Moorfields Care Home

Moorfields Care Home is situated in a residential area close to Bury town centre. The home is registered to provide accommodation and personal care for up to 20 people, some of whom live with dementia. Accommodation is provided over two floors with access via a passenger lift. There are 16 single bedrooms and two shared rooms, which were being used for single occupancy. At the time of the inspection there were 17 people living at the home.

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

Prior to this inspection we received some concerns in relation to governance, the environment and meal arrangements.

During the inspection we found shortfalls with regards to the environment and health and safety. The provider had failed to address maintenance work required following the servicing of the premises and equipment. We also found the general environment was tired and needed enhancing. For example, carpets needed replacing, and the premises needed redecoration and replacement of worn furniture.

Governance systems had not been sufficiently robust to identify the areas of improvement required. The new registered manager was implementing audits and checks which were providing better oversight of the service, as well as identifying further improvements to enhance the experiences of people and staff.

From our observations, discussions with people and the cook we found sufficient food supplies were available and a choice of meals were offered. The cook clearly understood the need for good nutrition and hydration and was aware of people’s individual preferences. People were complimentary about the meals provided.

Opportunities for people, their relatives and staff to comment about the service provided had been improved. Feedback surveys had been distributed as well as staff and resident meetings. A newsletter had also been sent to people’s relatives, so they too were kept informed about events within the home. People were seen to enjoy a good rapport with staff who understood their individual needs.

Sufficient numbers of staff were provided. Recruitment checks for new staff and agency staff were not robust enough, however the registered manager agreed they would address this. Staff training and development had been reviewed. The registered manager was exploring opportunities to further enhance staff skills. Staff felt morale was improving and said the appointment of the registered manager had been a positive one.

Feedback from people and their visitors was very positive about the care and support provided. One family member felt an on-going concerns were now being addressed with good communication from the registered manager.

We found appropriate systems were in place with regards to consent and capacity. 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.

Suitable arrangements were in place to safely manage people’s prescribed medicines, infection control procedures and safeguarding.

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 13 January 2020).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to governance, the environment and meal arrangements. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement

At this inspection we have identified breaches in relation to health and safety and the provider’s oversight of the service.

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

Follow up

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.

¿ The provider was participating in the home testing programme for people living at the home and staff.

¿ All people entering the building had their temperature checked, sanitised their hands and donned appropriate personal protective equipment (PPE) before entering the home. We discussed the pathway for entering and exiting the property so the risk of cross infection was minimised.

¿ Regular cleaning schedules were in place to ensure all areas were effectively cleaned and reduced the risk of cross infection. Additional advice was sought in relation to the safe disposal of waste due to the outbreak.

¿ Sufficient supplies of PPE were readily available. Staff were observed wearing appropriate PPE. Staff received guidance and regular training in infection prevention and control measures and the appropriate use of PPE.

¿ At the time of the inspection the service was not receiving visitors. Alternative arrangements had been made to help people maintain contact with friends and family. These included, using electronic devices, telephone calls and letters. A social media page was also being developed so that photographs and events could be shared, where people had consented.

¿ To help maintain people’s well-being staff encouraged people to socialise with each other and join activities whilst maintaining social distancing.

¿ Due to staff isolating alternative cover arrangements had been made utilising staff from another home registered by the provider. Staff did not work across both services during this time.

¿ The service worked in partnership with other agencies and health professionals, to ensure people's needs were effectively met.

Further information is in the detailed findings below.

Moorfield Care Home is situated in a residential area close to Bury town centre. The home is registered to provide accommodation and personal care for up to 20 people, some of whom live with dementia. Accommodation is provided over two floors with access via a passenger lift. There are 16 single bedrooms and two shared rooms. At the time of the inspection there were 18 people living at the home.

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

Sufficient action had been taken to address the shortfalls identified at the last inspection. Management systems providing oversight of the service needed embedding to evidence on-going and sustained improvements.

The provider continued to meet the regulations in relation to infection control, safeguarding and complaints, health care and nutrition, health and safety and maintenance checks.

People and their visitors spoke highly of the service and the quality of the support provided by staff. Interaction were seen to be polite and respect and support was provided in a discreet and sensitive way. Activities and opportunities were provided helping to promote people’s autonomy, choice and independence. People, their relatives and staff were able to share their views about the service.

Care records provided information about their individual needs, wishes and preferences. 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. Where risks to people’s health and wellbeing had been identified, these were assessed and planned for. We have made a recommendation that the provider review their approach to peoples care in line with the expectations of Accessible Information Standard (AIS).

Staff were safely recruited and received the training and support needed to carry out their role. From our observations and discussions with people and staff we found sufficient numbers of staff were available to support people in a timely manner. Staff said they were supported in their role and felt team work and communication was good as the team had been so stable.

The management and administration of people’s prescribed medicines was safe. Appropriate referrals and access to a range of healthcare support was provided to help maintain people’s health and well-being.

People said there was always plenty to eat and drink. People’s dietary needs were understood by kitchen staff. The kitchen was seen to be clean and well-organised.

A good standard of accommodation was provided, which was clean and well-maintained. Suitable aids and adaptations were available to aid people’s mobility and promote their safety. Further consideration is being given to provide a more ‘dementia friendly’ environment to help people independently orientate themselves around the home.

Safe systems were in place for responding and reporting safeguarding concerns and complaints. People told us they felt safe and were confident their views were listened and responded to.

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 6 December 2018). At this inspection we found improvements had been made and the provider was no longer in breach of the regulation.

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.

Moorfield Care Home is situated in a residential area close to Bury town centre. The home is registered with CQC for up to 20 people and at the time of the inspection was providing care, support and accommodation to 20 people who required personal care without nursing.

Moorfield Care Home had been taken over by a new provider, Churchlake Care Limited, and this was the first inspection under the new provider.

The service had a registered manager in place. 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance. This was because there were governance systems in place but these were not sufficiently robust to enable the provider to have good oversight.

Sufficient staff were in place to meet people’s care and support needs. However, there was no system in place to assess appropriate levels of staffing as people’s care needs changed.

The home was clean and tidy but not all actions from the previous infection control audit had been completed. This was addressed following inspection.

There were processes in place for the safe recruitment of staff and we spoke with the registered manager about ensuring records are accurately maintained in this area.

The registered manager had an overview of staff training. Staff were receiving relevant training, competency checks and supervision. However, some training needed refreshing as it had been some time since staff had completed it.

The registered manager was maintaining a record of accident and incidents and analysing this information to reduce the potential for reoccurrences.

People’s medicine was securely stored and people were safely supported to take any medicines they might need. This included medicines taken ‘as required’ for pain relief.

People could choose what they wanted to eat and the cook knew people, their preferences and nutritional needs well.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have choice and control of their lives; the policies and systems in the service supported this practice.

Staff were aware of their responsibilities in protecting people from abuse and could demonstrate their understanding of the procedure to follow so that people were kept safe.

People were supported by caring staff who knew them and their care needs well.

Care records reflected people’s current needs, interests and preferences.

People told us they would like to have more to do in relation to daily activities. We recommend the service review the activities on offer for people.

The service had a complaints procedure and a variety of ways for people and relatives to provide feedback on the service. People had confidence that the registered manager and deputy manager would address any concerns they raised.

People spoke positively about the registered manager and deputy manager. Staff told us they were happy coming to work and saw the home as a family.