Morton Cottage Residential Home

Morton Cottage Residential Home is a care home providing personal care for up to 32 older people, some of whom may be living with dementia. At the time of our inspection there were 20 people using the service.

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

The provider's systems for checking the quality of the service were not always followed. This meant audits and safety checks had not been carried out so improvements had not been put in place. There were shortfalls relating to the availability and maintenance of some records. These included recruitment and training records.

The premises had not always achieved good infection control measures. The provider was working closely with a local authority Infection Control officer to address the shortfalls.

People and relatives spoke positively about the staff and the home. There was a calm, friendly atmosphere at the home. People said they felt “safe” and “comfortable”.

There were sufficient staff deployed to meet people's needs including their emotional and social needs. Staff spent time with people and assisted them in a patient, unhurried way.

An electronic system was in place to manage medicines and people received these in the right way. There were some minor recording issues relating to medicines management, which the registered manager said would be addressed straight away.

People were supported to eat and drink enough to maintain their health. There was an emphasis on individual choices of meals and dining times.

People were assisted to access health and social care services when required. The provider and registered manager worked with other agencies to support better outcomes for people and were open and honest in their dealings with them.

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

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

Rating at last inspection

The last rating for this service was good (published 10 July 2018).

At our last inspection we recommended that home continue to seek the advice of the local authority in order to ensure that people's rights under the Mental Capacity Act are upheld. At this inspection we found the provider had acted on that recommendation.

Why we inspected

We received concerns in relation to the premises and infection control. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Morton Cottage Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

All staff and essential visitors used appropriate personal protective equipment (PPE).

The home had sufficient supplies of appropriate PPE which was stored hygienically and kept safe.

Staff were provided with separate areas to put on and take off and dispose of PPE safely.

Staff supported people's social and emotional wellbeing. Where people required additional support, they were referred to appropriate services.

The provider explained the quality systems they had in place to check the service was providing safe care.

Deep cleaning of all areas of the home was completed and recorded. The provider acknowledged that some redecoration was required to enable effective decontamination.

All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Further information is in the detailed findings below.

At the last inspection of this service in January 2017 we found two breaches of regulations relating to staff recruitment checks and to the governance of the home. The overall rating for the service at that time was 'Requires Improvement'. During this inspection we found improvements had been made in relation to the breaches and significant improvements had been made across the service as a whole. The overall rating has improved to ‘Good'.

Morton Cottage Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Morton Cottage Residential Home accommodates up to 32 people in one adapted building. There were 22 people accommodated at the home at the time of this inspection, some of whom were living with dementia.

The home had a registered manager who had been in this role for several years. 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.

All the people and relatives we spoke with felt the home was a safe and comfortable place to live. Staff were clear about how to recognise and report any suspicions of abuse. The provider carried out checks to make sure only suitable staff were employed. People were assisted with their medicines in a safe way. The home was clean and odour-free.

People told us they were happy with the care and felt there were enough staff to assist them. They told us staff responded quickly to any requests for support. People’s consent and permission was sought before staff carried out any care. If people were subject to any restrictions to keep them safe, such as bed rails, this had been arranged in people’s best interests. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was seeking advice from the local authority about people who may be under constant supervision, including people staying for a short-break. We have made a recommendation about this.

Before people moved to the home their needs were assessed to make sure the home could provide the right care. Staff said they had good training and support to care for people in the right way. Staff worked well with other health agencies and people were supported to access health services.

Relatives said the staff cared for people in an effective way and responded quickly to any changes in people’s well-being. People were supported to have enough to eat and drink. People said the meals were very good and they had choices about their meals and where to dine.

The provider and registered manager made good use of technology to support the service. This included a computerised medication system, computerised care records and use of a call alarm system that alerted staff by pager.

People felt the staff were caring and kind. There were good relationships between people and staff and there was a warm, uplifting atmosphere in the home. Staff spoke to people in a positive and friendly manner. People’s individual choices were respected and their dignity was upheld. Staff spoke about people with compassion and were sensitive to people’s needs at the end stages of their lives.

People received personalised care that was based on their preferences and needs. Staff were knowledgeable about people’s individual care needs and how they wanted to be assisted. People had opportunities to join in some activities, spend time in the garden or go out with staff from time to time. There were plans for this to be improved.

People had information about how to make a complaint they were confident that these would be acted upon. People and relatives felt the registered manager and director were approachable and asked for their views. Staff said the provider and registered manager were open and supportive. Staff said they enjoyed their jobs and felt valued.

The provider used quality assurance audits to continuously check the quality and safety of the service. People and relatives’ views were sought and acted upon. The provider and registered manager had plans to continuously improve the service for the people who lived there.

The inspection took place on 9 and 10 January 2017 and was unannounced.

At our last inspection of this service in July 2016 we found breaches in nine of the legal regulations including regulations around safe care and treatment, safeguarding, staffing and good governance. The service was rated as Inadequate and was placed in ‘special measures’. At our most recent inspection of 10 January 2017, we found that the registered provider had made improvements and progress towards meeting the legal requirements, although there remained breaches of two regulations around staff recruitment and good governance.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Morton Cottage Residential Home is registered to provide care and accommodation for up to 32 mainly older people, some of whom may be living with dementia. Accommodation is provided over two floors in single bedrooms with en-suite facilities. There are further communal facilities such as bathrooms, toilets, sitting rooms and a dining room available.

There was a registered manager in post 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.

After our last inspection of this home, the registered manager sent us an action plan describing how things would be improved. The action plan included actions to be taken, timescales to show when the improvements would be in place by and who was responsible for the improvements.

At this inspection we found that the provider had taken action to make significant improvements to the standard of care and safety at Morton Cottage Residential Home.

On the day of our visit the home was clean, tidy and there were no unpleasant odours. The housekeepers and care staff spoke to us about the changes and developments that had taken place to promote good hygiene and reduce the risks of cross infection.

Some areas of the home had been redecorated and new furnishings were in place. Dark corridors had been enhanced by new and more effective lighting. However, adaptations and environmental improvements to help support people living with dementia were limited.

We have made a recommendation that the service seek advice and guidance in relation to environmental adaptations to help meet the specialist needs of people living with dementia.

We found that staffing levels and staff deployment had improved, although the registered provider did not yet have a system in place to ensure this was consistently maintained as people’s needs changed.

We observed some good interactions and friendly exchanges between staff, visitors and people who used the service. Staff supported people with their mobility and care needs in a safe manner and also ensured that privacy and dignity was not compromised.

We saw that meaningful activities had started to be introduced at the service. The registered provider was able to show us that a programme of activities and entertainments was being drawn up but this was in the early stages of development. During our visit we noticed that there were few items in the communal areas of the home, for example books, magazines or jigsaws that would have provided some alternative and independent activities for people using this service.

We have made a recommendation that the service seek advice and guidance from a reputable source, and based on current best practice, in relation to creating a stimulating environment to help meet the specialist needs of people living with dementia.

Changes had been made to improve the ways in which people were supported with eating and drinking. People who used the service had access to dieticians and speech and language therapists when needed.

A new care planning system had been installed at the home. Staff had received training on the use of this system and we found that people’s care plans, risk assessments and other records had been reviewed and updated, to meet their individual needs. These records had been written in a person centred way and the information recorded had been checked with the person directly or with one of their close relatives where appropriate.

The people we spoke to during our inspection thought that the service had made significant improvements since our last visit. People commented on the improved staffing levels and cleanliness of the home. One person said; “It’s improved a lot lately, the home is much brighter and cleaner and there seems to be more people about.”

Visitors told us that staff kept them up to date with any concerns there might be regarding their relatives. They also told us that they were being encouraged to take part in the development and reviews of their relative’s care plans. Many of the people who used the service were not able to tell us about their experiences at Morton Cottage, but we did not see any signs of people feeling uncomfortable around staff.

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

A new system had been installed at the home to help improve the way in which people’s medicines were managed. Our pharmacist inspector reviewed this system and the associated records. They found that most medicines were managed safely. However, there were still some concerns around the management of topical ointments and lotions. We have made a recommendation about the use of and recording of prescribed creams and ointments.

The staff training programme had been reviewed and staff told us that they had recently attended many different training courses and refresher training. One member of staff told us; “There has been so much training to reinforce what you should be doing.”

We reviewed the staff recruitment practices that were in place at Morton Cottage. Although most checks had been carried out appropriately there remained some gaps that could have compromised the safety of people using this service. We found that staff were supported and regularly supervised in their work. This included staff meetings and direct observations of their practice to help ensure they carried out their role safely.

The service had made significant improvements to the systems in place to help monitor and improve the quality and safety of the service. Regular equipment checks had been carried out, the medicines were frequently audited and the registered provider carried out daily visual checks of the environment, cleanliness and staff competencies. Some work had been carried out around the management of environmental risks and risks to the health and wellbeing of people who used the service. However, there was further work needed, particularly around falls risk assessment and management.

We have made a recommendation that the service seeks advice and guidance from a reputable source about the management of accidents, particularly in relation to falls assessment and prevention.

We found breaches of regulation in relation to staff recruitment and good governance.

There is a registered manager in post 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.

This inspection took place over three days, 27 and 28 July and 11 August 2016. The inspection was unannounced.

We had previously carried out an unannounced comprehensive inspection of this service on 29 September 2015. Eleven breaches of the legal requirements were found. We judged that this service was “Inadequate” and Morton Cottage Residential Home was placed in special measures. We issued eleven requirement notices to the provider.

Requirement notices were issued as people who lived at the home did not receive respectful and dignified care or appropriate care and treatment that met their needs and reflected their preferences. People were at risk from unsafe practices relating to the control of infections and contamination, of having unlawful restrictions placed on their liberty and at risk as their nutritional and hydration needs were not met. People who lived at the home did not receive their care and support from people who had the skills, competence and experience to do so safely. The management of the service was not open and transparent, with no clear lines of accountability in place. There were no systems in place to effectively monitor and improve the quality and safety of the service and to ensure compliance with the requirements. The registered provider sent us an action plan to show how they would ensure compliance with these parts of the regulations.

Our unannounced inspection on 27 and 28 July and 11 August 2016 was a full comprehensive inspection. We found that improvements had not been made and breaches of the regulations continued. People who lived at the home did not receive care or treatment that had been personalised specifically for them. This placed people at risk of receiving care or treatment that did not meet their individual needs or expectations.

People who lived at the home did not receive care and treatment that ensured their dignity or treated them with respect. Procedures for obtaining consent to care and treatment did not always follow current legislation and guidance. This meant that people who used this service were placed at risk of receiving care or treatment that they had not agreed or consented to.

People who lived at the home were not protected from the risks of receiving unsafe care, treatment and avoidable harm. Medicines were not managed safely and people were placed at risk of not receiving their medicines as prescribed.

There were no systems in place to ensure people were protected from the risks associated with infection prevention and control. The premises were not clean and properly maintained. Equipment was not used properly or safely.

People who lived at the home were not always protected from the risks of abuse and improper treatment. The provider did not have effective systems and processes in place to monitor and assess the quality and safety of the service. This meant that the provider had no way of checking that they were keeping people safe or meeting the requirements of the regulations.

People were not provided with adequate support with their nutrition and hydration. This meant that people who used this service were placed at risk of malnutrition and dehydration.

The provider did not ensure that there were a sufficient number of suitably qualified, skilled and experienced persons deployed at the home. This meant that people who used the service did not always have their needs met appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

We have also made a recommendation in relation to risk assessing whether staff were safe to work with vulnerable people.

People who lived at the home told us the home was “alright” and that the staff were “very kind.”

We observed that staff were well meaning and we heard them speaking cheerfully and kindly to people. We also noticed appropriate interactions between staff and people who lived at Morton Cottage. Visitors to the home told us that their relatives seemed “happy” and that they had never seen anything at the home to cause them to worry. However this did not reflect our findings.

The service did not have an effective system in place to help monitor and improve the quality and safety of the service. We found that people did not always receive care, treatment and support that met their needs and preferences. Some people did not have care plans or risk assessments, whilst others were out of date and inaccurate. Medicines were poorly managed and people were placed at risk of not receiving their medicines as prescribed. We found that the home was not clean or properly maintained and staff did not always follow good hygiene practices. There were not always enough staff available to meet the needs of people who used this service and sometimes people had to wait for help.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We observed staff supporting people with their day to day needs. We saw that where possible, people were encouraged to do things for themselves. Staff treated people in a dignified and friendly manner. We observed and heard the good rapport between staff and people who lived at the home.

We found that although the provider had systems in place to monitor the quality of the service provided thorough audits and checks had not been carried out for some time. During our inspection we found areas for improvement that would have been identified if the auditing system had been maintained and effectively implemented. For example, record keeping and notifying CQC about adverse events at the home.

We noted improvements in the general environment at the home. New seating, dining tables and chairs had recently been purchased and the provider told us of the plans to purchase new profiling beds over the next twelve months.

The people we spoke to during our visit to Morton Cottage were all very happy with the home and the service they received. People told us;

'I am very satisfied. The staff are excellent. I don't need much help but they (the staff) are always there if I need them.'

'If I have any concerns the staff will listen and do something about it. They have been very good and I have no complaints.'

'It's homely here and very nice.'

'The carers are lovely girls and very helpful.'