Moorland House provides accommodation and personal care for up to 20 older people, some of whom are living with dementia. The home is set in its own grounds close to the beach, cafe and local shops. The accommodation comprises two lounges and a dining room which overlooks the garden. Planning permission for a new extension had been granted.

Moorland House 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.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality 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.

Fire and legionella risks assessments needed to be more robust. Infection prevention and control procedures continue to require some improvement.

Improvements had been made to ensure staff received training, supervision and appraisal to provide them with the required skills, knowledge and competencies for their roles.

There was a positive, supportive and open culture within the home. Staff felt supported and listened to by the registered manager and providers who were visible and approachable.

People were protected from abuse. Staff had received training in how to keep people safe from abuse and understood how to identify and report abuse if they suspected abuse was taking place.

Safe recruitment procedures ensured only suitable staff were employed. There were sufficient staff deployed on all shifts to meet people’s needs and keep them safe.

The management of people’s medicines was robust. Staff received training in administering medicines and people received their medicines as prescribed.

Risks associated with people’s health, safety and welfare had been identified and assessed. Emergency evacuation procedures were in place and known to staff.

People’s rights were protected because staff understood the principles of the Mental Capacity Act (MCA) 2005). Deprivation of liberty safeguards had been submitted to the local authority for authorisation when required.

People were supported by staff to maintain their health and wellbeing and had access to healthcare services when required. People were offered a choice of home cooked food and drink that met their preferences and dietary needs.

Staff were kind and caring and treated people with dignity and respect and encouraged them to make choices and retain their independence. People were encouraged to maintain relationships with people who were important to them. Family and friends could visit at any time.

People and their relatives were involved in planning their care. Care plans were detailed and described how people wanted to receive their care. People took part in a wide range of activities and events at the home.

The provider was working towards meeting the Accessible Information Standards. Staff used a variety of communication methods to communicate with people which helped them to make decisions about their care.

People and relatives were offered opportunities to feedback their views about their care and this was used to improve the service.

Complaints procedures were available and displayed at the home. People knew who to speak to if they wanted to complain.

The registered manager understood their responsibilities under the Health and Social Care Act 2008, including submitting notifications of events as required to the commission.

We last inspected the service in August 2017 when we rated the service ‘requires improvement’ although we did not identify any breaches of regulation. The home has continued to make improvements and these now need to be embedded to ensure consistency of the delivery of

Moorland House offers accommodation for up to 20 people who require personal care, including those who are living with dementia.

At our inspection in October 2015 we identified the provider was not meeting the fundamental standards in a number of areas. We issued seven requirement notices and asked the provider to make improvements to the systems in place to keep people safe from harm and to prevent unlawful restrictions on people. Consent to care was not always sought In line with current legislation and guidance. Risk assessments had not always been completed and actions were not taken to mitigate risks. Staff training and medicines management required improvement and recruitment practices were not safe. Staff were not familiar with and able to apply the principles and codes of conduct associated with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The systems in place to assess, monitor and improve the quality and safety of the service were not operated effectively and records had not been accurately maintained.

At our inspection in December 2016 we found some improvements had been made. However, some concerns were on-going and new areas of concern were also identified.

Following the inspection, we issued four enforcement notices to the provider and registered manager for their on-going failure to meet four regulations in relation to the need for consent; safeguarding people from abuse; safe care and treatment and good governance and told them to take action to make the required improvements.

We also placed the service in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection in July and August 2017, the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The previous registered manager resigned in January 2017. An acting manager [manager] was in place at the home and they had applied to register with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality 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.

We found the manager had a good understanding of their responsibilities in relation to meeting the Health and Social Care Act 2008 regulations. They had notified us appropriately of events required by law. The manager and provider had understood the seriousness of the concerns we highlighted during our previous inspection and had worked closely with other agencies for support and advice in how to make the improvements required.

People and relatives told us they felt the home was safe. Staff had received additional safeguarding training, understood how to identify abuse and explained the action they would take if they identified any concerns about people’s safety.

Individual and environmental risks relating to people’s health and welfare had been reviewed to identify, assess and reduce those risks. Up to date guidance was available for staff in how to support people in line with the risk assessments. Incidents and accidents had been investigated and learning shared with staff to reduce the risk of re-occurrence.

Systems were in place to ensure the management and administration of medicines, including controlled drugs, were safe. Some minor issues were identified which the manager said they would address. Staff received training to administer medicines and were assessed for competency.

Robust recruitment processes ensured that only suitable staff were employed. There were sufficient staff deployed to meet people’s needs during the day. Staff

Moorland House offers accommodation for up to 20 people who require personal care, including those who are living with dementia. We carried out an unannounced inspection on 5, 6 and 12 December 2016 and found breaches of legal requirements.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timescale.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our previous inspection in October 2015 we identified the provider was not meeting seven regulations. Systems and processes were not established and operated effectively to prevent abuse. Staff failed to recognise restrictive practice and to assess less restrictive options for people’s support. Risk assessments were not always completed and regularly reviewed and actions were not taken to mitigate risks. Staff training, and procedures regarding the administration of medicines were inconsistent and did not ensure the proper and safe management of medicines. Staff recruitment procedures were not established and operated effectively to ensure safe recruitment decisions. Consent to care was not always sought In line with current legislation and guidance. Staff were not familiar with and able to apply the principles and codes of conduct associated with the Mental Capacity Act 2005. The provider had not acted at all times in accordance with the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. People were deprived of their liberty for the purpose of receiving care without lawful authority. Systems in place to assess, monitor and improve the quality and safety of the service were not operated effectively, in particular in regard to people’s health and welfare. Records in respect of service users, persons employed and the management of the regulated activity were not accurately maintained.

Following the inspection, the provider sent us an action plan telling us the steps they were taking to make the improvements required. In July 2016 they sent us an updated action plan which informed us they had completed their actions or they were in hand. At this inspection, we found some improvements had been made. For example, staff training, supervision and appraisals had been completed. Staff recruitment procedures had been improved and all appropriate checks had been completed. Some improvements had been made to the safety of the environment.

However, on-going concerns remained in all other areas of the management of the home and in the care of people who lived there.

There

We inspected Moorland House to check that the provider had made improvements in the area of record keeping. We also inspected other areas to check that the provider had met the standards required. We spoke with three people who used the service. We spoke with four members of staff, including the registered manager. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking to people who use the service, the staff supporting them and looking at records.

Is the service safe?

People we spoke with told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us that they were treated well by staff and that they felt listened to and their wishes respected.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints and concerns.

Is the service effective?

People’s health care needs were assessed with them, and they or their family were involved in writing their care plans. Specialist input, such as occupational health, was provided to support the planning and delivery of people’s care.

People’s care plans and risk assessments were updated regularly or when people’s support needs changed.

Is the service caring?

We spoke with three people being supported by the service and asked their opinions about the staff who supported them. Feedback was positive. One person told us “I’m well looked after and cared for, oh yes, I think so” and another said “Staff are lovely.”

We observed that staff spoke to people with kindness and respect. It was clear that staff knew people well and responded to them positively when supporting them.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We saw that the service had received one complaint and this had been investigated and responded to in line with the complaints policy.

The service worked well with other agencies and services, such as care management and GPs, to ensure that people received appropriate care and support.

We saw that when people’s needs changed, the service responded in a timely way and communicated this to staff and other agencies.

Is the service well led?

The service had a quality assurance system and records showed that any identified issues, or opportunities for improvement, were addressed promptly.

Staff meetings took place which enabled staff to discuss and plan improvements within the service.

Staff received supervision and appraisals to identify training needs and monitor staff performance. However, these had not happened in line with the frequency in the company policy.

Staff told us that they were clear about their roles and responsibilities. They told us that they received training which supported them to carry out their roles.

We were assisted by the manager throughout the inspection and also met with the Nominated Individual for the organisation. We spoke with five people who lived at the home. They could only give a limited account of their experiences of living at the home because of a diagnosis of dementia. We therefore spent the majority of the inspection in the communal areas to observe how people were cared for and supported. We also spoke with three members of staff and with one visiting relative.

We found that where people had capacity to be involved in their care, consent had been obtained about how they wished to be cared for and supported. Mental capacity assessments had been carried out to identify those people who did not have capacity to be involved in their care and support. Consent from relatives and health professionals had been sought in making ‘best interest’ decisions on behalf of those people who did not have capacity.

People’s care and welfare needs were being met at the home. Assessments of people’s needs had been carried out and care plans put in place to inform the staff team up on how to care and look after people.

There were sufficient numbers of staff employed to meet the needs of people accommodated at the home.

There were systems in place to monitor the quality of service provided to people living at Moorland House.

The manager had taken steps to improve record keeping following concerns identified through adult safeguarding proceedings. However, there were still some omissions in people’s care records and gaps in recording.

The aim of this inspection was to follow up on a warning notice and compliance action we issued following the last inspection of Moorland House on 3 September, 2012.

We were assisted throughout the inspection by the home’s deputy manager. We observed interactions between staff and residents during the inspection and spoke to some people living at the home. Owing to dementia these people were not able to tell us about living at Moorland House. We visited one person in their bedroom to look at how they were being cared for. We spoke with three members of staff and also met with an operations manager for the organisation.

We focused on how the care and welfare needs of three people were assessed, planned and delivered. We looked at their care plans and assessments and found that there had been significant improvements since the last inspection. Members of staff we spoke with also told us of improvements that had been made since the last inspection. We found that people were now protected from the risk of receiving inappropriate or unsafe care.

We were assisted at this inspection by the manager of the home and also met with the provider. We spoke with four people living at the home; however, owing to their mental frailty they were not able to provide much information about their experience of living at the home. We therefore used the Short Observational Framework for Inspection (SOFI). We also spoke with two visiting relatives who told us they were happy with the care provided and that they had no concerns or complaints.

We, however, did have serious concerns about the way in which people’s care was planned and monitored. The care records that we looked at for three people were out of date and proper steps to make sure care was both planned and delivered were not in place. We did observe though, that staff were attentive to people's needs throughout the inspection. They were also knowledgeable about people and there seemed good relationships between staff and people living at the home. We saw that activities took place to stimulate people.

We found that storage arrangements for controlled drugs did not meet current legal requirements and some improvements could be made concerning medication administration.

We found that staff were being recruited appropriately.

People we spoke with said they were well treated and staff provided the care they needed. One person said staff were very respectful when talking to him.

People told us they felt safe in the home and that there were sufficient staff available to meet their needs. We were told home was always kept clean.

This inspection visit took place on 23 and 28 October 2015 and was unannounced.

Moorland House is a small, privately owned residential home providing care and support for up to twenty older people, some of whom are living with dementia. There were seventeen people using the service at the time of this inspection.

The service has 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 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 not protected from the risk of avoidable harm and improper treatment because managers and staff did not always recognise potential abuse.

Risks to people’s health and welfare were not always assessed and reasonable steps were not always taken to mitigate risks.

Medicines were not always managed in a safe and proper way to protect people.

Recruitment procedures were not robust and relevant checks were not always completed appropriately to make sure staff were suitable for their role.

Staff did not follow legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests.

The systems in place to monitor the quality and safety of the service were inconsistently applied.

We have made a recommendation about making the environment more suited to the specialist needs of people living with dementia.

We have made a recommendation about supporting people who are living with dementia to make choices about eating and drinking.

Overall, people received support to have sufficient to eat and drink. Staff were aware of those people who required assistance with eating and drinking. People’s comments about food and drink were mostly positive.

People were protected by the procedures that were in place for the prevention and control of infection.

Staff were responsive to people’s changing health needs and supported them to access healthcare professionals. Where people used their call bells we saw staff responded promptly.

People did not always receive personalised care that was responsive to their needs. We observed staff were very busy with tasks and did not have much time to spend interacting socially with people. Staff were aware of people’s overall care needs and support preferences and approached and spoke to people in a friendly and helpful manner.

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

This inspection visit took place on 23 and 28 October 2015 and was unannounced.

Moorland House is a small, privately owned residential home providing care and support for up to twenty older people, some of whom are living with dementia. There were seventeen people using the service at the time of this inspection.

The service has 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 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 not protected from the risk of avoidable harm and improper treatment because managers and staff did not always recognise potential abuse.

Risks to people’s health and welfare were not always assessed and reasonable steps were not always taken to mitigate risks.

Medicines were not always managed in a safe and proper way to protect people.

Recruitment procedures were not robust and relevant checks were not always completed appropriately to make sure staff were suitable for their role.

Staff did not follow legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests.

The systems in place to monitor the quality and safety of the service were inconsistently applied.

We have made a recommendation about making the environment more suited to the specialist needs of people living with dementia.

We have made a recommendation about supporting people who are living with dementia to make choices about eating and drinking.

Overall, people received support to have sufficient to eat and drink. Staff were aware of those people who required assistance with eating and drinking. People’s comments about food and drink were mostly positive.

People were protected by the procedures that were in place for the prevention and control of infection.

Staff were responsive to people’s changing health needs and supported them to access healthcare professionals. Where people used their call bells we saw staff responded promptly.

People did not always receive personalised care that was responsive to their needs. We observed staff were very busy with tasks and did not have much time to spend interacting socially with people. Staff were aware of people’s overall care needs and support preferences and approached and spoke to people in a friendly and helpful manner.

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