We undertook an unannounced focused inspection of Moorhouse Nursing Home on 15 November 2018. This inspection was done as we had received concerns about staffing levels, how risks to people were managed and the lack of management oversight at the service. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led?

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Moorhouse Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Moorhouse Nursing Home accommodates up to 38 older people, some of whom may be living with a physical disability, in one adapted building. At the time of our inspection there were 26 people using the service.

At the time of the inspection there was not a registered manager in post. The manager who was present was leaving and a new manager, who was also present, had been appointed three days previously. The new manager told us they would be applying to register with CQC as manager in line with the requirements of their registration. 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.

There were not enough staff to meet people’s needs which left them waiting for care to be delivered. Risks to people were not always managed effectively which placed people at risk of harm. Where incidents and accidents occurred, these were not analysed to reduce the risk of them re-occurring. There had been a high turnover of managers in the last six months which had affected the care being delivered to people. There was a lack of management oversight and audits on the quality of care were not being completed. Staff did not feel listened to when they raised concerns about staffing levels. We asked for information about how the service acted with external agencies but this was not provided.

People received their medicines when they needed them. The management of medicines was safe. People were kept safe from the risk of abuse as staff knew what to do should they have concerns about the standard of care provided. There were safe infection control practices in place which staff followed. The environment was clean and well maintained and safe recruitment procedures were in place.

We identified two breaches of the Health and Social Care Act 2008 (HSCA). You can see what action we asked the provider to take at the back of this report.

Moorhouse Nursing Home is registered to provide accommodation for up to thirty-six older people who require residential or nursing care. The rooms are arranged over three floors. There are stair lifts and a lift to each floor. On the ground floor there is a large dining room, two lounges and further sitting areas. The home also has its own gardens. At the time of our inspection there were 21 people were living at the service.

There was a registered manager in post. 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. The registered manager was at the home during the time of our inspection.

We last carried out a comprehensive inspection of Moorhouse Nursing Home in December 2016 and a focused inspection in February 2017 where we found the registered provider was in breach of regulations. These related to staffing levels; staff had not received support, training, professional development and supervision in order that they could fulfil their duties and responsibilities. Following this inspection the registered provider sent us an action plan of how they would address these issues.

The inspection took place on 13 March 2018 and was unannounced. During this inspection we found that the concerns raised at our previous inspection had been dealt with, but we did identify new concerns about record keeping.

Not all records included all full guidance to help ensure that staff were able to deliver the care people needed. Accidents and incidents were recorded but not all had an analysis of why accidents or incidents had occurred or what action could be taken to prevent further accidents.

There were enough staff to meet the needs of the people but the deployment of staff requires monitoring, especially at weekends. Robust recruitment procedures were completed to ensure staff were safe to work at the service. People felt safe living at the home. Staff understood their responsibilities around protecting people from harm. The provider had identified risks to people’s health and safety with them, and put guidelines in place for staff to minimise the risk. Infection control processes were in lace that helped to reduce the risk of infection. People received their medicines as prescribed by their GP.

Staff received appropriate training and had opportunities to meet with their line manager regularly that helped them to provide effective care to people. Where there were restrictions in place, staff had followed the legal requirements to make sure that this was done in the person’s best interest. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that decisions were made in the least restrictive way. People’s nutritional needs were assessed and individual dietary needs were met. People could choose what they ate.

People had involvement from external healthcare professionals and staff supported them to remain healthy. The environment was suitable for people living with dementia.

People’s care and support was delivered in line with their care plans. People’s privacy and dignity was respected. Staff were knowledgeable about the people they cared for and were aware of people’s individual needs and how to meet them. People were supported with their religious beliefs and were able to practice their faith. Visitors were welcomed at the home and people could meet with them in the privacy of their bedrooms.

A variety of activities were available for people to take part both internally and externally on trips and excursions to places that interested them. Documentation that enabled staff to support people and to record the care they had received was up to date and reviewed on a regular basis. Staff were knowledg

This inspection was carried out on the 2 February 2017. MoorHouse Nursing Home is registered to provide support and accommodation for a maximum of 38 older people who require residential or nursing care. Services offered at the home include nursing care, end of life care, respite care and short breaks. At the time of the inspection there were 23 people living at the home.

We carried out an unannounced comprehensive inspection of this service on 22 November and 2 December 2016 and identified a breach of regulation 18 as the provider had not ensured that sufficient numbers of staff received support, training, professional development and supervision in order that they could fulfil their duties and responsibilities. As a result we issued a requirement notice. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation. The rating awarded to the service was Requires Improvement.

After that inspection we received concerns in relation to staffing levels at the home. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Moorhouse Nursing Home on our website at www.cqc.org.uk.

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were insufficient staff available to safely meet people’s needs. Call bells were not answered promptly which meant people were waiting for extended periods of time before staff attended to them. People and relatives all said that there were not enough staff working in the home and that the staffing levels had been reduced recently which had impacted on the quality of care being provided.

There should have been regular analysis completed by the manager of call bell response times. However the call bell monitoring system had a technical fault which meant that the data was not available for this analysis to be completed. The manager told us this was being addressed by the software company.

There had been no review of recent accidents and incidents, people who had recent falls had not had their needs reviewed to minimise the risk of falls re-occurring.

This was an unannounced inspection which took place on 22 November and 2 December 2016.

MoorHouse Nursing Home is registered to provide support and accommodation for a maximum of 38 older people who require residential or nursing care. Services offered at the home include nursing care, end of life care, respite care and short breaks. The rooms are arranged over three floors. There are stair lifts and a lift to each floor. On the ground floor there is a large dining room, two lounges and further sitting areas. At the time of the inspection there were 24 people living at the home. People had a range of needs. Some people were living with dementia; others required nursing care whilst other people required minimal assistance.

The manager was not on duty on the first day of our inspection but came to the home for a short while whilst we were there and was present for the second day. They had been in post since 16 August 2016 and had submitted an application to be the registered manager with CQC. 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.

MoorHouse Nursing Home was last inspected on 7 and 8 April 2016 where it was rated as ‘Inadequate’ and placed into ‘Special Measures’. Five breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. These related to personalised care, risk management and medicines, consent, staffing and quality monitoring. Warning Notices were served in relation to Regulations 12 and 17. Requirement actions were set in relation to Regulations 9, 11 and 18. The registered provider sent us weekly reports that details steps that were being taken to make the required improvements. At this inspection we found that the Warning Notices and requirement actions had been met apart from the breach of regulation 18 and that the service had made improvements. It was no longer rated ‘Inadequate’ in any key area, and was therefore removed from ‘Special Measures.’ We did find that further work was needed to ensure the improvements were fully embedded, sustained and that actions continued to take place to improve the quality of service people received.

People said that the home had been through a period of instability due to a lack of consistent management. They said that since the manager had been in post management of the home and the quality of service people received was improving. The manager demonstrated an open and honest demeanour throughout our inspection. As a result of our feedback on the first day of inspection actions were taken immediately and evidenced by the second day. This demonstrated a commitment by the manager to improve the quality and safety of service that people received.

Staff had started to receive supervision and training and the manager had implemented a system for monitoring this. However staff did not have the necessary skills and knowledge to meet all the needs of the people who lived at the home. Further work was needed to ensure support and training was consistently and regularly provided to all staff. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) 2014.

Risk management systems had improved to reduce accidents and incidents occurring. However, further work should be undertaken to reduce falls and injuries associated with these. We have made a recommendation about this in the main body of our report.

People were happy with the meals provided at the home. Since our last inspection a ‘Resident of the Day’ system has been introduced. This included the person in question being seen by the Chef who asks for food preferences which are incorporated into the menus. There were gaps in people’s food and fluid records that could ha

This was an unannounced inspection which took place on 7 and 8 April 2016.

MoorHouse Nursing Home provides support and accommodation for a maximum of 38 older people who require residential or nursing care. Services offered at the home include nursing care, end of life care, respite care and short breaks. The rooms are arranged over three floors. There are stair lifts and a lift to each floor. On the ground floor there is a large dining room, two lounges and further sitting areas. At the time of the inspection there were 33 people living at the home. People had a range of needs. Some people were living with dementia; others required nursing care to manage pressure areas whilst other people required minimal assistance.

The home did not have a registered manager. The previous registered manager had not worked at the home since 10 March 2016. A new manager had been recruited and in post since 21 March 2016 and was present during our inspection. 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. The manager was in the process of submitting an application to register with us.

MoorHouse Nursing Home was last inspected on 12 October 2015 where it was rated as ‘Requires Improvement’. Four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. These related to personalised care, risk management, recruitment procedures and quality monitoring. Requirement actions were set in relation to these and the registered provider sent us a report that detailed steps that would be taken to make the required improvements. At this inspection we found that although initially the registered provider had taken steps to address the requirement actions these had not been sustained and issues remained in three areas. In addition, new areas of concern were identified.

There had been changes in senior management and of management of the home. These had not been managed well by the registered provider and had impacted on the quality and safety of service people received. The registered provider had not ensured the quality and safety of service was monitored or that action was taken to improve service delivery.

The numbers and deployment of staff on duty did not meet people’s needs. People told us that staffing levels impacted on their bathing and personal care preferences. People did not receive their medicines on time and some people did not have all the medicines they had been prescribed. People did not get the care and support they needed or wanted at the times they required this.

People with specific nursing needs did not receive care and treatment safely. Assessment and care planning was not robust and did not ensure that people’s needs were managed effectively. There were not enough nurses on duty to meet the nursing needs of people.

Staff did not receive sufficient supervision to understand their roles and to undertake their responsibilities. Some training had been provided but knowledge gained from this was not reflected in practice.

Although staff sought peoples consent when delivering care, formal consent processes were not being used. Staff were not following the requirements of the Mental Capacity Act 2005 for people who used bed rails and were not able to consent to the use of this equipment. Formal systems were not being used consistently to support people to be involved in making decisions about their care and support.

People told us they felt safe. However staff did not recognise that neglect was a form of abuse. Up to date information was not available for staff to refer to about definitions of abuse and how to report concerns.

Despite the concerns about staff levels people told us that staff were kind and carin

This was an unannounced inspection which took place on 12 October 2015.

MoorHouse Nursing Home provides support and accommodation for a maximum of 36 older people who require residential or nursing care. Services offered at the home include nursing care, end of life care, respite care and short breaks. The rooms are arranged over three floors. There are fifteen rooms on the ground floor, fourteen on the first floor and six on the second floor. There are stair lifts and a lift to each floor. On the ground floor there is a large dining room, two lounges and further sitting areas. At the time of the inspection there were 34 people living at the home.

During our inspection the manager was present. The manager had been in post since 15 June 2015. They had submitted an application to register as a manager with us. 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. The manager’s application was being processed at the time of this inspection.

People said that the home was well-led and that management was good. Although the manager had started to take action to drive improvements at the home a consistently good quality service was not provided to everyone.

The majority of people said that there were enough staff on duty to meet their needs and to provide assistance at the times they wanted. However, we found that call bells were not always responded to in a timely way and that this meant that at times, some people did not receive care and support that they required at the times they preferred.

Recruitment records for staff did not always contain information from their previous employer or proof of identity to ensure they were safe to care for people.

People said that they were happy with the medical care and attention they received. However there were inconsistencies with the assessing and implementation of care plans which meant that some people, at times, were at risk of receiving care that did not meet their needs. Other people had assessments and care plans that were personalised and reflected their individual needs.

The manager had completed some audits of the service such as people’s weight and activities but not for other aspects of the service and as a result systems were not being used to identify and take action to reduce risks to people and to monitor the quality of service they received. The manager acknowledged further work was required in this area and explained that since being in post she had prioritised areas such as ensuring staffing levels were maintained. Records confirmed that improvements in staffing had occurred since the manager had been in post.

People said that they were treated with kindness and respect. In the main people were treated with dignity and respect and their privacy was promoted. Throughout our inspection we noted that the majority of people’s bedroom doors were ajar and this had the potential to impact on their privacy and dignity. We have made a recommendation in the main body of our report in relation to this.

People said that they were happy with choice of activities available to them. The home employed dedicated activity staff and an activity programme was in place. The home was surrounded by lovely, accessible and secure gardens and people some people told us that when their family members visited they walked in the gardens. We noted that the garden area was not included in the activity programme. Also apart from reading to people who could not leave their beds specific time was not allocated to them. We have made a recommendation in the main body of our report in relation to this.

Formal systems were not being used consistently to support people to express their views and to be involved in making decisions about their care and support. There had been no residents or relatives meetings since the manager had been in post and although people’s care plans were reviewed on a regular basis they were not invited to join in the review process and be actively involved in their future care choices. We have made a recommendation in the main body of our report in relation to this.

Medicines were managed safely at MoorHouse Nursing Home. There were systems in place to ensure that medicines had been stored, administered, and reviewed appropriately. Risks to people’s safety were assessed and actions taken to reduce incidents and accidents being repeated where possible.

People said that they would speak to staff if they were worried or unhappy about anything. Staff had received safeguarding training and were aware of their responsibilities in relation to safeguarding.

People said that the food at the home was good. Staff assisted people when required and offered encouragement and support.

Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. A training programme was in place that included courses that were relevant to the needs of people who lived at MoorHouse Nursing Home. Staff received support to understand their roles and responsibilities and said that the manager was approachable.

MoorHouse Nursing Home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm. Staff understood their responsibilities in relation to capacity and decision making. This was in line with the Mental Capacity Act (2005) Code of Practice which guided staff to ensure practice and decisions were made in people’s best interests.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with twelve people who lived at Moorhouse, four relatives, one visiting professional and eight staff members. We read three care plans and other documentation regarding the care and welfare of people who lived there. We read four staff files and looked at policies and procedures.

One person who lived at the home told us “it is very nice here, it is home here, the staff make it home.” Another said they were “very happy” living at Moorhouse and relatives told us the “atmosphere is friendly but staff are still professional.”

We found staff were knowledgeable regarding the individual needs of people who lived there. We saw they treated people with dignity and kindness assisting them in a calm and patient manner. Access to the home did not protect people's safety or security.

People who lived there told us they enjoyed the food, being offered a choice of meal and where to eat it. They liked the newly refurbished dining area.

The home was clean, tidy and free from offensive odour. Staff protected people from the risk of the spread of infection. Systems for the management of laundry were not always preventing the risk of cross infection.

Staff were supported to do their job by having the necessary training and being supported by the manager and other senior staff members.

People told us they knew how to complain, however none we spoke with had needed to do so. Any complaints which had been made had been managed to the satisfaction of all parties.

We last inspected this service on 10 October 2012 and found the provider was not meeting a number of the essential standards. The provider sent us their action plan which addressed how and by when they would become compliant with the required standards.

This inspection on 17 January 2013 was for the purpose of following up on whether the provider had achieved compliance with these standards.

The provider had informed us that the registered manager was on sick leave and that the deputy manager was managing the service, they assisted us during the inspection.

During this inspection we spoke with people who used the service and their relatives. People told us that ‘the staff look after you well’ and ‘the care is amazing’.

People told us that the staff were polite to them and treated them with dignity. They felt that they were being given choices regarding their care.

We found that staff had updated their safeguarding training or were booked onto the training. The provider’s safeguarding policy had been reviewed and staff were aware of the relevant policies.

We found that the provider had introduced systems to ensure that medicines were safely managed.

We also saw that the deputy manager had completed audits of the quality of the service and introduced systems to ensure that any adverse events were properly recorded. Resident’s meetings were being held more frequently to enable people to provide their feedback regarding the service to the provider.

People who used the service generally liked it. We were told by people that it was ‘a lovely home’ and that ‘they look after you ok’.

We found that people had their care needs assessed. Care plans had been devised to address people's needs. People we spoke to told us that they had been involved in their care planning. We found however that people were not given a proper choice in all aspects of their care for example bathing and a choice of main meal. We also found that not all staff had treated people with dignity.

People were not safeguarded from the risk of abuse. The provider had not reviewed their safeguarding policy and not all staff had updated their safeguarding training.

We found that there were not effective systems in place to ensure that medicines were managed safely.

We found that there was sufficient equipment to meet people’s needs and that staff had received the appropriate training to use it safely.

Since the last inspection the manager had implemented their action plan in relation to staffing. We found that there were sufficient staff.

We found that the provider was not effectively seeking the views of people who used the service with regard to the quality of the service provided. They had not implemented effective systems to either audit the quality of the service or to analyse adverse events that had occurred. The manager had not completed the necessary risk assessments in relation to the storage of items.

We spoke to six people using the service and they told us that the staff were kind and tried to do their best.

They mentioned particular staff members that they felt excelled in their duties and praised the staff for their hard work.

People said that they felt that the staff knew what they needed yet sometimes their needs were not met as there was not enough staff.

We spoke to several people and their relatives and friends during the site visit. All the people we spoke with praised the level of care, support and dedication of the staff at Moorhouse.

We observed that staff were attentive to people’s needs. People were involved in making decisions and their independence promoted. People said that they felt their rights to respect, dignity and privacy were honoured by staff.

The location offers a lot for people to do which includes entertainment in the home, keep fit exercise classes, reading, meeting with friends and family, attending church services, participating in local community functions, maintaining interests and hobbies and visiting places of interest.

The general atmosphere of the location during the visit was welcoming and friendly and people appeared relaxed and at ease in their surroundings with some saying it was home from home.