Moreton Hill Care Centre is a care home for 67 people, some of whom are living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Moreton Hill Care Centre provides accommodation with nursing and personal care. At the time of our inspection 41 people were living in the home.

At the last inspection in June 2016, the service was rated Good. We carried out a comprehensive inspection on 10 and 11 January 2018. At this inspection we found the service remained Good.

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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was effectively monitored. Staff received supervision and training to ensure they could meet people’s needs.

People’s medicines were managed safely and audits and checks were completed. Actions were taken when errors were identified.

Staff demonstrated a good understanding of safeguarding and whistleblowing and knew how to report concerns.

Risk assessments and risk management plans were in place. We found improvements were needed to make all risks were fully considered and appropriate actions taken to keep people safe.

Incidents and accidents were recorded and the records showed that actions were taken to minimise future occurrences.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

A range of activities were offered and provided people with entertainment both in and out of the home.

Systems were in place for monitoring quality and safety and actions were taken where areas for improvement and shortfalls had been identified.

This inspection was undertaken by two Adult Social Care Inspectors. We looked at five standards during the inspection and set out to answer these key 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 home’s staff and from looking at records. Please read the full report if you want to see the evidence supporting this summary.

Is the service safe?

Arrangements were being made to ensure that there were sufficient staff to support people safely. Risks were being assessed so that hazards to people were reduced when receiving care and when undertaking activities of their choice.

The environment and the facilities were being checked so that people benefited from a safe environment. When accidents and incidents occurred, the circumstances were analysed so that any improvements in safety would be identified.

Is the service effective?

People we met with were appreciative of the care they received and how staff went about their work. For example, people who used the service commented “I can’t fault the staff” and “they often ask me how I’m feeling and they want to know I’m OK”. Relatives we met with felt that the needs of their family members were being met.

People’s needs were being assessed in different areas of their lives. This meant that people at particular risk, for example because of poor nutrition or mobility, were being identified. Care plans helped to ensure that staff effectively supported each person with their needs.

Is the service caring?

People spoke positively about the way that staff treated them. A relative told us that they were kept well informed by staff about any changes in the health of their family member at the home.

The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff used gentle humour, body language and physical gestures to aid communication and to engage with people with dementia.

Is the service responsive?

People who used the service were consulted about the care and support that they wished to receive. They told us that their views were being respected. However, when people did not have capacity to make decisions there was a lack of documentary evidence to show that the appropriate procedures had always been followed.

Surveys were being used to gain the views of the people who used the service, their relatives and from staff. The feedback provided information about what was working well and how the service could be improved.

Complaints were being used as a means to identify what the service could do better. The manager gave us examples of improvements that had been made during the last year. These included changes in the décor and a better working relationship with the pharmacist.

Is the service well led?

The home was without a registered manager at the time of this inspection. However there was a temporary manager who was assisted by a deputy manager and the provider’s regional operations director. A new permanent manager was due to start in the week following our inspection.

Nurses and heads of unit took the lead on each shift. Other staff such as a head housekeeper, had specific responsibilities in relation to the day to day work. These arrangements showed that there was a structure in place for overseeing the running of the home to make sure that the appropriate procedures were being followed.

Audits and director’s visits were being undertaken. This meant that areas for improvement were being identified for the benefit of the people who used the service.

The manager was not available on the day of our visit. The deputy manager and nurses were available throughout the day and all were knowledgeable about the people in their care, and the policies, procedures and systems in place to ensure the running of the home.

During the day we were able to speak with people, either in their rooms, at lunch or as they moved around the home. In addition, we observed people who mostly rested throughout the day in their room,

We observed that care workers were attentive and treated people with dignity and respect. We found that people were well cared for and were very positive about the care and support they received from all of the staff. People were happy to talk with us.

We found that the home was well maintained, with appropriate furnishings and decor. The home had made adaptations such as hand rails to enable people to maintain their independence. We found that most areas of the home were clean, however in some areas, the level of cleanliness had not been maintained.

During the day we spoke with many people in each of the different areas of the home. People said they liked living in the home and thought the staff treated them very well. The home had a warm and cosy atmosphere throughout, with a number of lounges and communal areas where people could socialise.

On the day of our visit we saw that several people were taking part in a cooking group making 'ginger bread' men. Everyone was engaged and seemed to be enjoying themselves. People told us there was a range of activities they could take part in, if they wished.

People received appropriate care which met their needs. Care plans were reviewed monthly and contained assessments which were specific to that person. During our visit we informed the manager that one carpet in a bedroom did not smell fresh and a bathroom was not clean, they said they would follow this up.

People told us they felt safe in the home and would tell the staff if they had any problems with other residents or if they did not like something. One relative said, "Yes, absolutely no worries at all, it's a fantastic home". People told us they knew how to make a complaint if they needed to.

One visitor told us this is a ‘very friendly home’ and another said his wife’s standard of care was ‘excellent’ and that the home has a ‘personal touch’.

People told us that they liked the food and could make choices about what they ate and where they ate it.

People using the service and visitors told us that if they had any concerns they would tell one of the nurses or the manager and would feel comfortable doing so. Where people have raised concerns, they told us that these have been corrected promptly.

A relative said that there was good continuity of care, and that all relevant staff knew how to deal with his wife’s seizures.

This inspection took place on 25 and 29 June 2015 and was unannounced. The previous inspection was carried out on 13 June 2014. We had no previous concerns prior to this inspection.

Moreton Hill Care Centre provides accommodation and nursing care for up to 67 people. At the time of our visit there were 45 people living at the service. The registered manager told us the service had 13 vacant beds. Nine further beds were not being used as the service had recently closed its Memory Lane dementia unit and moved people to the upstairs Cotswold Rise dementia floor.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager and staff understood their role and responsibilities to protect people from harm. Risks had been assessed and appropriate assessments were in place to reduce or eliminate the risk. Staffing numbers on each shift were sufficient to ensure people were kept safe.

Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only the appropriate people were employed to work at the service.

All medicines were stored, administered and disposed of safely. The service had policies and procedures for dealing with medicines and these were adhered to.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and the DoLS.

People had access to a range of healthcare professionals when they required specialist help. Care records showed advice had been sought from a range of health and social care professionals.

People had their nutritional needs assessed and monitored and were supported to enjoy a range of food and drink of their choice throughout the day.

There was an open culture at the service which was promoted by the registered manager who was visible and approachable. People and staff spoke positively about them.

The registered manager assessed and monitored the quality of the service provided to people. Systems were in place to check on the standards within the service. These included regular audits of care records, medicine management, health and safety, infection control and staff training and supervision.