people in the home. People told us, “The staff are very good. They’re so perceptive. They understand what I need.”, and, “Staff are good 90% of the time. You sometimes get someone on a bad day.” Staff told us they were mostly satisfied with the training they received and they felt well supported. They said, “We’ve a good staff team here. We all help each other.”, and, “It’s a lovely place to work. I enjoy working here.”

We spoke with several people over lunch time, during the tour of the home, and on a one to one basis.

They were all pleased with the decision they made about coming to live at Moorlands. One person told us it was not home, but the next best thing.

People told us there privacy and dignity was respected; the care staff always knock on my door and wait before entering.

The people we spoke with told us about the good level of contact they have with the local community and are involved in activities at the local chapel.

One person told us, “Family and friends are made welcome, when they visit and they can go out or stay at the home.”

Two of the people we spoke with told us they knew about their care plan, had been involved in drawing this up, had signed their care plan and had a copy.”

The other people told us, "I've seen my care plan and staff talk to me about my care and family attend care plan meetings."

All the people we spoke with confirmed that staff encouraged them to be as independent as possible.

One person told us, "staff respect my wishes I choose which dinning room I have my meals." Moorlands have two dinning rooms a smaller upstairs and a large downstairs.

People also felt that all their needs were met at Moorlands, with one person adding, "I ask and it's done.” We were told that the staff are very helpful and the manager is positive.”

People felt that a range of suitable activities were offered and they had the choice as to whether they took part or not. People told us they go out each afternoon for a walk in the village.

The people we spoke with told us that they felt safe living at Moorlands, with one person adding, "I feel very safe." All the people we spoke with confirmed that they knew the staff names and that they were respect by them.