Moors Park House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Moors Park House provides personal care and accommodation for up to 37 older people who may also be living with dementia. Nursing care is not provided by the service. This service is provided by community nurses working for the National Health Service. At the time of this inspection, 33 people were living at the home. The provider company Crocus Care group has three services, with the provider living locally.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

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 on holiday but came to the inspection to support staff. They were very knowledgable about people and their needs and were clearly passionate about the work they do.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised electronic care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people's needs and any changes in the support they required.

People had access to a wide range of group and individual activities, and events they could choose to participate in, which were tailored to meet their specific social needs and interests. This enabled people to live an active and fulfilling life.

People who preferred or needed to stay in their bedroom were protected from social isolation. People regularly participated in outings and activities in the local community. The service also had strong links with local community groups and institutions.

When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded.

Staff were aware of people's communication methods. They provided them with any support they required to communicate to ensure their wishes were identified, enabling them to make informed decisions and choices about the care and support they received.

The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the managers.

People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. The registered manager took time to ensure they employed staff who were able to promote the Crocus Care ethos of ‘Caring for life with dignity’. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.

People's medicines were managed safely and the provider ensured that incidents and accidents were fully investigated. The home was well kept and hygienic. There was ongoing investment in the older style building. The home was dementia friendly and met the needs of the people living there. Staff demonstrated they knew people well, and people and their relatives were all positive about the care provided.

Staff were well supported through training, supervision and appraisal. They worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them.

People enjoyed the meals avail

Moors Park House offers accommodation with care and support to up to 37 older people. Nursing care is not provided by the service. Any nursing care that is required is provided by community nurses working for the National Health Service. The service was inspected on 19 and 21 July when there were 30 people living there.

The service was last inspected on 2 and 3 December 2014 when it was rated as ‘Requires Improvement’ overall. We found; there were not sufficient staff to meet the needs of people living at the service; staff said they did not receive sufficient training to support people; some people did not receive the support they needed at mealtimes; records did not provide staff with information about people’s changing healthcare needs; people’s needs and preferences about the support they received were not sufficiently understood by staff; people’s needs were not sufficiently understood by staff and quality assurance systems were not always effective. At this inspection in July 2016 we checked to see that improvements had been made and found that they had.

Prior to this inspection we had received some concerns about the quality of care provided to people. We had asked the provider to look into these matters and they provided us with a full response following a thorough investigation. At this inspection in July 2016 we also looked into the issues that had been raised. We found no evidence to support the concerns.

A registered manager was employed by 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.

People’s needs were met by ensuring there were sufficient staff on duty. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

Not everyone living at Moors Park House was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. Each time staff entered the lounge they spoke to people and tried to engage them in conversation.

People’s needs were met by kind and caring staff. One visitor told us that in the two years their relative had been at the service things had been “Absolutely brilliant, the care is excellent”. People’s privacy and dignity was respected and all personal care was provided in private.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals.

People and th

At our last visit to Moors Park House in October 2013 we found that they were not meeting the outcome for consent to care and treatment. We found no evidence that people living at the home or their representatives had been involved in drawing up their care plans or given consent to receive the care identified in the plans. We also found improvements were needed to the way care workers supervised people in the lounge areas.

Prior to our visit in February 2014 we received anonymous concerns about the care people received at the home. These concerns included, the way people were supervised in the lounge areas, that people were left in wheelchairs for long periods of time, that personal care routines were not followed particularly at night and that care workers did not ensure people drank fluids that were given to them. At our visit in February 2014 we found no evidence to support these concerns.

As part of our inspection in February 2014 we used our SOFI (Short Observational Framework for Inspection) tool to help us see people’s experiences in the lounge area. We found that people were well supervised in the lounge areas.

We saw care plans were individualised and set out how care workers were to meet specific needs. Where possible, consent had been sought in relation to care and treatment provided and people’s representatives had been involved in the care planning process.

We (the Care Quality Commission) spoke with four people who lived at the home, three staff, and the management of the home. We also spent time observing care and we looked at three care plans. On the day of our inspection 28 people were living at the home and receiving care from the service.

People living at the home we spoke with told us they were looked after well. One said “They are very good, I like it here.”

Many people who lived at this home had dementia. Staff had a good understanding of how to meet each person’s individual and diverse physical and mental health needs.

We saw clear evidence of the involvement of external healthcare and community support services. We saw that people had opportunities to participate in some activities of their choosing. We saw that people were consulted about what they wanted to do, and about how they wanted their care to be delivered.

We saw that people were relaxed in the company of staff. They were kept safe from abuse because staff knew how to recognise abuse and how to report this. Staff training, supervision and annual appraisals were linked to ensure that staff had the skills to meet people’s needs.

The home was clean and well maintained.

Records were up to date and securely stored.

During our visit, we met with 14 people and two visiting relatives in their rooms, in the dining room and in the lounges. When people were unable to speak with us, we observed how they interacted with staff.

People told us that staff were always polite, kind and never rude. People who were highly dependent said that staff know how to carry out their caring duties, including careful use of moving and handling equipment. People said that staff came quickly if they rang their call bell. One person said they could always have support with “a good wash”, but had to take turns with using the bathrooms.

People we saw in their rooms were happy with the room and furniture. Some had glass doors to the garden or courtyard from their room. One person told us they had been “wheeled into the garden” in the summer. Another person said it “is lovely here in the summer”, and they were pleased that their relatives had an attractive place to come to when visiting them.

We saw that it was easy for an independent wheelchair user to get around the ground floor, with no steps to hinder them.

People told us that they were asked what they would like to eat, that they were well looked after, and that lunch was brought to them in their room if they were not feeling well. We saw that the menu was written on a blackboard in the entrance hall, with a choice of main meal and dessert, but no-one who spoke with us knew what they would be having for lunch and were not aware that they could make a choice. We saw that when a meal was brought to the table, if the person said they did not want it, staff quickly brought something else for them to eat.

We were told that people did not always get their clothes back from the laundry. They had had to replace items. Relatives were aware of their right to make a written complaint to the management. People who live in the home said that if they wanted to complain about anything, they would speak directly to staff.

The inspection took place on the 2 and 3 December 2014 and was unannounced.

Moors Park provides care and accommodation for up to 37 older people who may also be living with dementia. On the day of the inspection 32 people were living in the home. 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.

Staff were caring and kind. Comments from people included “The staff are kind, they always check on me and help me with anything I ask”. Feedback from relatives included “The staff are kind and caring, I just think they are always so busy and don’t have time to spend doing things with people”.

People’s safety was compromised because staff were not employed in sufficient numbers. Staff were caring and worked hard to support people but there were not enough staff to meet people’s needs and keep them safe. Due to the low numbers of staff, call bells were regularly not responded to within the timescale set by the provider as being acceptable and safe. The provider did not have an effective system to assess staffing levels and make changes when people’s needs changed. This meant they could not be sure there were enough staff to meet people’s needs and to keep them safe. Staff told us they wanted to spend time with people and meet their needs but felt the low staffing levels had a negative impact on staff morale and the quality of care provided.

Staff undertook an induction when they first started work and an on-going training plan was in place. However, some staff said the training plan did not provide them with the necessary skills and knowledge to support people recently admitted to the home or to support people as their needs changed and increased.

Medicines were stored and administered safely. However, some of the documentation in relation to medicines had not been completed in line with the provider’s medicines policies and procedures. These issues were discussed with the registered manager at the time of the inspection and we were told this would be addressed as a matter of priority.

Some people who required assistance during their meals did not get the support in an appropriate or timely manner. However, people told us that the food was good and they were able to make choices about what they ate. People had support to access healthcare services when required.

The provider’s admissions process did not always ensure that people had appropriate and consistent care when moving into the service.

People said they had their needs met by staff. However, records did not in all cases provide staff with sufficient information about people’s needs and how they chose and preferred to be supported.

The roles and responsibilities of management and senior staff were not clearly defined and led to confusion about decisions relating to people’s needs and support arrangements. Staff said that they were well supported by their colleagues and the registered manager

A system was in place for receiving and responding to complaints. However, the provider did not always respond to concerns positively and this could have an impact on whether or not people felt confident to raise concerns about the service.

Staff knew how to recognise signs of possible abuse. They said they were confident that reported signs of suspected abuse would be taken seriously and investigated thoroughly. Staff knew who to contact externally should they feel that their concerns had not been dealt with appropriately by the registered manager. Staff understood their role and correct procedures had been followed when it had been assessed people did not have capacity to make decisions themselves. This helped ensure people’s human rights were protected.

Recruitment practices were appropriate and helped keep people safe.

Family and friends were able to visit the home without any restrictions and staff supported people to maintain links with people who mattered to them.

Systems were in place to seek feedback from people about the quality of the service. Improvements had been made in relation to the environment and activities as a result of this feedback.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 ( Regulated Activities) 2014. Staff were not available in sufficient numbers to meet people’s assessed needs and to keep them safe.

You can see what action we told the provider to take at the back of the full version of this report.