Moss View

Moss View is a care home providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. The service can support up to 75 people.

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

Records in relation to people’s care and treatment were not always completed or well organised which put people at risk of unsafe care. People requiring specific diets, such as diabetic or high protein did not always have food and fluid charts in place. There were mixed responses with regards to staffing. All of the staff we spoke with told us they felt there was not enough of them to support people safely. Our assessment of rotas and dependency tools showed staffing levels appeared to be consistent across the units, however following our inspection and feedback with the provider, this was being re-assessed. Medication was mostly managed safely. We did feedback some issues which were rectified at the time of our inspection. People had risk assessments in place which covered most aspects of their care and support. The service had enough PPE to keep people safe. Incidents and accidents were well recorded and analysed. Relatives we spoke with said they mostly felt their family member were safe and well cared for. One person said, “They take great care of [person].”

There was no registered manager in post at the time of our inspection. Audits and checks on the provision of care were in place, however they required improving as they did not always highlight areas for improvement within care plans. Staff told us they felt unappreciated by the senior managers of the home. They also said they felt unsupported. One staff member said, “We are never listened to”. The provider has since taken action to improve this. People were routinely asked for feedback about the home.

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 requires improvement. (Published July 2019) The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about staffing and medications. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

The provider has since taken action to mitigate these risks and has contacted us separately to confirm this. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Enforcement - For enforcement decisions taken during the period that the ‘COVID-19 – Enforcement principles and decision-making framework’ applies, add the following paragraph: 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 monitor the service.

We have identified breaches in relation to governance. This was because records were not clear or organised and could put people at risk of harm.

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.

Moss View is a purpose built two storey building situated in Liverpool. The service supports people some of whom are living with dementia and people with nursing needs. The service can accommodate up to 78 people. At the time of the inspection, there were 66 people living at the home.

People’s experience of using the service

At our last inspection in July 2018 the registered provider was in breach of regulations in relation to safe care and treatment, consent and governance. We found during this inspection the service had taken action to meet these breaches. However, we found some issues regarding medicines management, as well as staffing, and made recommendations

Medications were mostly managed well. One of the clinic room temperatures exceeded the recommended storage temperature of medications which we raised with the manager. Action was being taken to rectify this and this has since been corrected. There were some minor recording errors in the Medication Administration Record charts which the providers own audit had already picked up. We did see however, for one person, the directions of their medication was recorded incorrectly on the MAR, which we brought to the attention of the manager who was not aware of this. This was corrected straight away. We have made a recommendation regarding medicines.

A dependency tool and analysis were used to determine staffing numbers. Whilst rotas evidenced the correct number of staff were being used, people fed back and we observed that while the number of staff in the building was acceptable, their deployment was not always in line with people’s needs. We have made a recommendation regarding this.

Records were of good quality in most areas however, there were some minor inaccuracies which we discussed at the time with the manager. We saw that audits had highlighted some of the issues during our inspection, in relation to medication and minor care planning inaccuracies. There was a manager in post who had not yet registered with the Care Quality Commission. The staff had team meetings and people told us they felt engaged with and they liked the manager.

Staff training was in date and staff had undergone a recent refresher update. We saw no unexplainable gaps in the training matrix in relation to subjects the registered provider had deemed mandatory. Additionally, induction for agency staff was robust.

We observed kind and caring interactions from long standing staff. People told us they liked the staff, they just wished they had more time to spend with them.

Complaints were dealt with in accordance with the organisation’s complaints procedure, people said they knew how to complain.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 20 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive inspection.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found that improvements had been made and the provider was no longer in breach of regulations, however we have made two recommendations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

Moss View 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 home is situated in the Huyton area of Liverpool. It provides, residential, nursing and dementia care for up to 78 people and at the time of the inspection there were 71 people living in the home.

A registered manager was 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. We asked people their views of how the home was managed and feedback was positive.

The environment was not always maintained safely. The home’s electrical system had been checked and found to be unsatisfactory and we saw a number of fire doors wedged open.

Risk to people was not always assessed and managed appropriately. Risk assessments had not all been accurately completed to ensure the level of risk people faced was known and actions could be taken to reduce that risk.

Although medicines were stored safely, we found that they were not always managed safely as directions were not always clear and guidance for safe administration was not always followed.

Some applications had been made to deprive people of their liberty lawfully, however the registered manager told us there were a number of applications still to be made. These were completed before the end of the inspection. Not all conditions on the authorisations in place had been met.

Consent was not always gained and recorded in line with the principles of the Mental Capacity Act 2005 (MCA). Not all staff had a good understanding of the MCA and how to record agreements to care when people were unable to provide their consent.

Care plans did not all contain sufficient detail to inform staff of people’s needs and how they should be met and did not all reflect the current support being provided to people.

We looked at the systems in place to monitor the quality and safety of the service and found that they were not always effective as they did not identify all of the issues highlighted during the inspection. When areas for improvement were identified, it was not always clear whether actions had been taken to address them.

People told us they felt safe living in Moss View. Staff were aware of safeguarding procedures and how to raise concerns and accidents were recorded and analysed. Feedback received regarding staffing levels was mixed. We saw that staff were busy during the inspection, but were able to meet people’s needs. Staff had been recruited safely to ensure they were suitable to work with vulnerable people.

Staff were supported in their roles through induction, supervision and regular training. Staff told us they felt were supported and were able to raise any concerns with the registered manager.

People told us they had enough to eat and that they always had a choice. People were provided with support when needed. Staff were aware of most people’s individual dietary requirements.

Some steps had been taken to ensure the environment was suitable for people, though some areas required further refurbishment. The registered manager told us they had plans in place to make the environment more dementia friendly.

People living in the home, their relatives and visiting health professionals told us staff were kind and caring and treated people well. Staff were aware of people’s needs and preferences and how they liked to spend their day. We saw staff provide support in ways that protected people’s dignity.

People agreed that staff supported them to remain as independent as they could be and records of care showed that staff respected people’s decisions.

People’s family and friends were able to visit at any time and were made welcome by staff. If people did not have family or friends to support them, details of local advocacy services were available.

Staff worked closely with health professionals to support people at the end of their lives.

A range of activities were available and people told us they enjoyed them. People had choice over how they spent their days.

A system was in place to manage complaints and people were aware of how to raise any issues they had. The registered manager held meetings and issued surveys to gather feedback from people.

A range of policies and procedures were available to guide staff in their role and staff told us they enjoyed working at Moss View.

Ratings from the last inspection were displayed within the home as required.

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

A separate unit known as Dodd unit provided care without nursing for people living with dementia. This unit provided two lounges and a dining room for people to share. The rest of the home was for people who had nursing and non-nursing needs. The ground floor had three big lounges and a dining room, with a sitting area in the entrance. The first floor had a small lounge.

The home 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 2008 and associated Regulations about how the service is run. A manager had been appointed to manage the home and had applied to become the registered manager.

The manager was familiar with the home and how it operated and was enthusiastic about further developing the service provided.

During the inspection we spoke individually with eight of the people living at the home and with four of their relatives. We also spoke individually with eight members of staff who held different roles within the home. We examined a variety of records relating to people living at the home and the staff team. We also looked at systems for checking the quality and safety of the service.

People told us that they though Moss View was a safe place to live. Safeguarding policies and procedures were in place to provide guidance for staff and these had been followed when needed. People felt confident to raise concerns or complaints and systems were in place for dealing with them.

People’s legal rights were protected and they were supported make as many decisions for themselves as possible.

Medication was safely managed with systems in place for minimising the risks of errors occurring. People received their medication on time and as prescribed. Staff were aware of people’s health care needs and monitored their health, providing the support people needed.

People’s support needs were assessed and evaluated regularly. Care plans contained information about the person, how they communicated and decisions they could make. This meant staff had up to date guidance available on how to support people safely and in line with their wishes.

People were able to personalise their bedrooms if they chose to do so. The home provided equipment to support people with their mobility and health. A lift was available and corridors were wide enough for people using a wheelchair or mobility aid to get around easily. Externally a number of enclosed areas were available, not all were currently in use. .A full refurbishment of the home was planned by the provider to take place in 2017.

Staff knew people well and spent time talking with them and meeting or anticipating their support needs. Staff were busy but able to meet people’s care needs. Procedures were in place and followed for recruiting new staff. These were not always robustly recorded. Staff had a good understanding of their role in supporting people, received training and used this to suggest improvements to the service they provided.

People had plenty to eat and drink and could request an alternative at mealtimes. Staff monitored people’s food and drink intake and the quality of meals provided.

Systems were in place for auditing the quality of the service and were effective at identifying areas where improvements could be made.

People who used the service and their relatives told us they were very satisfied with the care and support given to them. They told us:

'It's very good here, I feel at home',

'It's like home from home'

'It's excellent'.

Care and support plans identified people's needs and how their needs were to be met. Risk assessments and care plans were seen to be individualised and covered all aspects of a person's needs including physical, behavioural, mental health and social. Risk assessments and care plans had been completed in full and reviewed every month.

People were protected from the risks of abuse as staff were trained and knowledgeable in safeguarding vulnerable adults. Appropriate guidance and support was available.

There were sufficient numbers of suitably qualified and experienced staff in order to care and support people. Records were found to be held securely, yet accessible and were accurate.

We spoke with three people who lived at Moss View and four relatives. Their comments included:

"Happy with the care provided"

"A caring, loving service, all the staff respect her (relatives comment)"

"I cannot fault any of them"

"Come here, it's very welcoming. The manager is very good"

We also met with several of the other people living there and observed the support provided to them. During our visit we observed a friendly relaxed atmosphere with positive interactions between staff and the people who lived at Moss View.

We saw evidence of robust care planning that had been personalised and addressed specific individual needs.

We were told that there was an activities coordinator within the home and we saw evidence of a wide programme of activities that had been provided.

We saw a complaints policy and information was displayed on notice boards on how to complain.