The Moorings Retirement Home

The Moorings Retirement Home provides all single bedrooms with ensuite facilities, a range of suitable communal rooms and access to a garden.

We found the following examples of good practice

There were procedures in place to support safe visiting by people’s friends, family members or professionals. Staff undertook screening of all visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

People and staff were regularly tested for COVID-19. Staff had LFT testing at least three times a week as well as standard Polymerase Chain Reaction (PCR) tests weekly. The registered manager understood the actions they needed to take should any tests return a positive result.

The service had a good supply of PPE to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe at the time of this inspection.

The registered manager was aware of actions they should take should a person be admitted to the home or return following a hospital admission. The home had a range of lounges, a dining room and conservatory providing space for people to socially distance whilst in these communal areas. All bedrooms were for single occupancy.

The home was kept clean. Staff kept records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles.

The provider supported staff wellbeing. Staff had access to a mental health counsellor and could book massages from the inhouse massage therapist.

The Moorings Retirement Home is a residential care home providing personal care for up to 40 people aged 65 years and over including people living with dementia or a physical disability. At the time of the inspection there were 38 people living at the home.

The home is based over four floors. A passenger lift provides access to all upper floors. Most bedrooms had en-suite facilities and there is a variety of communal areas. Level access is available to an enclosed garden.

People’s experience of using this service and what we found

The environment was warm and homely. We observed positive communication between staff, people and their relatives. People and their relatives all gave us positive feedback about the home and told us that staff were kind and caring.

Individual and environmental risks were managed appropriately. People had access to any necessary equipment where needed, which helped ensure people were safe from harm. Staff had received fire safety training and knew what to do in the event of a fire.

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed. There were enough staff to support people’s needs. Staff had received training and support to enable them to carry out their role safely. They received supervision to help develop their skills and support them in their role.

There were appropriate policies and systems in place to protect people from the risk of abuse and the management team and staff understood the signs to look for.

People were supported to take their medicines safely and as prescribed. They were able to access health and social care professionals if needed, received enough to eat and drink and were happy with the food provided.

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

People's care plans contained detailed information about them and their care and support needs, to help staff deliver care that was individual to each person. The management team reviewed the

care and support provided to people to make sure it continued to meet their needs.

Staff showed an understanding of equality and diversity. People were treated with dignity, and their privacy was respected. Activities had been developed in line with people's wishes and there were varied and interesting options to promote people's health and well-being.

The management team (provider, registered manager, compliance manager and deputy manager) carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities. People and their relatives said the management team were approachable and supportive. Staff were very positive about the management team and also told us they were supportive and approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was requires improvement (published 9 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is registered to accommodate up to 39 people, including people living with dementia care needs. There were 38 people living at the home when we visited. The home is a large building, based on multiple levels. There is a range of communal areas where people can spend their time and all bedrooms had en-suite bathrooms.

The home had 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.

Although people told us they felt safe at The Moorings, we found not all staff were clear about the correct action to take in the event of a fire. Most other risks to people were managed effectively. The risks associated with some blood thinning medicines had not been assessed but this was addressed during the inspection.

There were clear recruitment procedures in place to help ensure only suitable staff were employed; however, these were not always followed.

Staff acted in people’s best interests, but did not fully follow legislation designed to protect people’s rights. Some staff did not demonstrate an understanding of related legislation designed to protect people’s freedom.

Staff were suitably trained and said they felt supported in their work. However, there was not a process in place to demonstrate that new staff had the necessary practical skills before they were permitted to support people on their own. Records of one-to-one meetings between managers and staff were not adequate to show staff had been offered appropriate support and personal development.

Although new quality assurance procedures had recently been put in place, these had not identified the concerns we found during the inspection. Therefore, the procedures had not been fully effective.

Staff felt motivated and were engaged in the running of the service; however, records of staff meetings did not demonstrate how issues raised by staff were progressed or resolved.

There were enough staff deployed to meet people’s needs. Staff knew how to protect people from the risk of abuse.

All areas of the home were clean and there were procedures were in place to protect people from the risk of infection.

People’s nutrition and hydration needs were met and people were satisfied with the quality of the meals.

Staff monitored people’s health and supported them to access healthcare services when needed. They also made appropriate use of technology to support people.

People consistently told us they were treated in a kind and compassionate way and we observed positive interactions between staff and people. Staff respected people’s privacy and protected their dignity.

Staff encouraged people to be as independent as possible and involved them in discussions about their care.

Staff knew people well and took a person-centred approach to the delivery of care and support. They responded promptly when people’s needs changed and were committed to supporting people at the end of their lives to have a comfortable, dignified and pain-free death.

People had access to a range of activities based on their individual interests and used creative approaches to engage people.

There was a complaints procedure in place and people told us they felt able to raise concerns. There was an open and transparent culture where visitors were welcomed. Positive links had been developed which benefited people.

The home had 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.

At our previous inspection on 26 & 29 June 2015, we found medicines were not always managed safely and staff were not following legislation designed to protect people’s human rights. The provider sent us an action plan detailing steps they would take to become compliant with the regulations. At this inspection we found action had been taken, but further improvement was required.

There were appropriate arrangements in place for the ordering, storing and disposing of medicines. However, there was a lack of information available to help staff know when to administer some medicines that were prescribed on an ‘as required’ basis. Staff were unable to confirm that hand written entries on people’s medication administration records were checked by a second member of staff and this had led to some discrepancies. The deputy manager had already identified these concerns and was taking action to address them. Time is needed for these improvements to be fully implemented and sustained over time.

There were not always enough staff in the evenings to meet people’s needs. The registered manager was in the process of recruiting additional staff to support people more effectively at this time. Time is needed for this work to be completed.

Risks to people were not always managed effectively. Special mattresses designed to reduce the risk of pressure injuries were not always set correctly. Staff did not monitor the fluid output of a person’s catheter to check it was operating properly. However, the registered manager took immediate action to rectify these issues.

The risks of people falling were managed effectively and appropriate action was taken when people had fallen. People were supported to take risks that helped maintain their independence.

People said they felt safe at The Moorings and staff knew how to identify, prevent and report incidents of abuse. The process used to recruit staff helped ensure only suitable people were employed. Staff knew how to deal with foreseeable emergencies, such as a fire, and had been trained to deliver first aid.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

People were satisfied with the meals and were supported appropriately to eat and drink enough. They were supported to access healthcare services and were referred to doctors and nurses when needed.

Staff were knowledgeable about people’s needs. They had received relevant training and were supported in their work through one-to-one sessions of supervision and appraisal.

People were cared for with kindness, patience and compassion. We observed positive interactions between people and staff. People’s privacy and dignity were protected at all times. They could choose the gender of the staff who supported them with personal care. Staff encouraged people to remain as independent as possible and involved them and their families (where appropriate) in planning the care and support they received.

People needs were met in a personalised way. Staff knew how people preferred to receive care and tailored their approach to suit people’s individual needs. They recognised that people’s needs varied from day to day and accommodated them accordingly.

Care plans provided comprehensive information and were reviewed regularly to help ensure they remained up to date. They included information about people’s interests and this had been used to arrange suitable activities. Links had been developed with the community, including with a local school, whose children visited regularly. This benefitted people, who enjoyed interacting with the children.

People felt the service was run well. There was a clear management structure in place and staff understood their roles. Staff spoke positively about the management of the home and worked well as a team.

There was an open transparent culture. Visitors were welcomed and there were good working relationships with external professionals. The provider notified CQC of significant events and they had clearly displayed the previous inspection rating for visitors to view.

There was an appropriate quality assurance process in place. This used a series of audits and spot checks to assess, monitor and improve the service. The provider sought and acted on feedback from people, and were continuing to develop the service.

At a scheduled inspection prior to that, in August 2013, we had identified concerns in relation to infection control. We set a compliance action and the provider wrote to us telling us how they were going to meet the requirements of that regulation.

During this inspection, in June 2014, we looked at outcomes relating to the care of welfare of people, the safeguarding of vulnerable adults, infection control, the levels of staffing, the assessing and monitoring the quality of service provision and the notification of incidents to CQC.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with 11 people who used the service, two family members of people who we were unable to communicate with us due to their mental frailty, seven members of staff and the manager. We also looked at four care plans and records relating to the management of the service.

We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

The service was safe because the provider ensured there were sufficient staff with the right skills to meet people's needs, and most risks were managed effectively. Equipment required to manage risks was readily available, such as walking aids and pressure relieving cushions. However, the provider may find it useful to note that not all staff were aware of whether bed rails should be used for one person and there was conflicting information in their care records. This meant the person may not have received consistent and safe care.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to an incident of potential abuse.

We found appropriate arrangements to manage infection control risks had been put in place. People were cared for in an environment that was visibly clean. Training records showed staff had completed training in infection control since our last inspection and best practice guidance was being followed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. One person was subject of a DoLS authorisation and we saw they were receiving appropriate monitoring and support.

Is the service effective?

The service was effective because people were cared for by staff who were knowledgeable about their needs and had the skills to provide appropriate care and support. People told us their (or their relative's) needs were met consistently. One person said, 'The care is good here.' Another person told us 'Anything you want they will get it for you ' they never say 'no' and there are no 'don'ts.' A further person said, 'The staff are very good, they talk to me respectfully.' A family member said, 'We're very happy with the care.'

Care and treatment was planned and delivered in line with people's individual care plans. We looked at care plans and related records of care for four of the 30 people living at the home. We saw pre-admission assessments were completed and information from other agencies was taken into account when planning people's care. Records of care delivered confirmed people's care plans had been followed.

Is the service caring?

We found people were supported in a kind and caring way. One person said of the staff, 'If you want to do things yourself they help you.' Another person told us 'I like it very much here; staff are very nice, very kind, very thoughtful'. A further person said, 'The staff are very good, they talk to me respectfully.'

We observed care and support being provided in communal areas. We saw staff interacting with people, using people's preferred names and speaking with them in a calm and respectful way. At lunchtime they took time to sit and engage with people who needed support. We saw a staff member approach a person who was carrying a glass of water; they offered to refresh it and carry it down to the conservatory for them. This showed people were treated with compassion.

People had a choice of how they spent their day and where they spent their time. The most popular lounge had old songs playing on the sound system. We spoke with the people in there who told us they liked this.

Is the service responsive?

The service was responsive to people's changing needs. We saw assessments were carried out before people moved into the home and their care plans were updated monthly. One person had recently had a comprehensive review of their care. New care plans had been completed or revised to ensure each of their individual needs were identified and assessed.

Opportunities were provided for people to express their views and influence the way the home was run. For example, after suggestions made at a residents' meeting, we saw a 'cake trolley' had been introduced and plans had been put in place to increase the range of activities available to people.

The provider may find it useful to note that two people told us they were sometimes attended to by male members of staff but would prefer female care staff. The manager agreed to make arrangements for these people to receive personal care from female care staff.

Is the service well-led?

The home did not have a registered manager in post at the time of our inspection. However, the current manager had applied to be registered and was awaiting completion of this process. This would ensure the service met the conditions of their registration.

Staff told us they were supervised effectively. One staff member said, 'The manager's good; they're always reminding staff about things and teaching staff how to do things.' Another staff member told us 'The manager's on the ball. They identify issues and deal with them immediately so they don't fester.' This meant people benefitted from staff who were well-led.

The provider used a system of audits to monitor the quality of service provided. An infection control audit had been completed in May 2014. Audits of a wide range of other aspects of the service, including care plans, supervision and medication, had been completed shortly before our inspection. The manager described how these would be used to identify and make improvements.

The provider took account of complaints and comments to improve the service. We saw records showing complaints were recorded, investigated and resolved in a timely way, although one person told us a complaint they had made had not been resolved.

Providers are required to notify CQC of a range of incidents, including those where people using the service were abused or seriously injured. We viewed records of incidents of serious injury, abuse or alleged abuse that were required to be reported to CQC. We found all incidents had been reported, apart from one incident of alleged abuse. However, the incident had been reported to the local safeguarding authority and other appropriate action had been taken.

People using the service were mainly older people, many of whom were living with dementia and required full assistance with personal care. The home was a large building, based on multiple levels. The floors were connected by numerous flights of stairs (for staff use) and two passenger lifts. At the time of our inspection, 34 people were being accommodated.

We spoke with 16 members of care staff, eight people using the service, three family members and two external healthcare professionals. We also looked at nine care plans and a file containing night care plans for 22 of the 34 people using the service.

The risk of people falling was not being managed effectively. We found four people had suffered multiple falls, some of which had resulted in serious injury. Reviews were not conducted when people had suffered falls to ensure preventative measures were put in place. Equipment used by people to aid their mobility and reduce their risk of falling was not always available.

The provider did not respond appropriately to incidents of abuse where people were assaulted or abused by other people using the service. Risk assessments were not put in place and incidents were not reported to the local safeguarding authority in accordance with the multi-agency procedures.

The home's policy on the use of restraint was not being followed by staff. This put people at risk of being restrained unlawfully.

There were not enough qualified, skilled and experienced staff to meet people's needs at all times. People were put at risk by a shortage of staff, particularly in the evenings. One person said, 'Staffing has been short lately so things take a little longer'. A family member told us 'I'm concerned about staffing levels, especially in evening when there's only three staff with residents who need a lot of help. [Staff] do their best, but there's not enough of them'.

Providers are required to notify CQC of a range of incidents, including those where people using the service are abused or seriously injured. Records showed the provider had not notified CQC of incidents or allegations of abuse.

In this report the name of a registered manager appeared who was not in post and not managing the regulatory activities at this location at the time of the inspection. This was because they were still a registered manager on our register at the time of this inspection.

During this inspection we found improvements had been made, but the provider had not completed all of the actions specified in their report.

We found most areas of the home were visibly clean and had been well maintained. We looked at the laundry and saw hand washing facilities had been installed since our last inspection. The procedures for dealing with soiled linen complied with best practices guidance.

We spoke with six members of staff who told us they had received training in infection control and had access to equipment to control the risk and spread of infection. We saw the home's infection control policy had been updated and was supported by risk assessments and cleaning schedules.

However, we found eight armchairs in the main lounge were heavily worn with ground-in dirt on the arms, and a carpet and a bed base were stained with urine.

An infection control audit had not been conducted, and no annual statement on infection control had been completed. The provider was, therefore, unable to demonstrate that their systems for controlling the risk and spread of infection were effective.

We saw staff interacted warmly and positively with people throughout the day and people were treated with respect. One person said, 'I'm treated just how I want to be. I've always said treat people how you'd want to be treated yourself and that's what they do here'.

We spoke with the manager and three members of care staff. Each demonstrated a good understanding of the care and support needs of people in their care. People told us their needs were met. One family member said of the care, 'It's brilliant here, we can't fault it'.

All areas of the home were visibly clean. However, we found people were not protected from the risk of infection because appropriate guidance had not been followed. The home's infection control policy was out of date and there were no hand washing facilities in the laundry.

We saw the home was adequately maintained and found the environment was safe and fit for purpose. Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place.

There were effective systems in place to assess and manage most of the risks to the health, safety and welfare of people using the service. Reviews of care plans included opportunities for people to comment on the care they received. One comment said, 'Happy, enjoy the food and company of staff'.

We visited the home again on 28 December 2012. On this occasion we found that people's dignity was respected and they were involved in decisions about their care. We spoke to the provider and four members of staff, including the acting manager. We also spoke to five people who used the service and one relative who was visiting. They all told us they were happy with the care provided. One person told us 'The staff are wonderful'.

We saw that people's care was regularly reviewed, and that they were involved in the review process. However, we noted that care plans indicated that people had not been involved in the initial planning of their care.

A new private consulting area had recently been created which could be screened off. This allowed people to be seen by visiting doctors and nurses in privacy.

We looked at four care plans and three staff files. We found that they contained relevant information, were accurate and fit for purpose. Other records relating to the management of the service were also viewed. They were found to contain appropriate information, and were readily accessible. All records were held securely in a locked office.