This inspection took place on 6 and 7 February 2017. The first day of the inspection was unannounced. We had previously inspected this service in December 2015 when we found it to be meeting all the regulations we reviewed.

Boldlawn Ltd is registered to provide accommodation for persons who require personal care at Moorland View Care Home. Accommodation is provided in 32 single bedrooms over two floors. 16 of the bedrooms have en-suite facilities. The home is located in a residential area in Darwen. At the time of this inspection there were 30 people using the service.

The service had a registered manager in place as required under the conditions of the provider’s registration 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. The registered manager was also the owner of the service.

People told us they felt safe in Moorland View and had no concerns about the care and support they received. Staff had received training in safeguarding adults from abuse. They were able to demonstrate their understanding of the correct action to take if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff told us they would be confident to use the whistleblowing policy that was in place should they witness poor practice in the service.

Staff had been safely recruited and there were sufficient numbers of staff available to meet people’s needs in a timely manner. Records showed staff had received the necessary induction, training and supervision to help them to deliver effective care.

People who used the service told us they felt the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

Systems in relation to the administration of creams needed to be improved. However a visiting district nurse told us they had no concerns regarding the skin integrity of anyone who used the service.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity or gas supply. Personal emergency evacuation plans were in place to help ensure people who used the service received the support they required in the event of an emergency at the home.

People’s care records contained enough information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. Care records had been regularly reviewed to ensure they were an accurate reflection of people’s needs.

Records we reviewed showed staff worked in cooperation with health professionals to help ensure that people received appropriate care and treatment. The visiting district nurse we spoke with told us the quality of care provided in the service was very good.

Wherever possible people who used the service were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems were in place to help ensure people’s health and nutritional needs were met. People told us the quality of food provided in the service was generally good.

People were provided with the opportunity to engage in a range of activities to promote their well-being.

People had opportunities to comment on the care they received in Moorland View. People we spoke with told us they would feel confident to raise any concerns they might have wit

This was an unannounced inspection which took place on 16 December 2015. The service was last inspected in April 2014 when it was found to be meeting all the legal requirements we reviewed.

Boldlawn Ltd is registered to provide accommodation for persons who require personal care at Moorland View Care Home. Accommodation is provided in 32 single bedrooms over two floors. 16 of the bedrooms have en-suite facilities. The home is located in a residential in Darwen. At the time of this inspection there were 28 people using the service.

The service had a registered manager in place who was also the provider of the service. 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.

Recruitment processes were generally robust enough to help ensure people were always protected from the risk of unsuitable staff. However, we noted one staff member’s file did not include a full employment history.

People who used the service told us they felt safe in Moorland View. Visitors we spoke with said they were happy with the care their relative received and had no concerns about their safety. Staff had received training in safeguarding adults and knew the correct action to take should they witness or suspect abuse. They told us they were confident they would be listened to and taken seriously should they raise any concerns.

People we spoke to told us that the staff at Moorland View were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs, interests and preferences of people who used the service. However, care plans did not always contain detailed information for staff to follow to help ensure people received safe and effective care, including advice received from other professionals such as the Speech and Language Therapist (SALT).

Although staff generally responded promptly to people’s request for assistance, the deployment of staff at lunchtime did not ensure that people received the individual support required to eat their meals.

Systems to ensure the safe administration of medicines needed to be improved; this was because records did not always show when staff had applied prescribed creams. However, a visiting health professional told us they had no concerns regarding the skin care people received. People were supported to be as independent as possible when taking their prescribed medicines.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care such as utility failures. Regular checks were in place to ensure staff were aware of the action they should take in the event of a fire at the service. However, personal evacuation plans (PEEPS) had not been developed. This meant there was a risk people who used the service would not receive the support they required in the event that an evacuation of the home was necessary.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The majority of staff had received training in the Mental Capacity Act (MCA) 2005 and told us how they would support people to make their own decisions wherever possible. The registered manager was aware of the action to take to ensure any restrictions in place were legally authorised under the Deprivation of Liberty Safeguards (DoLS).

Staff told us that they completed an induction when they started work at Moorland View. We saw that systems were in place to ensure staff received the training, supervision and appraisal to support them to deliver effective care.

People told us they enjoyed the food provided in Moorland View. We observed the food to be well presented and nutritionally balanced. Systems were in place to help ensure people’s nutritional and health needs were met. Visiting health professionals we spoke with told us the standard of care provided by staff was very good.

A programme of activities was in place to help stimulate people and maintain their contacts within the local community.

Records we reviewed showed people had opportunities to comment on the care provided in Moorland View. All the people we spoke with told us they would feel confident to raise any concerns with the staff and registered manager.

Staff told us they enjoyed working in the service and received good support from both the registered manager and senior staff. Regular staff meetings provided staff with an opportunity to comment on the service provided and to suggest any improvements they felt could be made.

A system of audits and quality assurance monitoring was in place. However, this needed to be more robust to identify and drive forward required improvements in the service.

The inspection team included an inspector and an expert by experience. The team gathered evidence against the outcomes we inspected to help us answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people people who used the service and two relatives. We also spoke with two professional visitors, four staff members and looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Comments made to us included, “I feel safe because there is no one to bother you” and “I feel safe here because the staff are always about”. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to record and review complaints, accidents and incidents. This should help reduce the risk to people and help the service to continually improve.

The home had policies in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Staff understood the need to seek consent from people before they provided any care. This should help ensure people’s rights were safeguarded.

Recruitment procedures were safe and thorough. Staff were supported to gain appropriate skills and knowledge for their role. This should help ensure people received safe and appropriate care.

Is the service effective?

Most of the people we spoke with told us they were happy with the care they received and their needs had been met. It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs. One person who used the service told us, “They (staff) come quickly when I ring the bell, I get on with all of them they are all nice girls. The staff talk to me whilst they are bathing me”. Staff had received training to meet the needs of people who used the service.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. Risk assessments were regularly reviewed and care plans amended to reflect people’s changing needs.

Is the service caring?

People were supported by kind and attentive staff. We observed staff took care to support and protect people while assisting them to mobilise around the home.

We spoke with two professional visitors. They told us they considered the quality of care provided by staff was good. Comments they made to us included, “The service is wonderful. They are genuine and caring staff”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records we looked at showed us people had the opportunity to meet with their key worker to review their care.

Systems were in place to ensure staff had access to up to date information regarding people’s needs. This should help ensure they were supported to respond appropriately to any changes to a person’s condition.

Is the service well led?

The service worked well with other agencies to make sure people received care in a joined up way. We saw positive feedback had been received by the home from the local hospital. This related to the quality of information provided when a person from Moorland View had been admitted to hospital. This information helped to ensure the person was provided with the care they required when they were away from the home.

Quality assurance processes were in place in the home. Records we looked at showed us people had recently completed a satisfaction survey. We were told the provider was in the process of analysing the results and an action plan would be developed to address the issues raised.

People who used the service were regularly asked their opinion about the service. Regular meetings were held with staff. These provided the opportunity for staff to discuss any concerns or practice issues in the home.

On the day of our inspection we spoke with four people who lived at Moorland View and three relatives. All the people spoken with told us they were happy with the care and support provided at Moorland View. One person told us, “It’s brilliant here. All the staff are very helpful”. Another person commented, “It’s lovely here. I wouldn’t want to be anywhere else”.

We reviewed the care files of six people who lived at Moorland View. We found evidence that there were some systems in place to record the decisions people were able to make for themselves. Staff told us they understood the need to seek consent from people before providing any care or treatment.

We saw care plans identified the needs of the person and included some information on how they wished their care to be delivered.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We found there were sufficient numbers of staff on duty to meet the needs of people in Moorland View.

We found that suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people in Moorland View.

We spoke with nine of the people who use the service. They told us they were mostly satisfied with the service provided. One person told us, "The staff are very good. I am very happy here". People told us staff treated them with respect and that their rights to privacy and dignity were upheld. We spoke with two relatives who told us they were happy with the service provided.

People's care was planned and delivered in accordance to their needs. People had individual care plans which were supported by a series of risk assessments. Although the people we spoke with were not always familiar with their care plan, they told us that they usually received the care and support they required and that staff were aware of their wishes and preferences as to how this care should be provided. However people told us they sometimes had to wait for staff to respond to their requests for support.

We found that staff had received training on safeguarding vulnerable adults and had access to appropriate policies and procedures. All people spoken with said they felt safe in the home.

We saw evidence that there were systems in place to ensure staff received appropriate training, supervision and appraisal. This meant that staff were supported to deliver care that was safe and appropriate to people's needs.

We found that there were systems in place to safeguard the records of both people using the service and staff.

We tried to speak to some of the people using the service but they were unable to communicate clearly enough to give us their view of the service they received.

We spoke to a person living at Moorland View who told us he was happy with the facilities and care provided at the home. The people we spoke to were satisfied with the food served and they made positive comments about the menu and choice of food

The resident we spoke to told us that he felt he had satisfactory choices in his daily life such as rising and retiring times, food eaten and activities. There were varied and interesting activities to suit individual preferences.

Residents and their relatives or representatives spoke positively about the staff and felt they treated people using the service properly and looked after them in a way that respected their privacy, dignity and independence.

We asked a visiting relative about the staff abilities to do the job and she told us, “Staff are very good caring and contentious. I have no concerns”.

Another relative told us, “They bent over backwards, got the bed, hoist, made adjustments. They’ve been good with my relative, we’re happy with the way they look after them”.