CQC report explained · a nursing home
What the CQC found at Morton Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff to meet people's needs. Risks, medicines, infection control, safeguarding and equipment were managed safely.
- Effective?
- Good
- Staff received training and support. People's choices, capacity, nutrition and health needs were considered, with referrals made when needed.
- Caring?
- Good
- People had positive relationships with staff and reported kind and inclusive care. Privacy, dignity, independence and personal choices were respected.
- Responsive?
- Outstanding
- Activities reflected people's life histories, interests and abilities. Care plans included personal, cultural and communication needs, and end of life care followed people's wishes.
- Well-led?
- Good
- The home had stable leadership and used audits, feedback and meetings to improve care and the environment. Complaints were investigated and lessons were shared.
What inspectors found, September 2018
Rated Good overall, with Outstanding responsive care and improvements since the previous inspection.
The inspection was unannounced and took place on 14 May 2018. Inspectors spoke with people using the home, relatives and staff. They observed care and checked care records, audits, recruitment files and information held by CQC.
The home was rated Good for Safe, Effective, Caring and Well-led. It was rated Outstanding for Responsive. Inspectors found enough staff, safe medicines, suitable training, kind care and good leadership.
Activities were closely linked to people's interests, history and choices. Inspectors also found that end of life care reflected people's wishes and that complaints were responded to.
At the previous inspection in October 2016, the home was rated Requires Improvement and had breaches relating to safe care, staffing, dignity and respect, and governance. Inspectors found the required improvements had been made.
Personalised activities
The home offered a wide range of activities linked to people's past interests and new ideas. People were also involved in events, gardening and parts of the home's running.
“People's life experience was used to provide opportunities to receive activities and attend events.” from the report
End of life care
Staff had training in end of life care and supported people's individual wishes. The home had achieved platinum status in the Gold Standard Framework for End of Life Care.
“Each person is different and we need to respect their wishes and provide the care they wish for right to the end.” from the report
Respect and choice
People were supported to make choices about their care, appearance, routines and relationships. Inspectors found that privacy, dignity and independence were respected.
“People had established positive relationships with staff and felt they received kind and inclusive care.” from the report
Safety improvements
Staffing levels had been increased since the previous inspection. Risks were assessed, medicines were managed safely and lessons from falls were used to reduce future risks.
“The provider had increased the staffing levels to provide a good level of support, which ensured people's needs were met.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you decide whether there are enough staff for my relative's needs, particularly at busy mealtimes?
- 02How are falls and other incidents reviewed, and how would you tell me about any changes made after one?
- 03How would you record and follow my relative's wishes about end of life care?
- 04How would you use my relative's history, interests, cultural needs and communication preferences to plan their care and activities?
- 05Have the call bell response systems now been linked across all three units?
This was an unannounced inspection covering all five quality areas and the overall rating; inspectors spoke with people, relatives and staff, observed care, and reviewed records and audits. This explanation was written from the published report of 29 September 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.
What inspectors found, February 2017
Rated Requires Improvement; inspectors found unsafe staffing levels, poor risk monitoring and inconsistent dignity, despite some kind care and good health support.
Inspectors visited on 17 and 18 October 2016. The first day was unannounced. They reviewed care plans, medicine records, staff records and management systems. They spoke with people living there, relatives, staff and healthcare professionals.
The home was not always safe or well organised. People sometimes waited for help with the toilet, moving around or eating. Repeated falls were not properly analysed. At busy times, people were left without support or social contact. Some routines, including showers and lunch arrangements, were too fixed and did not respect people's choices.
There were also positive findings. Medicines were generally managed safely. Staff had relevant training and worked well with community healthcare services. People and families described some staff and managers as kind and approachable. Activities included trips, events and personalised interests.
All five areas were rated Requires Improvement. The home was in breach of Regulations 10, 12, 17 and 18. The previous inspection in January 2014 found the home compliant in all areas inspected, so this report identified a poorer position at this inspection.
Relevant staff training
Staff had training and induction arrangements relevant to their roles. They said they felt supported to develop their skills.
“Staff had access to training relevant to their role.” from the report
Healthcare links
The home worked closely with community healthcare professionals. Inspectors found that referrals and instructions were handled well.
“There was good communication between themselves, the nurses and carers.” from the report
Activities and relationships
People could take part in group, individual and community activities. The home also arranged events that helped people maintain important family relationships.
“People were supported to enjoy a range of activities and maintain their interests and hobbies, either independently or with other people.” from the report
Some caring interactions
Inspectors saw examples of kind and sensitive care. Some people and relatives also spoke positively about staff.
“We saw some caring and sensitive interactions between staff and people which demonstrated respect and compassion.” from the report
Insufficient staffing
seriousPeople waited for help with toileting, moving and eating. Some meals became cold, and people were left without assistance or conversation.
“These examples demonstrated there were insufficient staff on duty to meet the individual needs of people and staff were not deployed effectively.” from the report
Risks not properly reviewed
seriousRepeated incidents, including many unwitnessed falls, were recorded but not analysed for patterns or causes. This meant action to reduce future risks was not clear.
“We saw no evidence of a plan to analyse any themes or reasons for the falls” from the report
Dignity and choice
seriousPeople were not always involved in decisions about their care. Inspectors saw fixed routines, unwanted tabards and lunch arrangements that did not always respect dignity or choice.
“People were not always treated with dignity and respect.” from the report
Weak improvement systems
seriousAudits and complaints did not show clear learning or action. Records were disorganised, and staff supervision was not consistently planned or recorded.
“The quality assurance systems in place were not effective at identifying poor practice or the dissatisfaction of people using the service.” from the report
Consent and involvement
needs fixingIt was not always clear how people with fluctuating capacity were involved in decisions. Inspectors recommended reviewing how consent was obtained and explained.
“We recommend the provider reviews how it obtains consent from people, particularly those with fluctuating capacity” from the report
- 01How many staff are now on duty at busy mealtimes and overnight, and how do you make sure people are helped promptly with toileting and mobility?
- 02What has changed in the way falls and repeated incidents are analysed, and can you show examples of actions taken to reduce them?
- 03How are residents now involved in risk assessments, care decisions and consent, particularly when their capacity fluctuates?
- 04How do you make sure people can choose where to eat, whether to wear a tabard and when to have a shower?
- 05How are audits, complaints, feedback and staff supervision now recorded and used to improve care?
This was a planned inspection covering all five CQC questions, with the first day unannounced; the report says the previous inspection was in January 2014. This explanation was written from the published report of 3 February 2017 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 Morton Grange
2 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- September 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- February 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 3 March 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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