CQC report explained · a residential care home
What the CQC found at Moorland House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, January 2023
Requires Improvement overall; inspectors rated the home Inadequate for safety and found serious gaps in risk management, medicines, infection control and staff recruitment.
Inspectors visited without warning on 16 and 17 November 2022. They spoke with people living in the home, relatives, staff and health professionals. They also checked care records, medicines, staffing, infection control and how the home was managed.
The home was not always safe. Risk assessments and care plans were missing or out of date. Medicines were not consistently recorded or managed safely. Infection control practices were inconsistent, and recruitment checks were incomplete. Inspectors were also concerned that some newer staff lacked the skills, training and communication needed to support people safely.
People were usually supported by enough staff, and established staff were described as kind and familiar with people's needs. Staff worked with health professionals, and the new provider had started an improvement programme. However, the systems used to check quality had not found or dealt with all the problems.
The overall rating changed from Good at the previous inspection, published in November 2018, to Requires Improvement. Safe was Inadequate, while Effective and Well-led were Requires Improvement. Caring and Responsive were not rated in this inspection.
Kind established staff
Established staff knew people well and generally supported them in a calm way. Inspectors also saw staff promoting independence and responding sensitively when someone became distressed.
“The longer standing staff knew people well and were kind and unhurried when meeting people's needs.” from the report
Healthcare links
The home worked with community health professionals and made referrals for assessment and treatment. Extra staff were arranged when people needed help attending healthcare appointments.
“People felt that staff supported them to stay as well as possible and there was evidence that staff worked with a range of community healthcare professionals.” from the report
Some positive activities
There was an activities timetable, including games, crafts and exercise. People also took part in singing and music sessions during the inspection.
“During the inspection, we saw staff briefly playing ball games with people and leading gentle exercise sessions.” from the report
New provider taking action
The provider had started repairs and improvements, arranged extra management support and appointed an external consultant. People and relatives spoke positively about the provider listening to feedback.
“The current provider had taken ownership of the service at the end of July 2022.” from the report
Risks were not properly planned
seriousSome people had no care plan or risk assessment for important needs, including moving, seizures, falls and swallowing. Inspectors also found a person eating without the required supervision and food that was not the required smooth texture.
“One person's moving and handling requirements were complex, but there was no care plan or risk assessment in place to guide staff.” from the report
Medicines records were unsafe
seriousMedicines administration records had missing signatures and unclear gaps. Some medicines were out of stock, and there were problems recording why as-needed medicines were given and whether they worked.
“We reviewed the medicines administration records (MARs) for October and November 2022 and found 8 occasions where staff had not signed the MAR or recorded a non-administration code.” from the report
Infection control gaps
seriousInspectors saw masks worn incorrectly, used protective clothing being worn around the home and an overflowing clinical bin. Cleaning records and some areas and equipment also needed improvement.
“We twice saw staff walking around the home in aprons and gloves that they had been wearing whilst providing personal care to people in their rooms.” from the report
Staff competence and communication
seriousNo staff had completed the specialist training offered for people's needs. Inspectors saw communication problems during a transfer and found that some staff could not clearly explain how they would respond to safeguarding or choking.
“No staff had completed any of this training.” from the report
Care planning and consent
seriousCare plans were incomplete or contradictory. Capacity assessments, best-interests decisions and consent processes were not always completed lawfully.
“Where the person lacked capacity to sign the consent form, there was no mental capacity assessment or best interests' consultation in place to inform care planning.” from the report
Food, drink and environment
needs fixingSome people did not have drinks in their rooms, food and fluid records were not being reviewed effectively, and information about dietary needs was not shared reliably with the chef. Parts of the building were worn and needed repair.
“Three of these did not have fluids in their room.” from the report
- 01How have you made sure every person now has current risk assessments and care plans for moving, falls, seizures, swallowing and dietary needs?
- 02What checks now confirm that medicines are in stock, recorded correctly and reviewed when as-needed medicines are used?
- 03How do you check that new staff can communicate effectively and apply moving and handling, safeguarding and choking training in practice?
- 04How are people's capacity, best-interests decisions and consent recorded before care is provided or a DoLS application is made?
- 05How do you monitor food and fluid intake, including drinks in people's rooms and support for people who are losing weight?
This was an unannounced focused inspection covering Safe, Effective and Well-led; Caring and Responsive were not rated and the previous overall rating was from the 2018 inspection. This explanation was written from the published report of 13 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2018
Rated Good overall; inspectors found kind, responsive care, but Safe Requires Improvement because some health, safety and cleanliness checks needed strengthening.
Inspectors visited without notice on 25 and 27 September 2018. They spoke with people living at the home, visitors, staff, the manager, providers and a health professional. They observed care and checked care records, medicines, recruitment, training, complaints and quality checks.
People were protected from abuse, medicines were managed safely and there were enough staff. Inspectors also found kind and respectful care, good support with food and health, detailed care planning, activities and an open management culture.
The Safe rating remained Requires Improvement. Infection control needed improvement, and fire and legionella risk assessments and checks were not robust enough. Records were not always accurate, and audits had not found every problem.
The overall rating was Good. Effective improved from Requires Improvement to Good, and Well-led also improved to Good, while Caring and Responsive remained Good. The home had improved since August 2017, but inspectors said improvements needed to become consistent.
Kind, respectful care
Inspectors saw warm relationships and staff supporting people's dignity, comfort, choices and independence.
“The atmosphere in the home was calm and friendly. Staff treated people with dignity and respect and understood that Moorland House was people's home.” from the report
Safe medicines practice
Medicines were available, stored correctly, recorded accurately and administered competently during the observed medicines round.
“The management of medicines was safe.” from the report
Good food and health support
People received food and drinks suited to their preferences and dietary needs, with access to healthcare when required.
“People were supported to eat a balanced and healthy diet which met their dietary needs and personal food preferences.” from the report
Detailed, personalised care
Care plans included people's histories, preferences, support needs and ways to promote independence and choice.
“People's care plans were detailed and included information about their life histories and the people and things which were important to them.” from the report
Open management
Staff said they felt listened to and supported. Management meetings, feedback and audits were used to oversee the service, although some checks needed strengthening.
“There was an open and supportive culture within the home which staff appreciated.” from the report
Cleanliness and infection control
needs fixingSome carpets were badly stained, there was a bad odour and some bathroom areas needed cleaning. Some surfaces were not suitable for hygienic cleaning, although several issues were addressed during the inspection.
“However, we did identify that some areas of the home looked a little 'tired' and some aspects of infection prevention and control required improvement.” from the report
Fire and water safety checks
seriousFire drills did not happen as often as the home's policy required, attendance was not recorded and some legionella monitoring needed a more robust approach.
“Fire safety systems were in place and checked regularly. Staff received fire training and whilst fire drills were carried out periodically, we noted that the frequency was not in line with the provider's policy.” from the report
Inaccurate records and incomplete audits
needs fixingSome care plans contained conflicting information, and the home's audits had not identified all the issues found by inspectors.
“Record keeping was not always accurate with some conflicting information in people's care plans.” from the report
Busy lunchtime support
minorA staff member administering medicines at lunchtime left two staff supporting several people with meals at once. Inspectors said this was not person-centred or conducive to a relaxed mealtime.
“These staff were supporting several people at the same time and moving from one to another which was not person centred or conducive to a relaxed mealtime experience for people.” from the report
- 01What has been done to improve infection prevention and control, including stained carpets, odours, bathroom cleaning and hygienic surfaces?
- 02Has a new, more robust fire risk assessment been completed, and are fire drills now held as often as the home's policy requires?
- 03Has the legionella risk assessment been updated by a specialist, and how are water safety checks recorded now?
- 04How do you check that care plans contain consistent and accurate information?
- 05How will lunchtime staffing and medicines rounds be arranged so people receive relaxed, individual support with meals?
This was an unannounced inspection covering all five CQC questions and checking improvements since the August 2017 inspection; inspectors observed care, spoke with people and staff, and reviewed records and management systems. This explanation was written from the published report of 22 November 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Moorland House
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- January 2023Requires improvementcurrent ratingdown from GoodSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2018Goodup from Requires improvementSafe: Requires improvementEffective: GoodWell-led: Good
- September 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2017Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2016Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- May 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 14 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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