Moorside Hall was inspected on the 07 March 2018 and the inspection was unannounced. Moorside Hall is registered to provide nursing care for up to 22 people who may be living with dementia. At the time of the inspection there were 21 people receiving support.

Moorside Hall 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. Set in its own grounds, and close to Lancaster City Centre, the home consists of mainly single bedrooms with en-suite facilities with a toilet and a hand-wash basin. There is a large conservatory with a dining room and a lounge adjacent to it.

At our last inspection in September 2015 the service was rated ‘Good.’ At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff were able to explain the support individuals required and the way in which they supported people who lived at the home. Relatives told us they were consulted and involved in their family members care.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found two care records required updating. Prior to the inspection concluding we were informed this had been carried out. Staff were knowledgeable of people’s needs and the support they required to maintain their safety. People who lived at Moorside Hall told us they felt safe.

Medicines were managed safely. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required.

We found people had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Moorside Hall.

We found people who received support were able to raise their views on the service. ‘Residents and relatives meetings’ were held to gain the views of people who used the service.

During the inspection we observed people being supported to eat and drink in accordance with their assessed needs. People told us they were happy with the meals provided.

The registered manager completed a series of checks to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these.

We found the environment was clean and staff wore protective clothing when required. This minimised the risk and spread of infection.

Staff told us they were aware of the procedures to follow if they suspected someone was at risk of harm or abuse. Staff told us they would report any concerns to the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure which was displayed within the service. People told us they had no complaints, but they were confident the registered manager and registered provider would respond to any complaints made.

Recruitment checks were carried out to ensure suitable people were employed to work at the service. We found staff were caring. We observed warm and respectful interactions between staff and people and who lived at the home. We saw staff had time to spend with people and staffing was arranged to ensure people received support when they needed or wanted it.

We observed activities taking place and these were enjoyed by people who lived at Moorside Hall. People also said if they did not wish to take part in activities, their wishes were respected.

The registere

This inspection was undertaken to review improvements made by the registered provider following the previous inspection undertaken on 28th April 2014. This inspection was undertaken by an inspection team, including a pharmacist.

Areas of non-compliance found at the last inspection related to the care and welfare of people, the lack of staff support to meet people`s dietary needs and there were no suitable arrangements in place to respond appropriately to allegations of abuse. There was a lack of suitably qualified and experienced staff to meet people`s needs and there was a lack of effective quality monitoring systems in place to protect people from the risks of unsafe care. Also of concern was the management of medication.

We asked the registered provider to provide us with an action plan demonstrating what they were doing to address the issues of non-compliance. We received their action plan in May 2014. This detailed the procedures put in place to address the shortfalls. We used this inspection to see what actions had been taken to address the areas of non-compliance.

In August 2014 the registered provider notified the Commission there had been a recent change in the management of the home. He told us he had appointed a new manager, who was currently applying to the Commission to become the registered manager at the home. The previous manager had submitted an application to be removed from Moorside Hall as their registered manager. At the time of our inspection the newly appointed manager had only been in post seven weeks.

Information we gathered during the inspection helped 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 wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There was a copy of the Local Authority safeguarding guidance clearly displayed in the office downstairs. Our discussions with staff confirmed they were aware of what actions to take should they have any concerns for the people they cared for. The manager told us she would not hesitate to take action should she have any concerns regarding any poor practice witnessed in the home.

We found there had been generally some improvements made with the management of medicines. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

Is the service effective?

We found concerns that some records were not being completed accurately.

Is the service caring?

We observed staff to treat people with respect and dignity. Staff were patient, kind and caring with people.

Is the service responsive?

Records of accidents, incidents and behavioural incidents within the home were being reported. Action was taken to protect people from the risks posed to them.

Is the service well led?

We saw evidence to show that a range of monthly audits were being implemented on a regular basis. The manager was submitting Notifications and reporting safeguarding concerns to the appropriate bodies. Staff were undertaking Dementia Awareness training.

The Local Authority had undertaken an independent inspection visit in July 2014 and the provider was given an action plan to assist them to make improvements in some areas. The Local Authority planned to return in October 2014 to see if those improvements had been made.

This was a responsive inspection undertaken because we had received some concerning information. This related to poor staffing levels within the home, a lack of equipment available for staff to provide safe care and there were several safeguarding incidents being investigated by the Local Authority.

The inspection was led by one inspector and a specialist adviser. Information we gathered during the inspection helped 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. The summary is based on our observations during the inspection, speaking with people who live at Moorside Hall, relatives, visitors, other professionals, and staff. We looked at care plan records.

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

Is the service safe?

At this inspection we found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and detailed care plan records were not always maintained.

We looked at the staffing levels. Despite there being an recent increase in the staffing levels in the afternoon we still found a lack of adequate staff support was available to meet people`s assessed needs. We observed the lunchtime period; there were times when people waited for long periods for assistance for their meal, food and for cutlery. People were left unsupported to eat their meals. We noted the least experienced member of the staff team was left to support 16 residents in the dining rooms and conservatory areas on her own for lengthy periods. This showed us the staffing levels in the home were inadequate to meet the needs of people and keep them safe and well. Visitors we spoke with told us they had concerns regarding the staffing levels in the home.

The home used assistive technology to help reduce the risks posed to people. There was the use of bed sensors, infra-red beams, and exit alarms in some people`s bedrooms. However there had been several incidents indicating a history of faults with this technology. Whilst faults had been remedied quickly by the maintenance member of staff there seems to be an issue in how the technology is used. Without the safe use of this equipment in place, would mean that some significant risks posed to people would not be managed safely.

Is the service effective?

During our observations we saw people were sat for long periods without any stimulation or activities provided to meet their needs. We noted one person who slept for most of the day had very limited interaction with others. A second person remained alone throughout the day in the smaller lounge either talking to the television or sleeping. This person was unable to leave their chair without staff assistance and they had no means of summoning staff as there was no call button. Staff and other residents rarely used the room.

Is the service caring?

We observed at times that some of the carers were very kind and patient with people they were caring for. Some staff we saw tried to respond to people`s care needs when requested or anticipated needs as they passed by. However it was a busy home and staff were not always available to support people when they requested assistance. On occasions we saw some staff ignored people`s requests. We saw one staff member asking a colleague if they could go on their dinner break rather than respond to a person`s request for support. There were other occasions when we saw poor practice such as moving and handling. On occasions the care being provided was not acceptable. We saw staff discuss people`s care needs in front of them and others. We saw that people were not always treated with respect and dignity. We reported our concerns to the registered manager and the provider.

Is the service responsive?

We noted that in one person`s daily notes there was a request from the community mental health team (CMHT) requesting a blood sample to be taken on the day of our inspection. However neither the nurse on duty nor the registered manager had any knowledge of this. The information had not been communicated through their systems and therefore the blood sample was not taken. This showed us that people did not always receive care and treatment to support their needs.

Records of accidents, incidents and behavioural incidents within the home were not being accurately recorded. There was no analysis of these incidents being undertaken. The records we looked at indicated a high level of falls taking place in the home between January 2014 and the date of our inspection. Information we looked at indicated there were serious injuries sustained by people. There was no records to indicate what actions had been taken to minimise the risks posed to people. We read of four incidents when people had injured themselves and there was no adequate explanations for these in the records we looked at.

Is the service well-led?

Although the management team had a range of systems in place to monitor the quality of the service, we did not see evidence that they were being effective. At a senior level, there was no evidence that quality audits were taking place to identify the shortfalls in the care planning system. This meant there was no action taken to ensure that care plan records were completed correctly, completed at the appropriate time or met the needs of the people being supported. This situation put people at risk of harm.

Records of accidents, incidents and behavioural incidents within the home were not being accurately recorded. There was no analysis of these incidents being undertaken. This showed us the risks posed to people were not being effectively managed.

Notifications regarding serious injuries to people and reporting safeguarding concerns were not being completed and reported to the appropriate authorities including the Commission.

We spoke with a range of people about the home. They included the proprietor, the manager, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Moorside Hall.

This home cares for people with a range of dementia conditions and conversation with some residents was limited. We therefore spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "It’s homely here. The staff are excellent and I am very happy.”

We spoke with a range of people about the home. They included the proprietor, home manager, staff members and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Moorside Hall.

Several people had contacted us before the inspection to express a range of concerns. In particular that there was insufficient staff for management of behaviour that challenged. On the inspection, there were enough staff on duty and they were deployed around the home.

We were able to speak with people during the day of the inspection about their care and support. We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how people’s care and support was being managed.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. We spoke with people about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.

We carried out an unannounced inspection of Moorside Hall on 08 and 09 September 2015.

Moorside Hall is a care home registered to accommodate up to 22 people with dementia, and to provide nursing care. Set in its own grounds, and close to Lancaster City Centre, the home consists of mainly single bedrooms with en-suite facilities with a toilet and a hand-wash basin. There is a large conservatory with a dining room and a lounge adjacent to it. There is also a small lounge on the first floor. The first floor is accessible by a passenger lift.

There was no registered manager at the time of our inspection. We saw evidence that an application had been sent and was being processed by the Care Quality Commission [CQC]. The provider was overseeing the day-to-day management of the home and people and staff told us they were accessible, supportive and visible within 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.

We last inspected the service on 24 September 2014. We found a breach of legal requirement relating to records, Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

The provider responded by sending CQC an action plan of how they had addressed the breach identified. We found the improvements the provider told us they had made had been maintained during this inspection.

The manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. Staff spoken with told us they were aware of the procedure. They said they wouldn’t hesitate to use this if they had any issues or concerns about other staff members care practice or conduct. People who lived at the home told us they felt safe and their rights and dignity were respected. One person who lived at the home told us, “I’ve never had any problems living here. I feel safe.”

We found recruitment procedures were safe. Required checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff. Recruitment records examined contained a Disclosure and Barring Service check (DBS). These checks can include information about any criminal convictions recorded. Staff spoken with and records seen confirmed a structured induction training and development programme was in place. This included mentoring and shadowing experienced staff members.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. We found staffing levels were sufficient with an appropriate skill mix to meet the needs of people. The deployment of staff was well managed and provided people with support to meet their needs.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

We found people who lived at the home and were living with dementia were supported to be as independent as possible. At lunch time we observed staff encouraging people to eat their meal independently.

Care plans we looked at confirmed the manager had completed an assessment of people’s support needs before they moved into the home. We saw people or a family member had been involved in the assessment and had consented to the support being provided. People we spoke with said they were happy with their care and they liked living at the home.

We observed staff demonstrated an effective understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussion with the manager confirmed she understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required. Systems were in place to protect people’s human rights and we observed staff followed their recorded preferences and diverse needs.

The environment was well maintained clean and hygienic when we visited. No offensive odours were observed by the inspection team. The people we spoke with said they were happy with the standard of hygiene in place.

We found medicine procedures in place were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place. People told us they received their medicines at the times they needed them.

People’s health needs were being met and any changes in health managed well. The people we spoke with said they had access to healthcare professionals when they needed them.

People told us they were happy with the activities arranged to keep them entertained. One person said, “It’s a nice place, staff do an incredible job and we do singing, baking and play board games.”

The manager used a variety of methods to assess and monitor the quality of the service. These included surveys which were issued to people to encourage feedback about the service they had received. We noted responses to surveys in meeting minutes and changes actioned due to feedback received. The people we spoke with during our inspection visit told us they were satisfied with the service they were receiving.