Archived: Moorland Nursing Home

Updated 4 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over five days on 12, 13, 14, 17 and 21 June 2017. The first day of the inspection visit was unannounced.

One adult social care inspection manager and two adult social care inspectors carried out the inspection.

Prior to our inspection, we reviewed all the information we held about the service. This included notifications the registered provider had sent us. We also reviewed information provided by the safeguarding authorities. Concerns had been raised that people at Moorland Nursing Home were not safe.

To ensure people who lived at Moorland Nursing Home were not exposed to the risk of harm, the local authority deployed social care staff and managers and the Commissioning Group (CCG) sourced agency trained nurses to work alongside Moorland Nursing Home staff.

During the inspection process, we spoke with three managers and two care staff from Lancashire County Council and two agency nurses. We were in regular communication with staff and management from the local authority and the local Clinical Commissioning Groups (NHS Blackpool CCG and NHS Fylde and Wyre CCG). We also spoke with two visiting professionals.

During our inspection visits, we spoke with seven people who lived at Moorland Nursing Home and nine relatives to seek their opinion of the service. Not everyone who lived at the home was able to tell us about their experiences of life at the home. We therefore carried out observations of how the staff interacted with people who lived at the home and how people were supported during meal times and during individual tasks.

We spoke with a range of staff at the home. This included the director of the company, the area manager, seven nurses employed at the home and six staff members.

To gather information, we looked at a variety of records. This included care plan files related to six people who lived at the home. We also looked at medicine administration records related to people who received support from staff to administer their medicines.

We viewed recruitment files belonging to three staff members and other documentation relevant to the management of the service. This included health and safety certification, training records, team meeting minutes, accidents and incidents records and findings from monthly audits.

We looked around the home in both communal and private areas to assess the environment to ensure it met the needs of people who lived there.

Updated 4 August 2017

The inspection visit at Moorland Nursing Home took place on the 12, 13, 14 17 22 and 27 June 2017. The inspection was unannounced on the first day with the following visits being announced.

Prior to the inspection taking place, we received several concerns about people’s safety and the management of the service. We carried out this inspection to check people were not at risk of receiving unsafe care.

Moorland Nursing Home is situated in a residential area in Poulton-le-Fylde. The service provides accommodation for up to 22 people. It is a care home that provides nursing and personal care. All areas of the home are accessible and there are aids to assist people with their mobility. Some rooms have en-suite facilities. There were 13 people residing at the home.

There was no registered manager at the time of the inspection. There had been no registered manager in place since May 2015. We were made aware by the registered provider an application had been submitted to register a new 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 this inspection visit carried out in June 2017, we found breaches in the regulations relating to safe care and treatment, person centred care, dignity and respect and safeguarding service users from abuse and improper treatment. We also found breaches in the regulations related to meeting nutritional and hydration needs, premises and equipment and good governance. There were further breaches in the regulations related to staffing, fit and proper persons employed, requirement as to display of performance assessments and notification of other incidents.

We looked at how the registered provider managed risk. The registered provider had failed to ensure risks were appropriately addressed to mitigate and manage risk. During the inspection process, we were informed one person who was living with dementia, left Moorland Nursing Home unsupported and the environment was not secured to prevent a reoccurrence of the incident.

Moorland Nursing Home had not been well led. There was no visible leadership and there was a lack of continuity in managerial and clinical oversight. The registered provider did not have robust arrangements to take appropriate timely action if there was a clinical or medical emergency.

We looked at how medicines were managed. We observed medicines being administered and noted the nurses did not follow good practice. They handled tablets and signed medicine administration forms before administering medicines. Documentation in relation to medicines was not robust and did not clearly guide staff about the administration of medicines, creams and powders.

Concerns related to a nurses clinical skills were disclosed during this inspection. They stated the nurse on shift failed to complete a clinical task safely. They raised additional concerns that the correct dressings were not available to manage people’s ongoing care requirements.

We looked at how the registered provider recruited staff. They had not documented staff members’ full employment histories, or gathered written explanations of any gaps in employment. One staff member’s application form was not in their file and the provider was unable to supply this during our inspection. We could not find information related to their Disclosure and Barring Home check (DBS) for one member of staff.

The systems the registered provider had in place to monitor and improve the quality of the service, were ineffective. The registered provider had failed to ensure all nurses working at Moorland Nursing Home maintained their professional registration with the nursing and midwifery council (NMC).

Staff actions meant people were not protected from malnutrition and dehydration. People were not always presented with food in a way that was easy to eat safely.

We found people’s dignity was not always respected and promoted. One person was provided with continence aids designed for an animal. The registered provider failed to ensure people were free from inhuman or degrading treatment (protected by Article 3 in the Human Rights Act).

Feedback from people who lived at the home indicated they were not always treated with dignity and respect. One person had their independence restricted preventing them from using the toilet independently. People expressed concern staff who spoke English, as a second language did not fully comprehend English. This affected how they engaged with people and hindered people’s ability to express their views.

We looked at staffing levels at Moorland Nursing Home. The registered provider did not continuously review staffing levels to respond to the changing needs and circumstances of people living at Moorland Nursing Home.

As part of our inspection, we had a walk around the home. We witnessed bedroom doors were lodged open with wooden wedges. Wedging or propping open a fire door can prove devastating as it allows fire to spread unchecked, putting lives and buildings at risk. We noted fire exits had had their alarms disabled.

As part of this inspection, we looked at audits. We noted some audits did take place, however, the information did not reflect our findings. Effective auditing systems were not consistently carried out to ensure care delivered was safe and person centred.

During the inspection visit, we were made aware of an incident whereby police had been called to the home to provide assistance. This was a notifiable incident, which should have been reported to CQC. This had not been completed.

As part of the inspection, process we looked to ensure the registered provider was meeting their statutory requirements in displaying their CQC rating. They did not have this on full display on the website as stated within the guidance.

Staff received training related to their role and told us they were knowledgeable about their responsibilities. However, staff failed in their responsibilities to identify, report and prevent abusive care practices taking place

We received mixed feedback on how the service managed complaints. It took one person seven requests before the manager met with them regarding a complaint. We also noted one person’s complaint had been documented and investigated in line with Moorland Nursing Home’s policy and procedures.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

We found people had access to healthcare professionals. There were established links with community based healthcare professionals.

People who lived at Moorland Nursing home had their favourite staff. Caring relationships had been established with these staff members.

Under Section 31 of the Health and Social Care Act 2008 we varied condition 2 of the service providers registration. Full information about CQC’s regulatory response can be found at the back of the full version of the report.