What life is like for people using this service:

People told us of a variety of reasons they felt safe at the home. They said they felt safe because of the quality of the care and support they experienced and because the staff were well trained. They told us their valuables and possessions were safe. People felt there were enough staff and that staff were attentive to their needs. Staff knew how to protect people from harm. People had their medicines on time. The home was clean, tidy and fresh.

People had a choice of healthy meals and their dietary requirements were met. The staff were knowledgeable about people’s food preferences. People had meals that met their cultural needs and were able to have their favourite meals. Staff made sure people saw their GPs and other healthcare professionals when they needed to.

People said they liked the way the with home was decorated. We saw that the home was well-maintained.

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

The staff treated people with kindness and respect. People told us that staff spent time to have conversations with them which they enjoyed. Staff checked that people were warm and comfortable. Relatives could visit the home at any time and were made welcome by staff. Staff encouraged people to mix with others; people formed friendships with other people. We saw lots of interactions between people.

People took apart in activities. They joined in with games that promoted movement and exercise. We saw people reading, watching television and talking with other people and staff. People who wanted were supported to follow their faith needs.

The provider and registered manager ensured information was provided to people in a way they found accessible. People’s care plans included ‘communication passports’ which explained how they wanted staff to communicate with them.

People told us that if they had any complaints about the service they would tell the registered manager or staff.

People told us they were happy living at the home and felt well-cared for.

The registered manager carried out audits to assess the quality of people’s experience of the service. They carried out checks to ensure the premises were safe. The registered manager was supported by a senior manager who also carried out audits to verify what the registered manager reported to them. We found that the service had not informed CQC of four of incidents between people which fell into a category of abuse.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

About the service:

Moriah House is a registered care service providing care for up to 50 older people. It is situated in a residential area of Carlton, a suburb of Nottingham. On the day of our inspection visit there were 33 people using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at last inspection: Good (report published on 19 May 2016)

More Information is in the detailed findings below.

We inspected the service on 30 March 2016. Moriah House Limited is a care home (without nursing) for older people, some of whom are living with dementia. Moriah House Limited provides accommodation and personal care for up to 39 people. On the day of our inspection there were 25 people who were using the service.

The service had a registered manager at the time of our inspection and an acting manager who was planning to apply to become registered. 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.

When we last inspected the service in February 2015 we found there were improvements needed in each of the five key questions we ask of services; whether the service is safe, effective, caring, responsive and well led. We found at this inspection that the provider had made the necessary improvements to the service.

People felt safe and were protected from the risk of abuse by staff who had a good understanding of their roles and responsibilities if they suspected abuse was happening.

The risks to people were reduced as staff understood risks that people may face and took action to ensure people’s safety. People received their medicines as prescribed and these were managed safely.

There were sufficient staff on duty to meet people’s needs and the number of staff required in the service was monitored by the registered manager.

People’s right to make decisions was respected and legislation to protect people who lacked capacity was being adhered to. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

Staff received training and supervision to ensure they had the appropriate knowledge and skills to provide people with safe and appropriate care.

People were encouraged to have sufficient to eat and drink and their health was monitored. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were treated with dignity and respect and had their choices acted on. We saw staff were, attentive, kind and supportive in their interactions with people.

People’s preferences as to how they received support were respected and we found that people were provided with stimulation and activities which reflected their interests and the level of support required.

People were given opportunities to express their views and be involved in the running of the service and there was evidence that action had been taken in response to people’s views. There were effective systems in place to monitor the quality of the service.

We inspected the service on 17 February 2015. Moriah House Limited is a care home (without nursing) for older people with or without dementia. Moriah House Limited provides accommodation and personal care for up to 39 people. On the day of our inspection there were 28 people who were using the service.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager left the service in June 2011. There was an acting manager in post to manage the service who had not applied to become the 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 and associated Regulations about how the service is run.

When we last inspected Moriah House Limited in August 2014 we found there were improvements needed in relation to staffing, assessing and monitoring the quality of service provision and records. The provider sent us an action plan telling us they would make these improvements by 30 November 2014. We found at this inspection that this had been completed and the provider had made all of the improvements in line with their action plan.

There were systems in place to provide people with the healthcare they required but we found examples where these had not been followed, which meant people did not receive the healthcare they needed. Staff understood the risks people could face through everyday living, but they did not always follow the actions needed to ensure their safety.

Staff knew how to keep people safe and to raise any concerns if they suspected someone was at risk of harm or abuse.

There were sufficient staff on duty to meet people’s needs. More staff had been employed since our last visit and action had been taken to ensure the right number of staff were on duty.

People received their medicines when they needed them. These were administered safely and in a sensitive manner.

People’s right to make decisions when they were able to was not protected because the legislation for this had not been correctly implemented. Staff received training and supervision to ensure they had the knowledge and skills to provide people with safe and appropriate care.

People were encouraged to have sufficient to eat and drink so that their health and well-being was maintained. Systems were in place to monitor and respond to any unwanted changes in people’s weight.

Whilst we saw people being treated with compassion and respect we also saw occasions where people did not receive their care and support in a compassionate way or have their dignity respected and promoted. People were not as fully involved in planning their care as they could be.

There were occasions when people did not receive their care and support when they wanted this, and there were not enough opportunities for people to follow their hobbies and interests. We found examples where people’s care plans were not accurate and these did not provide staff with the direction about people’s care they should.

People felt their concerns were acted upon and taken serviously, and we saw where complaints had been made these had been addressed and acted upon.

People who used the service, relatives and staff were able to express their views on how the service was run and felt there had been improvements made since our last inspection. There were systems in place to monitor the quality of the service and identify what was working well, and if any improvements were needed.

You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six of the 33 people who were using the service and four relatives or friends who were visiting and asked them for their views. We also spoke with six care workers, a cook, two deputy managers and the manager. We looked at some of the records held in the service including the care files for six people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

The home does not currently have a registered manager in post, however the current manager has managed the home for over six months and is in the process of applying to become the registered manager.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found-

Is the service safe?

The care planning system was thorough and action was only planned following an appropriate assessment of any risk. We saw there were systems to review care plans and analyse any incidents, such as someone who was at risk of or had fallen.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the provider had effective systems to involve people in planning their care, and obtaining people’s consent for this to be provided. A staff member said, “We have to act in people’s best interest if they are unable to decide for themselves.”

We found staff were effective in meeting people’s needs. A person who used the service said, “I wash myself in the mornings and have a bath every week. I get help to have my hair washed.” Staff followed a recognised approach for working with people who had dementia. This promoted their dignity and ability to continue to do as much as they could for themselves.

Staff received effective support to enable them to carry out their duties. A staff member said, “We get guidance sometimes on how to do things a better way.” A person who used the service said, “I think staff know what they are doing.”

Is the service caring?

During periods of observation we saw staff responding appropriately to people’s needs. We saw another person was hoisted in a sensitive and caring way. A person who used the service said, “Staff speak very nicely, there is nobody who doesn’t. I am very comfortable here.”

Is the service responsive?

We saw staff asking people’s permission before they provided them with any support. A person who used the service said, “I am asked first, I always say yes, but it is nice to be asked.”

Care plans described how staff should respond to people’s identified needs. A person who used the service said, “I’m alright, I have got a lot of independence.”

The current duty rotas showed the intended level of staff cover was not always provided. A person who used the service said, “They (staff) have to work very hard.” A staff member said, “We provide good care, except when we are short staffed.”

Is the service well-led?

The care planning system was thorough and action was only planned following an appropriate assessment of any risk. Staff told us the care plans were suitable and they were easy to follow. One staff member said they were, “Informative and easy to read.”

An auditing system was being introduced to ensure the service was well led through an effective quality assurance system. However we found some records were not completed as required and others were not audited to ensure people received the care and support they required.

The provider responded to the views of people who used the service. A person who used the service said, “I feel listened to.”

One person told us, “Staff listen and ask me what I want.” However, another person told us, “Staff tell me when to get up in the morning, about 6am. Staff know I don’t want to get up then but I can’t choose.” We looked at six people’s care plans and saw that Mental Capacity Act (2005) assessments had not been completed in any of the care plans we looked at.

We looked at the records for six people who used the service. The records were not kept up to date as care needs changed. People’s needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan.

During our tour of the premises we observed that the environment in communal and individual bedrooms looked generally clean.

We observed one staff member who was based in the conservatory/dining room during lunch. The staff member left the conservatory/dining room regularly throughout lunch which meant people did not receive assistance in a timely manner and staff were not always available to help.

Two of the three staff we spoke with told us they had not had any supervision meetings recently. Only one staff member had had an appraisal. We looked at the staff files and did not find evidence of supervision meetings or appraisals.

The latest complaints policy, which had been reviewed in April 2013, provided appropriate guidance about the complaints procedure at the home.

We saw that care plans, associated risk assessments and records related to support people needed all contained gaps. People’s personal records were not accurate nor were they fit for purpose.

We visited the location to carry out a responsive review as we had received some concerning information in respect of the quality of care delivered to people using the service.

People told us they could choose what time they got up in the morning. One person said, “You can please yourself what time you get up in the morning.”

Two people who use services told us there were enough staff. However, one person said, “They’re sometimes a bit short.” Another person said, “You sometimes wait a long time to go to the toilet.”

People told us they were receiving good care. One person said, “Staff look after you well and people that need extra attention get it.” Another person said, “I can’t fault the care. I’ve been very happy since I got here.”

We found that there were not enough qualified, skilled and experienced staff to meet people’s needs at all times. We also found that people were cared for by staff who were not fully supported to deliver care and treatment safely and to an appropriate standard. Not all staff had received regular supervision and appraisal. A number of staff had not attended all mandatory training.

We found that the provider had notified the Care Quality Commission of events that required notifications to be made under the Care Quality Commission (Registration) Regulations 2009.

We visited the location to carry out a follow up review in respect of a compliance action set at the previous inspection visit. We had also received some concerning information in respect of the quality of care delivered to people using the service.

Due to the complex needs of some people living at Moriah House they were unable to talk with us. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out this observation for a period of two hours.

We also spoke with three people using the service to establish their views and experiences.

We consulted with three members of staff in respect of their job roles and the support they offered to people using the service.

People using the service said they had received all of the information they needed before they made a decision to use the service.

People said staff listened to them, involved them in their care delivery and supported them in a way they preferred. One person said they could express their views in respect of the care and support they received, “Staff come and talk to me about my care plan so I can tell them what I want.”

Two people said they felt they were involved in any decisions about their care and support, “The staff are very good, I have my freedom and can make my own choices which helps me maintain my independence,” and “I get enough information and I can discuss the things that are important to me, I can make my own choices and decisions.”

All three people spoken with said activities were on offer if they chose to join in them and they were happy with these.

All three people also said they felt safe living at the care home and that staff would listen to them if they had any concerns. They said enough staff were available to help them when needed, “There are enough staff to help me,” “The staff are lovely, I get help when I need it, I have no problems,” and “There are enough staff, I do not have to wait long for help when I need it.”

People using the service said staff were approachable and they could offer feedback about the service at any time. One person said they knew feedback was being acted upon as they always got an update of the action taken after each ‘residents meeting’.

During our SOFI observations the atmosphere in the home was calm and friendly and staff supported people as needed. We saw people using the service were offered choices in respect of the care and support they received. Staff offered time for people to make decisions and they provided explanations as necessary to ensure people understood the choices available to them.

There were times when some people had little interaction with staff unless they needed assistance which meant they spent a lot of time either sleeping or watching what was going on around them. We found people spent time in a positive mood when they were joining in activities as they showed obvious enjoyment and pleasure.

With the exception of one occasion we saw staff treated people with respect and courtesy. The one occasion where this did not happen was due to the staff member being focussed on the task they were doing for the person rather than engaging with them in a meaningful and respectful manner. This issue was discussed with the manager so they could follow this up.

Due to the complex needs of some people living at Moriah House we were unable to talk with them and gain their views. We therefore spent time observing how they spent their day and the support they received from staff.

We also spoke with five people using services and they all said they were happy and settled living at Moriah House.

One person told us they had previously stayed at the home on respite care, so knew all they needed to about the home before they made the decision to move in permanently.

One relative told us they had visited the home before their relative moved in and they had received all the necessary paperwork and information needed.

One person said staff cared for them in a way they liked and they always asked for permission before they helped them. Another person said, “My needs are met, you couldn’t have a nicer place, the staff are always here to help, they are fantastic.”

People using the service said that staff knew what they liked and they supported them in the way that they preferred.

One person said, “There are not many activities I like doing, I could do with more.” Whereas two other people said, “I join in activities and I enjoy them,” and “I enjoy the activities they are not bad at all."

People spoken with said they knew who they could speak with if they were unhappy about any aspect of their care.

One person told us they felt safe living at the care home.

One relative told us they had experienced a time when another person using the service had exhibited challenging behaviour towards them. They said they had felt reassured that staff were to hand and that they diffused the situation quickly.

One person said staff were nice and friendly. Another person told us, “You can’t fault the staff, I enjoy my life here.”

One person said, “There are enough staff to help me as needed, I do not have to wait long for assistance.” Whereas another person said, “The staff are working very hard, they are short at times, but my needs are met and we do not have to wait long for help.”

One relative said the staff were friendly and they made them welcome when they visited.

One person said, “I attended the meeting today and had a say, I know who to complain to if I was unhappy, however I have no issues of concern.” Another person told us, “I attend the meetings, we can have a say in what things we do and any improvements we feel need to be made.”