The inspection took place on 27 March 2018 and was unannounced.

The Morewood Centre is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The care home provides residential and respite care. The service has accommodation for up to ten people; at the time of the inspection there were six people using the service. It is located in Alfreton and accessed by a long drive on land owned by the Derbyshire local authority; there is also a day service provision on this site. The home has two lounges and a dining room on each floor; there are five bedrooms with ensuite facilities on each floor. Public facilities are a short walk away from the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

Morewood Centre was last inspected in March 2017 and the service was rated as Requires Improvement. We identified concerns as procedures designed to ensure the safety and quality of services were not always followed for medicines given with food. Statutory notifications had not always been submitted as required. Printed records of care plans for staff to reference were not always consistent and clearly organised and mental capacity assessments and best interest decisions had not always been held as required.

On this inspection we found that improvements had been made, although further improvements were still required. Medicines were now managed safely to ensure that people received their medicines as prescribed and to keep well. Risks were assessed and reviewed to keep people safe although improvements were needed to ensure people were safe when they spent time outside of the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, improvements were needed to ensure decisions were only made in people’s best interests and applications to lawfully restrict people’s movement were only submitted where people lacked capacity. We have made a recommendation about this.

People were treated with kindness and compassion by staff who knew them well. People were given time and explanations to help them make choices and their privacy and dignity was respected. People received personalised care and were confident that staff supported them in the way they wanted to be supported. Staff knew people’s likes and dislikes and care records reflected how people wanted to be supported and how care was provided. The support plans reflected people’s specific needs and preferences for how they wished to be supported and were reviewed with them regularly.

People were supported to maintain their preferred diet and were helped to plan and prepare their meals when they wanted to eat. There were sufficient numbers of staff to meet peoples need. Staff supported people to keep healthy and well and ensured they could access healthcare services when this was needed. Staff had opportunities to develop further skills and knowledge to work effectively in their roles.

Staff felt well supported by the registered manager and provider. Regular quality checks were completed and people could comment on the quality of service provision. People fel

This inspection took place on 1 March 2017 and was unannounced. Telephone calls were made to families and social care professionals on 6 and 8 March 2017.

There is a requirement for Morewood to have a registered manager and a registered manager was 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.

The service is registered to provide residential care and respite care for up to 10 adults with learning disabilities or autistic spectrum disorder. At the time of our inspection five people used the service.

Policies and procedure designed to ensure the safety and quality of services were not always followed for medicines given with food. Statutory notifications had not always been submitted as required. Notifications are changes, events or incidents that providers must tell us about.

Printed records of care plans for staff to reference were not always consistent and clearly organised.

The principles of the Mental Capacity Act (MCA) had not always been applied when needed and mental capacity assessments and best interest decisions had not always been held as required.

Deprivation of Liberty Safeguards (DoLS) had not been renewed when they expired, and some DoLS had not been applied for some people as required.

Other systems to check on the quality and safety of services were in place and checks to ensure equipment had been serviced and fire safety checks had been completed.

Staff had been trained in and had an understanding of safeguarding and how to keep people safe from potential abuse. Staff were recruited in line with the provider’s policy and procedures, and checks were completed to ensure staff employed were suitable to work at the service.

Staffing levels were based on meeting people’s needs and sufficient staff were deployed to do so safely.

Medicines were stored securely and procedures were followed for when people took medicines off site with them. Medicine administration record (MAR) charts were completed and audited to reduce errors.

Risks to people’s health, for example from risks from choking or other health conditions were identified and actions taken to reduce those risks.

People were given the opportunity to express their preferences for meals and drinks. We saw people had access to food and drink throughout the day.

Other healthcare professionals were involved in supporting people’s health care needs when needed to ensure people maintained good health.

Staff were supported by the registered manager and deputy manager and were confident in their role and responsibilities. Staff had skills and knowledge relevant to people’s needs. The registered manager told us additional training would be arranged to support staff to fully understand people’s mental health conditions.

Staff provided care that respected people’s privacy and dignity. Staff had built caring relationships with people. Staff helped to create a calm and inclusive atmosphere in service.

People were supported to maintain and develop their independence. Staff supported people in positive, encouraging ways to develop their confidence. Resources had been made available to develop support for people’s independent living skills.

Care plans were developed to include people and their relatives’ views. People and families felt involved in any reviews of their care. Families felt welcomed when they visited.

People were supported to enjoy activities that were of interest to them. People had personalised their bedrooms to reflect their hobbies and interests, and people had regular contact with their local community.

Staff listened and responded to any views, suggestions and complaints. Any complaints were recorded, investigated and resolved t

This inspection took place on 8 July 2015 and was unannounced.

The Morewood Centre is required to have a registered manager. 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 manager was in the process of registering with the Care Quality Commission.

The Morewood Centre is a care home registered to provide care for up to 10 people. At the time of our inspection, seven people used the service, including two people who were on a short term break. The Morewood Centre has a range of resources available to help people develop their skills to live more independently.

At our previous inspection in June 2014, we identified a breach in the Regulation relating to people’s care and welfare. During this inspection we looked at whether or not these improvements had been met and we found that they had.

At this inspection, we found that systems to reduce the risks associated with medicines had not yet been fully embedded in staff practice. 

The manager had a good understanding of the Mental Capacity Act 2005 (MCA) and was taking action to ensure staff fully understood the principles of the MCA in relation to people's care. The manager had applied for a review and submitted further applications for Deprivation of Liberty Safeguards (DoLS) to ensure people's legal rights were upheld. This legislation ensures people who lack capacity and require assistance to make certain decisions receive appropriate support and are not subject to unauthorised restrictions in how they live their lives.

People told us they felt safe using the Morewood Centre and felt confident to talk with staff if anything worried them. Staff were confident to raise concerns if they felt people’s care and support was not safe. Staff understood how to manage any risks to people and any interventions used with people were based on the principles of being, ‘least restrictive.’ People were supported by sufficient numbers of staff, however staff told us of certain times of day when they felt more under pressure to meet people’s needs. Staff were only employed after checks had been completed to make sure they were suitable to work with people using the service.

Staff were able to support people well as they had the right skills and abilities to do so. The manager had created a supportive environment where staff felt they were able to develop and strengthen their skills and abilities further.

People received food and drink that they enjoyed and that met their needs and preferences. Staff made sure people had choices of food and checked to make sure people understood the choices being offered. Staff provided support to people who required help to reduce any identified risks associated with eating and drinking. People had access to any other healthcare services they required, including GP’s, opticians and specialist nurses.

We saw that people had fun while using the Morewood Centre and that they were supported by staff who had developed warm and caring relationships with them. People’s independence was supported because staff focused on what people could do and provided opportunities for people to use and develop their skills. Staff worked to support people in ways that promoted their dignity.

A system was in place to investigate and respond to complaints, and information was available explaining how to make a complaint. Compliments were also shared with the staff team. In addition, the manager was planning to use the views of people, families and other professionals in the development of the service.

People were supported to access a range of experiences that were of interest to them, and people’s views and wishes were respected. Staff supported people to contribute their views and ideas on how their care and support should be planned and developed.

The service promoted a positive culture and families and other professionals felt welcome and involved in people’s care and support. Staff told us they felt positive about the changes introduced at the service and were enjoying working with the new manager, who was in the process of applying to be registered with the Care Quality Commission. The manager had systems in place to check on the quality and safety of services people received.

On the day of our inspection we met four of the eight people who used the service and looked around the centre to understand what it felt like to live there. We also spoke with the manager,deputy manager and three members of staff. We were not able to gain everyone’s views about the service because of the different ways people communicated. A summary of what we found is set out below.

Is the service safe?

We spoke with the relatives of two people who used the service. One told us the service had improved recently. They said their relative had enjoyed their time there. Another told us they felt things had improved but they had concerns about the service’s ability to keep their relative safe. They told us their relative had complex needs and they needed to be closely monitored. The provider had developed a protocol for staff to follow. However, there had been two incidents one which resulted in a safeguarding referral. The person's support plan had not been revised as a result of the incidents to ensure their care was planned and delivered safely.

We found there were policies and systems in place to support people with their medicines. There were guidelines in place for ordering, receipt, recording, storage, handling and disposal of medicines. We reviewed these and found medicines were managed in accordance with the guidelines. This meant the service protected people against the risks associated with the unsafe management of medicines.

Personal evacuation plans were in place in the event of an emergency which were designed to keep people safe.

Is the service effective ?

We saw people had been assessed prior to moving to the centre and plans had been developed which identified the person’s individual needs. We saw risk assessments which had been completed to highlight what staff needed to do to keep people safe. We saw examples of support plans which had been reviewed and updated to reflect people’s changing needs.

Key workers were assigned to each person who were responsible for ensuring peoples’ needs were met as set out in their support plan.

There were a wide range of healthcare professionals involved in providing the service with advice and guidance on the most effective ways of supporting people. For example we saw the service had received an evidence based information leaflet to help support someone with a complex condition. The leaflet had been developed by a group of healthcare professionals who specialised in treating this condition.

Is the service caring?

We spoke with a person who used the service. They told us “Staff are kind to me”. They said “Staff take me into town shopping, I like shopping for clothes and shoes”.

We observed care staff interacting with people. Care staff knew the people who used the service well and could tell us about the person’s personality, family and when they first arrived at the centre. We saw that they understood what the person wanted and could interpret their behaviour. For example one person had returned to the centre and found their room door was open. We saw care staff realised this made the person feel insecure and they provided them with re-assurance and said they would speak to the other care staff about the importance of keeping their room locked.

One member of the care staff told us the service was applying for a silver dignity award. This was a scheme run by the local authority which assessed how well the service met a range of dignity and respect requirements. They told us they were a dignity champion which meant they were working on the application for the dignity award. They showed us the collection of pictures and photographs they were collecting to make display boards to illustrate things that were important to the people who used the service.

Is the service responsive?

The service had developed a questionnaire for obtaining the views of people who used the service for short respite. We saw many of these had been completed and people were happy with the care they had received.

Meetings were held every few weeks with the people who used the service. Records of the meetings showed meals, activities, trips and holidays had been discussed. We saw relatives were involved in regular meetings and were able to raise concerns. A relative told us things had improved but care staff did not always appear to understand some of the difficulties families experienced. Another relative told us they raised issues but did not feel these were strong enough systems in place to ensure these were fully addressed. They told us they had raised concerns about a person not having their own clothes. They said they had raised this a number of times but it had not been resolved, They also told us they had to ask care staff several times to arrange a dental appointment.

Is the service well led ?

Both relatives we spoke with told us the quality of the service had improved recently. One told us about the duty carer system which had recently been introduced. This meant a senior carer took overall responsibility for the service for the time they were on duty. We spoke with the person who was the duty carer. We saw the list of duties they had for the shift and they told us they were responsible for ensuring the safety and welfare for everyone using the service. They said they a list of people they could contact out of hours if an emergency occurred.

Quality visits were carried out every few months. These were conducted by a manager external to the centre, employed by the provider. We saw the reports from the last two quality visits. One was a themed review which looked at security at the centre. The most recent quality visit included a review of the environment, activities and complaints and identified the improvements required as a result of the visit.

The service provides short stay respite breaks as well as assessment and planning service for independent living. On the day of our visit ten people were residing at the service. Two people were on short stay respite and eight were undergoing assessment and planning. People who used the service told us that they liked it at the home. One person said, “It’s good here.” Another person said, “I really like it here.”

We saw people’s needs were assessed and individual person service plans were developed. These were written in a way that promoted each person’s independence and respected their privacy and dignity. Individual risk assessments were undertaken and control measures put in place.

The premises were purpose built and were accessible. Repairs and maintenance were undertaken by Derbyshire County Council's property services. Signage was used within the home to help people find their way around.

Safe staffing levels were maintained. Relief staff were used to cover absences and to enable people to attend appointments and activities.

Staff received regular training from Derbyshire County Council. Staff were supported through team meetings and supervisions.

We found systems were in place to assess and monitor the quality of service provision.

The people we spoke with said that their privacy and dignity was respected at Morewood Centre. One person told us, “Staff allow me time on my own.” People were involved, as far as possible, in planning their care. Staff respected their personal preferences and people thought that their needs were met. People were provided with a range of activities that were appreciated by them.

People told us they felt safe at Morewood Centre. They also felt well treated by staff: one person told us, “You can have fun with them.” Staff had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. Records we saw supported this.

People were asked for their views, and comments that they made were acted on. One person told us, “It’s nice here.”

People were involved in decisions about their care and treatment, and able to express their views. One person said ‘'staff discuss everything with me, and give me the information I need to make choices'’.

All comments we received relating to the care, support and services were very positive .One person said ‘'I like everything about the home and there's nothing I'd want to improve’'. A relative told us that ‘'the care and support my family member receives is excellent. My mind is at rest when they attend the centre. knowing they are well cared for. ‘' Another relative said ‘‘I am very pleased with the care and support and have no concerns'’.

The staff team are very good at their job; nothing is to much trouble. One relative described the staff and manager as ‘‘wonderful; I have never come across such a caring and committed team of staff’’.

People felt safe and able to report any concerns they may have to their social worker or to the person in charge.