The inspection took place on 24 and 26 September 2018 and was unannounced. At our last inspection in April 2016 we awarded an overall rating of Good.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Moorlands 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.

The care home accommodates 19 people across three floors. At the time of the inspection 17 people were being supported in the home. The service also provides domiciliary care registered at the same location which provides care and support to older people in and around Darlington. At the time of the inspection the service was supporting 63 people in the community.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Relatives felt staff provided exceptional care and support and demonstrated a high level of compassion and kindness to people at the end of their lives. Relatives were supported during the time up to and following the death of their loved ones.

Care records were written in an extremely person-centred way. In depth assessment and exploration of people’s life history was used to develop support and guidance for staff to ensure people lived a fulfilling life in Moorlands. People’s individual wishes, needs and choices were considered. People’s care and support was reviewed on a regular basis using a holistic review which included family and health care professionals were possible.

The provider ensured people were supported to attend a broad range of activities and entertainment within the setting and in the community to maintain an active and rewarding life.

The provider had policies and procedures in place to keep people safe. Staff were trained in safeguarding.

Accidents and incidents were recorded and monitored for themes and patterns.

The provider had a robust process in place to ensure the safe recruitment of new staff.

Risks to people and the environment were assessed with control measures in place for staff support and guidance.

Medicines were managed by trained staff whose competency to administer medicines was checked regularly. Medicine administration records (MAR) were completed correctly.

There was enough staff on duty to meet people’s needs. Staff were appropriately trained and received regular supervisions and appraisals.

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.

People enjoyed a varied health diet and had their nutritional needs assessed regularly. People’s health was monitored and when necessary staff ensured people had access to health care professionals.

Staff treated people with dignity and respect. People’s privacy was maintained. Staff supported and helped people to maintain their independence by encouraging self-care where possible.

The provider had a complaints procedure in place. People who used the service and visitors were aware of how to make a complaint.

Health and safety checks were completed regularly and records maintained.

The registered manager and staff worked with local commissioners and other stakeholders. Community links were maintained with people accessing local amenities on a regular basis. Members of the clergy made regular visits to the home.

The provider had an effective quality assurance process in place and maintained a development plan to dr

This inspection took place on 23 March 2016 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Moorlands Residential Care Home provides personal care and accommodation for up to 19 older people. The care home has been developed through converting three large terraced town houses near the centre of Darlington. It is situated overlooking a park and within walking distance of Darlington town centre. The service also provides domiciliary care registered at the same location which provides care to elderly people with physical, emotional or mental health needs in and around Darlington.

The home 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 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 service is a family run service and retained a very homely and family feel which people, staff and relatives confirmed was the case.

Moorlands Residential Care Home was last inspected by CQC on 8 September 2014 and was compliant.

There were robust systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and the correct action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety for people and staff was maintained. We saw accidents and incidents were closely monitored by the registered manager.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were extremely positive interactions between people and staff. People told us they were cared for and supported in an exceptionally responsive way. The service had devised a systematic approach and recording tool to ensure that people’s needs were reviewed with them each month and that they were asked for their views of the service in all-encompassing document. People told us they were fully involved in these reviews of their care and relatives were also invited to attend this monthly review meeting and to contribute in a meaningful way to their loved ones care and support at Moorlands.

People’s independence was actively encouraged through a range of imaginative, person-centred approaches to activity-planning. The service also accessed external activity support from trained professionals and we witnessed people enjoying fitness sessions with a trained instructor. People were supported to have an active part in the local community, from the service having a very active social media presence to people being involved in cleaning the local park and being supported to attend local hobby clubs. People also told us the service had worked with them to use technology to enable people to go out by themselves but to remain safe and to attend hobbies and clubs with staff support. This had a huge impact on people who were still physically able to access the community independently but were vulnerable. One person told us how they loved being able to go out when they wanted and to feel safe.

The service also used advocacy services to enable people to have their rights upheld and voices heard. We saw people being praised for carrying out any task for themselves no matter how small and we saw the positive impacts on people who used the service of this person-centred approach to activity planning, delivery and review.

We witnessed staff spending quality time in meaningful interactions with people. We saw that staff treated people with dignity and respect. Staff were attentive, observant, showed compassion, were patient and gave encouragement to people.

End of life care was care planned so that the person and their families were able to be

At the time of the inspection there were nineteen people who lived at Moorlands. We were able to meet and speak with some of them whilst we were there. All the people we spoke to who lived in the home told us they were very satisfied with the care and support they received. All the interactions we observed between the staff and the people who used the service were open, respectful and courteous.

We also spoke with two relatives by telephone who received care from the domiciliary care agency. One person told us, “The service is exceptional. All the staff are very reliable and very committed. I find the service very flexible and they treat my relative with complete dignity and respect.” Another told us, “I am very happy with this service, and my relative is very happy with the care she receives”.

We saw that the manager and staff provided the support that was required by the people who used the service in a way that demonstrated their knowledge of each person who lived at Moorlands. When we spoke to people living at the home they told us:

“It’s fine here, yes very good. I like to read and have a ready supply of books I get from the library.”

“It’s lovely here. I go out every Saturday. There are always activities, there is a quiz today. We meet as residents every two months and we can put our views forward.”

“I am happy here. I am going to move put some of my own things in my room here. The staff are very helpful.”

“Overall it is good here. I can talk to staff. I can bring things up at the residents meetings too.”

We saw that people who used the service were spoken to and supported in a sensitive and respectful manner. The staff told us that people who used the service were involved in day to day decision-making wherever possible.

The manager told us that she involved the relatives of people living in the home. She told us that all the people who used the service were supported to have regular contact with their families.

We found that people had their care and welfare needs met.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that there were good systems in place for the involvement of other health and social care professionals.

We found that staff were supported in their roles and had received training and guidance in supporting people. We found that people were safeguarded against abuse.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.

People told us that the care home was “smashing” they said they had “lovely discussions” with the staff and they made things “funny”. Another person said that they were “well looked after” and “everything was alright”. Another person said that they were involved in their care and “x (a member of staff) involved them in things”. They said they liked the care home and could get up when they wanted. They explained how they did not like to have liver for tea and that staff would make them something different on the day that was on the menu.

We also spoke with one person and a relative of another person, by telephone, who received care from the domiciliary care agency. One person said that the service they received was “very good” and the staff were “lovely”. The relative said that they found the service “perfectly adequate” and that they needed people like Moorlands to provide them with care in their home.

We spoke with two visiting professionals. One was visiting the care home during our inspection. They told us that they always found the staff friendly, and that the care home always made sure that the service users had all the equipment they needed. The other we spoke to was a care manager for a person who used the domiciliary care agency. They said that they always found the agency helpful and honest and they always try to resolve issues as far as possible.

We visited this location on a weekday and were able to talk to five people who used the service and their relatives. We were told that there is a ‘nice, family atmosphere’ that there is ‘lots going on’ and that staff are ‘are great, respectful and speak in the right way’. People who used the service also said that ‘the bedrooms are nice’ and that the ‘food is good.’

The relative of a person who used the service specifically commented that their relative ‘used to be isolated but this had totally changed’.

People who used the service said that they ‘feel safe’ and they confirmed that they knew how to discuss issues and with whom. People who used the service and their relatives said that staff were always professional in their approach and that they had confidence in the staff.

The inspection team consisted of one inspector. During the inspection, we spoke with five out of 18 people who lived at the home, the provider, registered manager, trainee manager, and three staff. We looked at four sets of care records. We also observed care practices and medication practices within the home. We also spoke with one staff member and three people who used the homecare service provided by Moorlands.

We set out to answer our five 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. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home and also those people who used the homecare service. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. We spoke with one staff member from the homecare service who told us they had reported an issue and it had been recorded and followed up with the local safeguarding team.

Care plans and risk assessments were in place and updated on a regular basis and were based on people’s individual needs and preferences.

We saw medication was stored and administered according to the service's policies and safe practice.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs. People were involved in reviewing their care plan each month along with their relatives if they so wished.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people who used the service and that they knew people well. Assessments included dietary, social and leisure and emotional needs.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

People had access to a range of health care professionals some of which visited the home and all was documented in the care files.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

People who used the service, their relatives and friends were asked for their views on the care and service provided. Where shortfalls or concerns were raised, these were addressed.

People told us that they were happy with the care and support provided to them.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to and there were regular opportunities for people to give feedback on the service through meetings or their monthly care plan review.

Is the service well-led?

There was a strong management team in place from the providers and trainee manager. The way the service was run was regularly reviewed. Actions were put in place where needed in relation to feedback from people who used the service and we were able to see that these actions had been addressed.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times. Staff also told us they could contact a manager easily for support.

What people said:

People who were able to express their views told us they were happy with the care and support they received. They told us:

“I like it here”,

“There is good company”,

“The food is nice, they offer healthy eating and I’ve lost five stone since I’ve been here and I feel much better as I was very overweight”,

“We have a residents meeting and you can bring anything up” and

“We go into town”.

One person told us; “I go out when I want, I have a mobile if there is any problems and once or twice when my mobility scooter has broken down they have come and rescued me.”

People using the homecare service told us:

“It is very good indeed and I have no problems”;

“They keep me informed of any issues”;

“We get on well with all the staff”,

“The young man who comes is very polite and helpful” and

“It’s very easy to contact the manager if I have any problems”.

Staff told us:

“The training was really good and they got me on that straight away”,

It’s a really nice company to work for”;

“There is always someone on call and they help out straight away”;

We spoke with one relative visiting the service who told us:

“The staff are excellent, they are very caring people” and “They let me know anything that’s going on”.