About the service: Moorlands Grange is a residential care home providing short term and intermediate care for people living in the Kirklees area. Some people are provided with support from an on-site health care team including health care assistants, pharmacists, nursing, physiotherapy and occupational therapy with support from a visiting GP. Moorland Grange provides care to 40 people. There were 36 people at the service on the first day of our inspection.

People’s experience of using this service:

Risk assessments were in place but were not specific to the needs of the individual. They did not consider person specific reduction measures to guide staff to manage the risk of harm.

People told us staff provided a service that made them feel safe, promoted their independence and had a positive impact in their lives. Staff knew how to report potential abuse and to take immediate action to protect people.

Medicines management did not always follow evidence-based practice. We have made a recommendation about the management of some medicines.

Maintenance checks on the environment were robust and the service had an onsite maintenance person to coordinate any response required.

There were enough staff to meet people's needs and keep them safe. Due to the increasing complexity of people’s needs, the provider had identified the need for night staffing levels to increase.

People were supported by staff who received appropriate training and support to carry out their roles and responsibilities. Staff felt supported by the management team.

People received support to eat and drink if this was part of their care plan. Staff knew how to access relevant healthcare professionals, and this was evidenced in people’s care records.

The service worked in partnership with other organisations and healthcare professionals to improve people's outcomes.

People's care and support had been planned in partnership with them, and regularly reviewed to ensure they achieved their goals. People were supported to have maximum 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.

A range of audits and checks were undertaken to help monitor the quality of the service. Some of these needed to be more robust to ensure that the service consistently met CQC standards. Management were keen to make improvements to ensure they improved their service and sought advice to support this aim.

Rating at last inspection: Good (published 3 September 2016)

Why we inspected: This was a scheduled inspection based on the service previous rating.

Enforcement: We found one breach in the regulation. Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 27 July 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Moorlands Grange on 21 March 2014, at which time the service was compliant with all regulatory standards inspected.

Moorlands Grange is a residential care home in Netherton, Huddersfield, providing accommodation and personal care for up to 40 older people. There were 36 people using the service at the time of our inspection. Moorlands Grange also provides short-term residential care for older people who need support with personal care after being in hospital or have had a change in circumstances whilst appropriate care packages are reviewed and implemented. People using this aspect of the service stay on the ‘Hawthorn Suite’, which is made up of 16 ground floor bedrooms. Moorlands Grange also has 24 bedrooms which are used to provide intermediate care for people who have been assessed as needing additional support before returning home. Most people using this aspect of the service stay on the ‘Oakmoor Suite’ and had access to an externally employed, on-site health care team who provided nursing, physiotherapy and occupational therapy support where required.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 sufficient numbers of staff on duty in order to safely meet the needs of people who used the service and to maintain the premises. We observed call bells responded to promptly throughout the inspection. All areas of the building were clean and well maintained, including external areas.

Staff were trained in safeguarding and displayed a good knowledge of safeguarding principles and what they would do should they have any concerns. People who used the service and their relatives expressed confidence in the ability of staff to protect people from harm.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service (DBS) checks, references and identity checks.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE).

Risk assessments took into account people’s individual needs and staff displayed a good knowledge of the risks people faced and how to reduce these risks.

People received the treatment they needed through prompt and regular liaison with nursing, physiotherapy and occupational therapy staff.

Mandatory staff training was regularly updated to ensure staff had a good working knowledge of people’s needs, whilst the Care Certificate modules were used to help refresh staff knowledge.

Staff received regular supervision and appraisal processes as well as regular team meetings.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. Staff displayed a good understanding of capacity and consent and we found related assessments and decisions had been

When we visited the home in September 2013 we found suitable arrangements were not in place for the purpose of obtaining consent from people. We found information kept in staff personnel files was not up to date, nor did it show that effective recruitment and selection processes had been followed. We saw there were not enough qualified, skilled and experienced staff working at the home to meet people’s needs. We also found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We asked the provider to make improvements.

We went back on this inspection to check whether improvements had been made.

On the day of our inspection 39 people were living at the home. We looked at the care records of five people and found they all contained documentation to show each person had given their consent to the care and treatment they received at the home.

We looked at four staff personnel records and saw they all contained evidence to show effective recruitment processes had been followed.

We looked at the rotas in place which showed the staffing levels for a two week period prior to our inspection. We saw staffing at night had been increased. This meant there were four members of staff to care for people at night.

We looked at nutritional charts for people living at the home and saw these were accurate and up to date.

At the time of our inspection there were 32 people using the service. We spoke with two people who used the service and they told us they received good care. One person told us 'There isn't much to do here but the staff are all very good. It just gets a bit boring'. Another person told us they looked forward to the entertainment provided but they felt this could be added to. Staff told us they felt they were supported by the manager and that the team worked well together. One staff member told us that sometimes they were really busy and they knew this meant people were having to wait. We saw that the outside space available to people was well maintained and people using the service could access this easily.

We spoke with three people using the service and they told us that they were happy with the care they receive. They were aware that a range of internal and external activities are provided and they could choose what they wanted to participate in.