This unannounced inspection took place over two days on 6 and 7 September 2017.

Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 45 people were using the service.

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 and associated Regulations about how the service is run.

At the last inspection on 7and 8 September 2016, we found one breach of the Health and Social Care Act 2014. Medicines were not safely managed and we asked the provider to take action to make improvements to ensure that people who received their medicines without their knowing (covertly) or who had their medicines crushed were appropriately managed. The provider sent us an action plan detailing the action they were taking to meet these requirements. At this inspection we found that the actions had been completed and that people who received their medicines without their knowing (covertly) or who had their medicines crushed were now appropriately managed. People received their medicines safely.

Staff knew people and their needs well but some care plans were not sufficiently detailed or person centred. This was an area of ongoing development.

An activities worker was employed and social and recreational activities and events were available.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

Staff received the training and support they needed to carry out their duties. They provided people with the support they needed and wanted.

People were supported to receive the healthcare that they needed. They told us they felt safe at Moreland House and were supported by kind and caring staff.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.

The provider’s recruitment process ensured staff were suitable to work with people who needed support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.

Complaints were taken seriously and action was taken to address any concerns.

Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional needs were met and if there were concerns about their eating, drinking or their weight, this was discussed with the GP. Support and advice were sought from the relevant healthcare professional, for example, a dietitian.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided.

This unannounced inspection took place on 7 and 8 September 2016.

Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 47 people were using the service.

The service did not have 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 and associated Regulations about how the service is run.The current manager was in the process of registering with CQC.

At the last inspection on 23 and 24 September 2015 we asked the provider to take action to make improvements with regard to medicines storage and recording, taking action when possible abuse had occurred and dealing with emergencies. The provider sent us an action plan detailing the action they were taking to meet these requirements. At this inspection we found that the actions had been completed.

The arrangements for administering medicines were not always safe. People who received their medicines without their knowledge (covertly) were not managed safely. However, the issues found at the previous inspection had now been addressed.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

Staff received the training and support they needed to carry out their duties and to provide people with the support they needed and wanted.

People were supported to receive the healthcare that they needed. They told us they felt safe at Moreland House and were supported by kind and caring staff.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.

The provider’s recruitment process ensured staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs. We have recommended that the floor cleaning system be reviewed to ensure that people are not placed at risk of falls due to wet floors. We have also recommended that further consideration be given to make the internal environment more dementia friendly.

Complaints were taken seriously and concerns addressed but some people were not aware of how to complain or whom to complain to. We have recommended that action be taken to remedy this.

Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People told us that the food was good and that they could have a drink when they wanted. People’s nutritional needs were met and if there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.

We have recommended that lunchtime arrangements and support be reviewed to ensure that people have a more pleasurable meal time experience at a pace that suits them.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

An activities worker was employed and social and recreational activities and events were available. People told us that they particularly enjoyed the exercise activity.

People’s care plans were being reviewed and updated to ensure that they were clear and sufficiently detailed to enable staff to support them safely and eff

We spoke with five people who used the service, two family members, and five members of staff which included the registered manager. One person said, "staff are looking after me. Slightest problem and they will put it right." Another person said, "I like it here. The staff are excellent." We saw that staff had a good rapport with people living in the home. We saw people enjoying activities and chatting with staff.

There were systems in place in place for obtaining informed consent from people who use the service. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. A relative of a person told us, "my father's care plan is reviewed quarterly and they ask for my feedback and I sign it."

We saw that all areas, including bedrooms and communal areas, were clean. No odours were evident. Staff had access to, and we saw they used personal protective equipment such as gloves, alcohol gel for cleaning hands and disposable plastic aprons. One person told us, "always clean here. The staff wear protective clothing."

We found that the provider had taken action to ensure all staff received regular supervision and ensuring training needs were identified since our last inspection. The provider had addressed the concerns we raised at the previous inspection.

People using the service said they could talk to staff or the manager if they had any concerns or complaints. They also felt confident that staff members would resolve their problem. One person told us, "I would go to the office and complain. They would deal with it."

People were happy with the quality of care that they received and how they were treated by the staff team. One person said “I am quite happy here. The staff treat me nicely.” A relative commented “I believe the home has provided good care facilities for my mother.”

People felt that they were treated with dignity and respect. A relative commented “staff are respectful and kind to her.” We saw that staff maintained people’s dignity. For example by discreetly asking them if they wanted to use the toilet. We also saw that staff asked people what they wanted or liked. They offered choices of drinks at lunch time and asked people if they wanted something to protect their clothing whilst they were eating.

Although staff received training to carry out their duties and to support people who used the service there was not a consistent or organised approach for identifying staff training needs and ensuring that staff attended training. We also found that staff were not receiving regular supervision or feedback about their work practice. This limited their opportunity to discuss work practice and issues relating to the operation and development of the service.

The manager and the provider monitored the quality of the service via visits and audits. People who used the service and their relatives were asked for their opinions about the service provided. Action was taken to address any issues that were identified.

This inspection took place on 23 and 24 September 2015 and was unannounced on 23 September 2015.

Moreland House is a purpose built 50 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 26 people were using the service. This was because in December 2014, when building work had been completed, Moreland House changed its registration from a 20 bed home providing personal care and accommodation for older people to a 50 bed home providing nursing and personal care or older people. The provider limited admissions to the service during the transition period.

We found that the arrangements for administering medicines were not always safe. Medicines records were not always accurate and we could not be confident that people received all of their prescribed medicines safely.

The systems in place to safeguard people from abuse and improper treatment were not effectively implemented.

People were supported to receive the healthcare that they needed. A healthcare professional told us, “From a medical point of view they are getting good support.”

People told us they felt safe at Moreland House and that they were supported by kind, caring staff. One person said, “Girls are marvellous. Make sure we’re safe.”

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs and provided care in a respectful way.

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.

Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People told us that the food was good and that they had a choice of food and drinks. We saw that people’s nutritional needs were met. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.

Staff received the training they needed to meet people’s overall needs. However they were not clear as to the action to take in the event of a person choking.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

The arrangements to meet people's social and recreational needs were limited. However this had been recognised by the provider and an activities worker had been recruited.

People’s care plans were being reviewed and updated to ensure that they contained all of the necessary information to enable staff to support them safely and effectively.

The service did not have registered manager but appropriate interim arrangements were in place. The service had not been consistently well managed but people were positive about the changes and improvements that were now taking place.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided. However we recommend that the provider monitoring reports clearly indicate any action required along with timescales for completion. Also that subsequent visits check and report on the progress made to complete the actions.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.