25, 29 September 2014
During an inspection looking at part of the service
The people living at Moorwood Cottage were older people with complex needs, limited mobility and dementia. Some people were unable to communicate with us. At the time of this visit 13 people were living at Moorwood Cottage.
We considered all the evidence we had gathered under the outcomes we inspected. 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 '
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
The service was not safe. We found that people using the service were not protected from the risk of abuse because some staff had not received safeguarding training.
The cleanliness of the home had improved but was not sufficiently clean to reduce the risk of infection. Wheelchairs were not clean and there was a bed rail stained with faeces. Records showed that cleaning schedules had not been completed.
People were protected against the risks associated with medicines. The provider had appropriate arrangements in place to manage people's medicines safely.
There were not sufficient numbers of suitably qualified trained and experienced nurses to meet people's needs. The service relied heavily on agency nurses to provide medical care as they had been unable to recruit nurses. Agency nurses were often left in charge of the home and this had resulted in them making decisions about the home and people's care when they were not familiar with the service or people using the service.
The acting manager was not familiar with the recent supreme court ruling in respect of Deprivation of Liberty Safeguarding (DoLS). A deprivation of Liberty occurs when 'the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements.' No DoLS applications had been made for people using the service and this meant they were potentially being illegally detained.
Is the service effective?
The service was not effective. The provider was not complying with the requirements of the Mental Capacity Act 2005 (MCA). Whilst mental capacity assessments were in place for people in relation to the activities of daily living, mental capacity assessments were not in place for other key decision areas. One person who had fluctuating capacity did not have a mental capacity assessment in place. Staff had not received training in the requirements of the MCA. This meant staff did not understand their responsibilities when acting or making decisions on behalf of those individuals who lack capacity to make these decisions for themselves.
Staff did not receive sufficient training to provide effective care to people using the service. Very little training had been provided since our last inspection.
A quality monitoring visit had identified improvements which needed to be made in respect of care planning. The provider had made a decision not to respond to these requirements as they planned to close the service although at the time of our inspection, no applications had been made in this respect. This meant that effective care planning was not in place.
Is the service caring?
The service was caring. We saw staff interacting kindly and sensitively with people using the service. People were reassured and supported to move around the home in a safe way. Some people told us they liked living in the home. People using the service reported an improvement in the attitude of staff towards them.
People were dressed in an appropriate manner and people who were distressed were comforted.
Is the service responsive?
The service was not responsive to people's needs. We found improvements to the responsiveness of the service to people's needs. However, we found inconsistencies which meant that people's needs were not always responded to in a timely way. For example one person had to stay in bed for 24 hours as a soiled sling was not laundered in time and staff did not have a clean sling to ensure they were hoisted safely. Another person did not receive the hourly checks they needed as the home was short staffed.
The home had responded to non-compliance identified during our inspections in May and June 2014. We found improvements in the standard of care provided, however multiple non-compliances remained. For example, we could not be assured that people using the service were receiving enough baths and showers to meet their hygiene needs and one person did not receive their required hourly checks.
Is the service well led?
The service was not well led. We found there was limited senior management support available at the home. Signing in records showed that senior management had spent little time in the home during previous weeks. The improvement plan stated that senior management would be in the home two to three days a week but this did not happen. The acting manager was also registered manager at another home owned by the provider and was therefore not able to spend all their time managing Moorwood Cottage.