Moor Park House Limited

Moor Park House Limited is a 54 bedded purpose-built home. The home provides personal and nursing care for young adults and older people, specialising in care for people needing support with complex needs, physical disability and acquired brain injury. There were 52 people living at the home when we visited.

People’s experience of using this service and what we found

The service was not always safe. At the last inspection we recommended that the provider implement systems to show an audit trail of accidents and incidents. At this inspection we found this had not been implemented effectively. We could not be assured that lessons had been learnt to prevent similar incidents reoccurring. We found medicines records were not always managed effectively. Systems and processes in place were not robust enough to ensure medicines policies and practices were consistently implemented. People did not always have risks to their personal safety identified and recorded. When they had been identified, control measures were not always documented to mitigate the risk. Staff were able to tell us about the risks to people and knew how to support people to minimise the risks.

The service was not always well led. The registered manager had not operated effectively systems to assess, monitor and improve the service. Some records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. The issues we found were not picked up by the auditing systems in place. This could have compromised the quality and safety of the service provided. Staff told us they felt well supported in their role. People we spoke with told us that they felt their loved ones were well cared for.

We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested. Additionally, they responded promptly to our concerns during and after the inspection.

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

Rating at last inspection

The last rating for this service was good (published 7 July 2018).

Why we inspected

The inspection was a targeted inspection prompted in part, due to concerns received about medicines and documentation. A decision was made for us to inspect and examine those risks.

We inspected and found there were concerns with oversight of risk and quality assurance, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well led.

The ratings from previous comprehensive inspections for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Moor Park House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service 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.

At this inspection we found the service remained Good.

We looked at how accidents and incidents were managed at the service. There was no central record for accident and incidents to monitor for trends and patterns and to ensure the management had oversight of these. We have made a recommendation about this.

We found people’s capacity to consent to care had not always been fully assessed and information was at times conflicting. For example, in one person’s care file their next of kin had signed for the consent to the service. We have made a recommendation about this.

Everyone we spoke with told us they felt safe with staff who supported them. We found people were protected from risks associated with their care because the registered provider had completed risk assessments. Systems were in place that showed people's medicines were managed consistently and safely by staff.

We found staff recruitment remained safe. People told us and we could see for ourselves that there was enough staff available to meet people's needs and to keep them safe. Staff were aware of their responsibilities in relation to infection control.

People we spoke with expressed their confidence in the staff and felt they knew their needs. Peoples needs for nutrition and fluids had been considered. People were supported by staff to live healthier lives. The staff training is ongoing and evidence has been seen of staff completing training.

We received consistent positive feedback about care provided at Moor Park House Limited from people who lived at the home and their relatives. We saw staff speaking with people who lived at the home in a respectful and dignified manner. People we spoke with told us they were offered a variety of choices, which promoted independence.

People we spoke with told us they felt staff were responsive to their needs. We saw people and their relatives had been involved in the planning and review of their care. People told us they were encouraged to give their views and raise concerns or complaints.

Staff understood the importance of supporting people to have a good end of life as well as living life to full whilst they were fit and able to do so. People told us that they were provided stimulation and opportunities to go on day trips in the mini bus.

There was a clear vision and credible strategy to deliver high quality care and support at the service. There was a positive staff culture at the service. Systems were in place which continuously assessed and monitored the quality of the service.

We found the management team receptive to feedback and keen to improve the home. The registered manager worked with us in a positive manner and provided all the information we requested.

Further information is in the detailed findings below.

Moor Park House is a 53 bedded purpose built home, situated on a main road position near to the city centre of Preston and opposite a large park. Other amenities are within easy reach. The home provides personal and nursing care for young adults and older people, specialising in care for people needing support with complex needs, physical disability and acquired brain injury. Car parking spaces are available and public transport links are within walking distance of the home.

At the time of our inspection there was 52 people who lived at the service.

There was a registered manager in place. The registered manager assisted throughout the inspection and received feedback. 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 told us they felt safe at the service and with the staff who supported them. They told us that they felt safe from abuse; harassment and their human rights were

protected. We observed staff speaking to people and they spoke in a respectful and dignified manner.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to

escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices. The service had a whistle blowing policy and this was understood by staff.

People were risk assessed against avoidable harm and injury. Care records showed continual review of people's needs and care plans were in place to highlight how known risk would be managed.

We raised concern during the inspection about wedged doors. Immediate action was taken by the registered manager and consequently advice was sought from Lancashire Fire and Rescue. The service had a fire risk assessment and fire testing was undertaken as planned.

We found that staff recruitment was safe and staff were supported throughout their induction process. We raised concern about staffing levels on the ground floor unit. During the inspection we found that staff were very busy and call bell response times were delayed. The registered manager took immediate action and deployed staff accordingly.

We found that medicines management systems were in place and closely monitored. We observed a staff member administering medicines during the inspection. We saw this was done in a competent manner and noted the staff member handled people’s medicines carefully and safely. Careful checks of the records were made each time a medicine was administered and the records were updated accurately at the correct times.

We found the home to be clean and odour free throughout the day of the inspection. Staff we spoke with were knowledgeable about infection control practices and told us they were provided with the necessary protective equipment to carry out their role.

Records and certificates of training showed that a wide range of training was provided for all staff.

We found staff knowledge of MCA and DoLS was sufficient. The service had robust procedures in place for assessing a person's mental capacity inline with the MCA 2005. Staff understood these procedures and showed good knowledge of people's needs who were subject to a DoLS order.

We found that the service promoted healthy eating and nutritious food was provided. People were assessed on an individual basis and nutrition care planning showed people's needs and preferences. The service engaged with external health care professionals such as dieticians, speech and language and diabetic screening services.

On the day of our inspection, we saw that staff interacted with people without exception in a compassionate and respectful way. It was clear from talking with staff and observing interactions, that they knew all the people who lived at the home well.

We saw within people's care plans that referrals were made to other professionals appropriately in order to promote people’s health and wellbeing. Examples

included referrals to social workers, tissue viability, physiotherapists and GP’s.

Information about advocacy and other services was displayed around the service and staff were aware of the need for promoting advocacy and involving next of kin

when appropriate.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be

listened to and addressed. We saw that the home had an up to date complaints policy which was on display in the reception area.

Records we saw reflected people’s needs accurately and we observed written instructions from community professionals being followed in day to day practice. People were encouraged to participate in the care planning process.

All the staff we spoke with told us they had a commitment to providing a good quality service for people who lived at the service. Staff confirmed that they had handover

meetings at the start of each shift, so they were aware of any issues during the previous shift.

We saw evidence of a wide range of audits being undertaken by the registered manager as part of the quality assurance process in place. These included; medication,

care plans, health and safety and infection control. The registered manager was committed to improving the service and auditing tools showed how improvements had been made.

There was a positive culture throughout the service. Staff told us that they enjoyed working at the service and felt supported.

Visiting professionals provided positive feedback about partnership working and how the service committed to providing safe person centred care.

We looked at the care records of five people. Each care plan was designed around the needs and preferences of the individual, and it was clear that significant emphasis was placed on supporting people to continue with their chosen activities, both inside and outside of Moor Park House; even when the person had considerable care needs.

The registered manager had run a recent campaign around privacy and dignity. People were encouraged to put their thoughts and ideas on the 'dignity tree'. There was a 'resident's charter' in place. The catering manager told us he held a 'tasting panel' four times a year, where people could tase and comment on new dishes.

We spoke to people living at Moor Park House and their carers and they told us;

"They certainly look after me"

"When I first landed here I had continuous chest infections. I had been here about three weeks, no more infections and I started to gain weight".

"I am extremely happy with dad being here. I can't fault anything".

"We are lucky to have found this, it's very pleasant".

We found staff to be well supported and appropriately trained and those living at Moor Park House looked comfortable in their presence. People we spoke with were very complimentary about the staff team and the managers of the home. We found systems to be in place, so that the quality of service provided could be assessed and appropriately monitored.

We looked at a number of areas during the inspection, which included how the home promoted the care and welfare of people using the service and how they safeguarded people from abuse. We found that the service was compliant in all the areas we assessed.

Comments from those living at the home included:

"The staff are very good. I have nothing but praise for them, although they do change over regularly."

'It is very warm and comfortable. The staff are very kind and friendly."

'They (the staff) are marvellous. We are well looked after, but the food is variable."