The inspection took place between 19 and 21 June 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be visiting the home.

We last inspected the home in January 2017 and rated the home as ‘Requires Improvement’ overall. This was because we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; namely, Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing). We rated the key questions of safe, effective, responsive and well led as ‘requires Improvement’.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. At this inspection we found sufficient improvements had been made to address the key question of safe but the home continued not to meet all the fundamental standards we inspected against for the key questions of responsive, effective and well led. This is the second time the service has been rated requires improvement.

Moorfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Moorfield House provides personal and nursing care and support for up to 35 people who require support with personal care, some of whom are living with dementia. At the time of the inspection there were 23 people living there.

The home had a new manager in post who had joined the home in April 2018. The manager had begun the process to become the registered manager. At the time of inspection this registration application had not been received by the CQC. A registered manager is a person who has registered with the Commission to manage the home. 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 home is run.

At this inspection we found that there were continued breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the governance and quality systems and processes, staff training and staff supervision/appraisal.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training around safeguarding vulnerable adults. Staff were safely recruited and they were provided with all the necessary induction training required for their role. The manager monitored when refresher training was required but not all staff had attended refresher courses. Staff had received training in end of life care and there was a staff champion for this.

Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. We observed that there were enough staff on duty to support people appropriately in line with their assessed needs.

During our inspection we found that the premises were safe for people living at the home. Regular checks of the premises, equipment and utilities were carried out but these were not fully documented. Infection control measures were in place and the home was clean. We saw domestic staff cleaning the home regularly during inspection. The premises were not fully ‘dementia friendly’ as the walls, floors and doors were painted in similar colours. There was pictorial signage to help people orientate themselves.

The home provided safe medicines management. Procedures were

This inspection took place on 11 & 12 January 2017 and was unannounced. This means the provider did not know we were coming. We last inspected this service on the 25 and 26 November 2015. At that inspection we found the service was not meeting one of the regulations that were in force at that time. We found that the service had not ensured that staff had been given the on-going training they needed to keep their knowledge up to date.

On this inspection we saw progress and plans to address staff training needs. However four further breaches of legal requirements were found.

Moorfield House is a care home which provides nursing and residential care for up to 35 people. Care is primarily provided for older people, including people who live with dementia. There were 23 people living in the home at the time of this inspection. The top floor was currently not being used.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us contradictory things about the service. Everyone we spoke with said that the staff were kind and caring. However, while some people were happy with the care given, others were not. People told us that at times there were not enough staff available to answer their call bell and provide support when they needed it. Care and support was mainly based around completing tasks and did not always take account of people’s differing needs, and there was little time for one to one time with people.

We also received mixed views from relatives about the care. Some said they were satisfied with the care while others said they had concerns about their relatives not getting care in a timely manner.

We recommended that the service undertake a full review of the dependency levels of people to check how many staff are needed to effectively meet people’s needs, and adjust staffing levels accordingly. With consideration given to the roles of staff to determine whether staff were being effectively deployed and managed to best effect.

The training given to staff had improved. The registered manager had reviewed the provision of staff training and begun to address the deficits identified at the previous inspection. We still found a need for this training to be more co-ordinated rather than a blanket provision for the whole staff team.

All staff had been scheduled to receive an annual appraisal during 2017. However we found the frequency and quality of the supervision and appraisals that staff received was poor and did not address practice and staff development issues.

People told us they felt safe. Staff were aware of the different types of abuse people might experience and of their responsibility for recognising and reporting signs of abuse.

We recommended that the provider reassess how staff could access information on safeguarding policies and procedures and how safeguarding could become embedded into the operating systems to have a higher profile in the home.

Possible risks to the health and safety of people using the service were not always assessed and therefore appropriate actions were not always taken to minimise risks. This was in regard to hazards in the home, such as infection control measures, and when managing risks to people falling and behaviours that may challenge the service.

People were supported to meet their health needs and access a range of healthcare services. They were assisted to take their medicines safely by staff who had been appropriately trained. Nutritional needs were monitored and specialist advice was sought when necessary. People were offered a varied diet with choices of meals and, where needed, were assisted with eating and drinking. We received positive

We spoke to four members of staff who spoke positively and without prompt regarding local management, training and support. We also spoke to the resident's representative who told us that they were happy in the home. We spent time in the home observing people and staff and found evidence that people were treated as individuals and with respect. We also found evidence of this by reviewing documents such as the service user inclusion file, extensive surveys conducted by the registered manager, activity plans and personalised care plans.

We viewed eight private rooms and the communal areas in the home and found a safe and friendly atmosphere throughout. There were two bright and airy communal lounges, a conservatory and a dining room and a garden that was available for people to use for activities but was in need of maintenance and upgrade. We found that the home was safe and fit for purpose and that the registered manager had submitted extensive plans for refurbishment that would make better use of space and provide a more inviting, homely environment for people.

We reviewed the complaints procedure with the registered manager and found that there were no current complaints and that a robust management system was in place to deal with concerns from people who lived there and their family members.

We found extensive evidence of the involvement of people in their own care and comprehensive, readily accessible documentation related to all aspects of safety.

We did not speak to people using the service on this visit so we therefore looked to see if they were getting the medicines that they needed by looking at their medication records and the storage of medicines. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Due to their needs, some people could not offer direct comments about the care they received. We spent time observing the care offered to people at meal times.

This inspection took place on 25 and 26 November 2015 and was unannounced.

We last inspected this service in January 2014. At that inspection we found the service was meeting all the legal requirements in place at the time.

Moorfield House is a care home for older people, some of whom have a dementia-related condition. It provides nursing care. It has 35 beds and 27 people were living there at the time of this inspection.

The service had a registered manager who had been in post for seven months. 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.

People were protected from abuse. Staff were fully aware of their responsibility to keep people safe and to report an actual or potential harm. People told us they felt safe in the home. Risks to people were regularly assessed and appropriate steps were taken to reduce such risks to a minimum. Frequent checks took place of the safety of the environment and all equipment used.

Accidents and incidents were recorded and analysed to see if lessons could be learned.

Staffing levels in the home were kept under constant review to ensure there were enough staff to meet people’s needs safely and in the ways they wanted. Robust systems of recruitment and selection meant that only applicants suitable to work with vulnerable people were employed.

People’s medicines were managed safely by trained staff whose competency was regularly re-assessed. People received their medicines at the times they were due and in the way they wanted.

The staff team was experienced and well-motivated. They demonstrated the knowledge and skills necessary to meet people’s needs effectively. They were given appropriate support to carry out their roles by means of staff supervision and appraisal. However, staff had not been kept up to date with their training needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom.

Appropriate assessments had been undertaken of people’s capacity to make particular decisions. Where it was deemed that people did not have capacity, we saw that appropriate ‘best interest’ decisions had been taken, with the involvement of the person’s family, and these were clearly recorded. People were asked for their consent before staff members carried out any care tasks or other interventions.

People’s nutritional needs were assessed and specialist advice was taken, where necessary, to ensure those needs were met. People received a varied and nutritious diet and had choice of their meals. People told us they enjoyed their meals.

People’s health needs were assessed and kept under regular review. Staff were alert to any deterioration in people’s health and reported and monitored people’s progress. Appropriate referrals were made to specialist services, where required. People had access to the full range of community health services such as GPs, dentists, opticians and podiatrists.

The staff team demonstrated a very caring, person-centred approach in their work. People and their relatives spoke highly of the sensitivity, care and commitment of the staff. Efforts were made to keep people fully informed about their care and about the running of the home, and there were regular meetings with people and their relatives to get their views about the service. People told us staff helped them do things for themselves and be as independent as they were able. They said they were treated with respect at all times and their privacy and dignity were protected by the staff team.

People were involved in identifying their needs and in describing how they wished those needs to be met. People’s views and preferences were incorporated into their care plans, which were very detailed and informative. Regular reviews of people’s care were undertaken and care plans were updated in line with people’s changing needs and preferences.

Social activities were available and the registered manager demonstrated a commitment to widen the range of these and make them more individualised. Care was taken to avoid the risks of social isolation. People were encouraged to make all possible choices about their daily lives.

Any complaints or concerns were taken seriously and investigated thoroughly. The registered manager spoke with each person in the home daily and acted on people’s feedback.

There was an open and reflective culture in the home, and new ideas and practices had been introduced to improve the service. Staff told us they were treated with respect and that their views were valued. Staff took an obvious pride in their work. Systems were in place to monitor the quality of the service, and to identify and address areas for improvement.

We found a breach of Regulations in relation to staff support (staff training).  You can see what action we told the provider to take at the back of the full version of the report.