About the service:

The Moreton Centre provides nursing and personal care for up to 64 people who live with dementia and people who live with a mental health diagnosis. The home is purpose-built over two floors and divided in to four separate units. There were 55 people living at the home at the time of the inspection with a range of complex mental health and health care needs. This included people who have had a stroke, acquired brain injury, who live with diabetes and for those approaching end of life. Ash unit provided accommodation for both male and female people living with dementia. Maple unit accommodated younger people with a mental health diagnosis and behaviours that may be challenging. A further two units, Willow and Oak provided single sex accommodation for those with a mental health diagnosis and behaviours that were challenging. People required varying levels of help and support in relation to their mobility and personal care needs.

People’s experience of using this service:

• The providers’ governance systems had not identified the shortfalls found at this inspection. There was a lack of clear and accurate records regarding some people's care and support. The management of behaviours that challenge were not always documented clearly and lacked details to manage them effectively.

• People’s health, safety and well-being was not always protected, because there were areas of the home that were not clean and some furniture that posed an infection control and choking risk due to split covers. People were placed at risk because some areas of the home that contained cleaning fluids and other items that may be harmful to people had been left open and people could access them.

• Risk of harm to people had not always been mitigated as good practice guidelines for the management of diabetes, behaviours that challenge, use of restraint and the use of covert medicines had not always been followed, This meant that people's safety and welfare had not been adequately maintained at all times.

Whilst there were areas of care planning and assessing risk to people that needed to be improved , there was also systems to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, these incidents and accidents were recorded, and lessons were learned.

• There were sufficient staff to meet people’s individual needs: all of whom had passed robust recruitment procedures which ensured they were suitable for their role.

• Staff received appropriate training and support to enable them to perform their roles effectively. Visitors told us, “Staff seem knowledgeable, look after my relative really well,” and “The staff team seems to have really improved.”

• People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave very positive feedback about the food. Comments included, “Good food,” “I like the food” and “Not bad, large portions, plenty of food”

• People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback. One person said, “We are looked after.”

• People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families. One person told us. “Staff help me to ring my family."

• People's care was person-centred. The care was designed to ensure people's independence was encouraged and maintained. Staff supported people with their mobility and encouraged them to remain active.

• People and families were involved in their care planning as much as possible. End of life care was planned for and staff confirmed they received training.

• Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT). Notifications had been

The Moreton Centre provides nursing and personal care for up to 64 people who live with dementia and people who live with a mental health diagnosis. The home is purpose-built over two floors and divided in to four separate units. The home was laid out in a style that meant people who liked to walk around could do so without encountering barriers. The corridors were wide enough to allow and encourage this and provided quiet areas for people to sit if they wished to. There were 57 people living at the home at the time of the inspection with a range of complex mental health and health care needs. This included people who have had a stroke, acquired brain injuries, who live with diabetes and for those approaching end of life. Ash unit provided accommodation for both male and female people living with dementia. Maple unit accommodated younger people with a mental health diagnosis and behaviours that may be challenging. A further two units, Willow and Oak provided single sex accommodation for those with a mental health diagnosis and behaviours that were challenging. People required varying levels of help and support in relation to their mobility and personal care needs.

There is a registered manager at the home. 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 Morton Centre was last inspected in August 2015. Three breaches of regulation were identified and it was rated as ‘requires improvement’ overall. We asked the provider to make improvements to ensure that medicines were handled safely and that there were sufficient staff to provide safe care and treatment. We also asked that improvements be made to the organisational quality assurance systems that were used to protect people from harm.

The provider sent us an action plan stating they would have addressed all of these concerns by January 2016. At this inspection on the 20, 21 and 22 September 2016, we found that improvements had been made and the breaches of regulation were met.

It was clear staff had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing support needs. People’s health and wellbeing carefully monitored and staff regularly liaised with a range of healthcare professionals for advice and guidance. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in people’s best interests.

People were provided with opportunities to take part in a range of activities and hobbies and to regularly access the local and wider area.

Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. .

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements

The Moreton Centre provides nursing and personal care for up to 64 people who live with dementia and people who live with a mental health diagnosis. The home is purpose-built over two floors and divided in to four units. The home was laid out in a style that meant people who liked to walk around could do so without encountering barriers. The corridors were wide enough to allow and encourage this and provided quiet areas for people to sit if they wished to. There were 54 people living at the home at the time of the inspection with a range of complex mental health and health care needs. This included people who have had a stroke, acquired brain injuries, who live with diabetes and for those approaching end of life. Two units, Maple and Ash provided accommodation for both male and female people living with dementia. Maple unit accommodated younger people. A further two units, Willow and Oak provided single sex accommodation for those with a mental health diagnosis and behaviours that were challenging. People required varying levels of help and support in relation to their mobility and personal care needs.

There is a registered manager at the home. 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 registered manager was known as matron and will be referred to as matron throughout this report.

This was an unannounced inspection. The inspection took place on 26 and 28 August 2015.

People’s safety was being compromised in a number of areas. Whilst people’s medicines were stored safely and in line with legal regulations, we found discrepancies in the management of controlled medicines and in the medicine administration records (MARs). We also found poor recording of skin creams and dietary supplements. A recent audit undertaken by the clinical lead had identified poor recording on MAR records and had addressed this with the staff concerned with supervision, further training and competency.

Staff deployment over the past three months had been an issue recognised by the organisation. This was because two registered nurses (RN’s) had left and a third was on maternity leave. This meant that the service operating with one RN on day duty instead of the two registered mental health nurse (RMN) identified as required when registered by the CQC. There were times when there was no RMN on duty. The units at this time were overseen by senior care staff whilst one registered nurse had overall responsibility for care to the people who lived in The Moreton Centre. Senior care staff administered medicines and ran the units whilst the RN undertook wound care, dressings and insulin management. The RN was not able to monitor and ensure that all units were running effectively and staff were delivering safe care.

We found that whilst risk assessments had been undertaken and risks for one person with complex needs identified, the care plan for this person was not in place and therefore staff lacked the information and guidance required to promote the person’s health and well-being. Specialist equipment such as pressure relieving mattresses to prevent pressure damage was in place when identified as required, but not all was being used in a safe way. For example, mattresses were set on incorrect settings recommended by the manufacturer. This may contra indicate the specific reasons for use. There was also no evidence that that the settings of equipment were being checked regularly.

Whilst there were quality assurance systems in place, they had not identified the shortfalls we found. We found that people’s safety was potentially at risk from poor medication practices and care plans were lacking in specific information that had the potential to cause harm to the individual. The registered manager acknowledged they had identified some medication and poor leadership skills through the audits and addressed them through supervision. The audit systems had failed to protect all people from harm.

People were looked after by staff who knew and understood them well. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. Care plans were personalised and reflected people’s individual needs and preferences. These were regularly reviewed.

There was enough staff to look after people. They had been safely recruited and were safe to work with people. Staff were well supported by the managers and colleagues. They received appropriate training to enable them to meet people’s individual needs.

People were supported to take part in a range of activities, maintain their own friendships and relationships.

People had their nutritional needs assessed and monitored and were supported to enjoy a range of food and drink throughout the day. Mealtimes appeared to be pleasant and relaxed occasions.

There was an open culture at the home and this was promoted by the manager and deputy manager who were visible and approachable. People and staff spoke positively of the management structure at The Moreton Centre.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.