CQC report explained · a nursing home
What the CQC found at Morton Manor
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found infection control concerns, unsafe areas of the environment, incomplete risk assessments and medicines that were not always stored, administered or recorded safely.
- Effective?
- Good
- People's assessed needs, nutrition, healthcare and choices were generally supported well. However, inspectors were not assured that all staff were competent in applying medicated creams or moving and handling.
- Caring?
- Good
- Staff were observed to be kind, respectful and caring. People and relatives said they were happy with the support and that staff knew people's preferences.
- Responsive?
- Good
- People's care was personalised, relatives were involved and activities had increased. People and relatives could raise concerns with the manager.
- Well-led?
- Requires improvement
- Quality and safety monitoring did not reliably identify or fix problems. Care plans and incident records were incomplete, and relatives had not received questionnaires or attended meetings to share their views.
What inspectors found, October 2023
Rated Requires Improvement; inspectors found kind and responsive care, but ongoing risks with safety, medicines and management.
The inspection was unannounced and took place on 19 June 2023. Inspectors spoke with people, relatives and staff, and checked care records, medicines records, staff files and management records.
The home was not always safe. Inspectors found problems with infection control, the laundry area, environmental repairs, risk assessments and medicines. Care plans and records did not always give staff enough guidance or show that risks had been managed.
People were treated kindly and respectfully. The home supported people's choices, food and drink needs, healthcare, activities and communication. The ratings were Good for Effective, Caring and Responsive, but Requires Improvement for Safe and Well-led, giving an overall rating of Requires Improvement.
The home remained in breach of two regulations from the previous focused inspection. The provider took action to reduce risks after the inspection, and the CQC said it would monitor progress and meet the provider to discuss improvements.
Kind and respectful staff
Inspectors saw positive interactions. People and relatives said staff were kind, caring and respectful, and supported privacy and dignity.
“People were supported by staff who treated them with kindness and respect.” from the report
Good daily support
People's food, drink and healthcare needs were supported. Staff offered choices and worked with outside health professionals when needed.
“People's diet and nutritional needs were being met.” from the report
Choice and involvement
People were offered choices and involved in care decisions where possible. Mental capacity and best-interest processes were in place when required.
“Throughout the inspection we observed staff providing choices to people.” from the report
Activities and relationships
An activities coordinator had recently been employed. Inspectors saw people enjoying games and singing, and relatives described more activities in the home.
“We observed people taking part in activities available in the home and they were visibly enjoying playing games and singing.” from the report
Recruitment checks
The home carried out required recruitment checks before staff started work, including checks through the Disclosure and Barring Service.
“Thorough checks including Disclosure and Barring Service (DBS) checks were conducted before staff started working at the service.” from the report
Medicine safety
seriousMedicine stock checks, handwritten records, cream administration records and storage were not always safe or complete. The home also did not always act when medicine rooms were too hot.
“The provider had failed to ensure medicines were managed safely and that risks relating to the health, safety and welfare of people and the environment were robustly managed, monitored and assessed.” from the report
Infection control
seriousSome areas were unclean, and the laundry room did not separate used and clean laundry properly. Inspectors found evidence that clean laundry could be contaminated.
“There was evidence of cross contamination as we observed some soiled laundry in the clean area.” from the report
Environmental safety
seriousSome heavy furniture was not fixed to walls, radiator covers were missing during the inspection and the smoking area was not made safe. The radiator covers were reattached on the day.
“Some radiator covers had not been reattached after maintenance which meant the radiators could be accessed and people were at risk of burns and scalds.” from the report
Incomplete risk assessments and care plans
needs fixingRisk assessments for e-cigarettes and bed rails were missing when needed. Care plans did not always explain changing needs, repositioning or how staff should reduce risks.
“Care plans did not always contain enough information for staff to know how to support people in line with their current needs.” from the report
Weak quality monitoring
needs fixingManagement checks did not consistently identify and correct problems. Records did not clearly show what action followed accidents, incidents or some safeguarding concerns.
“The systems and processes to assess, monitor and improve the quality and safety of the service were not always effective.” from the report
Limited family feedback
minorRelatives said they had not received questionnaires and meetings had not taken place for people and relatives to share their views.
“Relatives told us they had not received questionnaires to provide feedback and meetings had not taken place so people and relatives could share their views.” from the report
- 01What has been changed to make medicines safer, including cream records, medicine-room temperatures and stock checks?
- 02How have you separated used and clean laundry, and how do you now check that infection-control cleaning is completed?
- 03Which environmental repairs and safety changes have been completed, including furniture, radiator covers and the smoking area?
- 04How are care plans and risk assessments now kept up to date when people's needs change?
- 05What evidence can you show that the warning notices and the previous inspection findings have been fully addressed?
This was an unannounced inspection of the care home covering all five key questions, including infection prevention and control; Safe and Well-led remained Requires Improvement while Effective, Caring and Responsive were rated Good. This explanation was written from the published report of 17 October 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, January 2022
Rated Requires Improvement; inspectors found kind and timely care, but weaknesses in infection control and management oversight put people at risk.
Inspectors made an unannounced focused inspection on 15 and 16 December 2021. They spoke with people, relatives and staff, observed care, and checked care, medicine, staffing and management records.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. The inspection found poor cleanliness and infection control in the laundry area, safety checks that were not always completed, and audits that did not always identify risks.
There were also positive findings. People were treated well, received their medicines as prescribed, and did not have to wait for care. Staffing and recruitment arrangements were suitable. The provider began work on the laundry and sluice rooms immediately after the inspection.
Kind, respectful care
People said they liked living at the home. Staff encouraged people to make decisions and maintain their independence.
“It's a very happy place… they let me do the things I can do to keep me independent.” from the report
Timely support
People received the care and support they needed without unnecessary waits. Inspectors saw this during their visit.
“People told us they did not have to wait for the care and support they needed, and we observed this during the inspection.” from the report
Medicines managed safely
People received medicines as prescribed. Records showed administrations were completed, and medicines were ordered, stored and disposed of safely.
“People received their medicines as prescribed. We saw medicine administrations records (MAR) were completed when people had taken their medicines.” from the report
Enough suitable staff
The provider carried out recruitment checks and reviewed people's needs to decide staffing levels. Staff and people said there were enough staff.
“There were enough staff to meet people needs. Staff told us they felt there were enough staff on duty.” from the report
Poor infection control
seriousThe laundry room was dirty and damaged, and its layout did not keep used and clean laundry separate. The lack of a working sluice room in The Cottage increased the risk of spreading infection.
“This environment was not sufficiently clean and hygienic to meet infection control standards.” from the report
Weak management oversight
seriousThere was no registered manager and no clear day-to-day management arrangement. Audits did not always find problems, and improvement plans lacked priorities and timescales.
“The provider's governance systems were not robust enough to demonstrate the service was effectively managed.” from the report
Safety checks not consistent
needs fixingRoutine environmental checks were not always completed. Inspectors also found flooring stored in a communal area and an appliance without evidence of testing, although these were dealt with during the inspection.
“Daily environmental safety checks had not been carried out routinely as noted in the safe section of this report.” from the report
Family updates
minorRelatives said they usually had to ask for updates to keep informed about their family member's care.
“They did say that they usually had to request updates in order to keep up to date with their family members care.” from the report
- 01What work has been completed in the laundry room and The Cottage sluice room since the inspection?
- 02Who is responsible for the home's day-to-day management while there is no registered manager?
- 03How are daily environmental safety checks now recorded and reviewed?
- 04What are the priorities and timescales for repairing damaged doors, skirting and equipment?
- 05How will relatives receive regular updates without having to request them?
This was a focused inspection of Safe and Well-led only; the other ratings were carried over from previous comprehensive inspections. This explanation was written from the published report of 29 January 2022 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 Manor
3 rated inspections over 3 years: the service has held its Requires improvement rating throughout.
- October 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- March 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- June 2019
Registered with the Care Quality Commission on 5 June 2019.
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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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.