Mooncare Limited improved from its previous 'Requires Improvement' rating to an overall 'Good' at this July 2019 inspection, with strong performance across safe, caring, responsive and well-led domains. The single area of concern was the 'Effective' domain, where the provider failed to conduct mental capacity assessments in line with the Mental Capacity Act 2005, a known issue that remained unresolved from the prior inspection.
Concerns (4)
moderate
Consent / capacity
: “We found two people's relatives had signed consent forms in relation to their care, however, there were no associated mental capacity assessments in place”
moderateConsent / capacity: “the registered manager told us that she was not aware that it was her responsibility to conduct these assessments”
minorCare planning: “People's care plans did not always contain enough information about their likes and dislikes in relation to food”
minorRecord keeping: “there was limited written information about people's current circumstances or their life histories”
Strengths
· Clear and personalised risk assessments in place with guidelines for care workers on managing identified risks
· Care workers demonstrated good safeguarding knowledge and annual safeguarding training was completed
· Robust infection control training and good practice demonstrated by care workers
· Appropriate pre-employment checks conducted including DBS, references and right-to-work checks
· Regular supervision every three months and annual appraisals provided to care workers
Quality-Statement breakdown (26)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: End of life care and supportGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Promoting a positive person-centred, open, inclusive and empowering cultureGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsGood
Mooncare Limited received a Good rating across all five key questions at its January 2016 inspection, having successfully addressed two prior regulatory breaches relating to recruitment and record keeping. The service demonstrated sustained improvements in care planning, staff training, MCA understanding and quality assurance, with relatives consistently praising the reliability, cultural sensitivity and compassion of support staff.
Concerns (3)
minorRecord keeping: “the registered manager had not effectively audited records written by staff; a member of staff had used inappropriate terminology during a one-to-one supervision meeting and there was no record of any discussions”
minorComplaints handling: “the provider had used an incorrect address for people and their relatives to contact the Care Quality Commission”
minorCare planning: “the care plans did not contain recent assessments and reviews carried out by external professionals such as people's social workers, psychologists and/or occupational therapists”
Strengths
· Relatives reported staff were kind, trustworthy and made people feel safe, with consistent allocation of one or two familiar staff members
· Effective recruitment practices in place including two verified references, DBS checks and proof of eligibility to work in the UK
· Medicines policy updated with comprehensive guidance for staff, and all staff received medicines training
· Staff received MCA training and demonstrated understanding of key principles and application in practice
· Broad training programme developed including mental health awareness, mental capacity, equality and diversity, and health and social care qualifications
Mooncare Limited was rated Requires Improvement overall following its April/May 2018 inspection, with three regulatory breaches identified covering risk assessment (Reg 12), consent documentation (Reg 11), and governance (Reg 17). Caring was rated Good, reflecting strong staff relationships and culturally sensitive support, but significant weaknesses in care planning, mandatory training, record keeping, and quality assurance systems undermined safe and well-led practice.
Concerns (8)
criticalCare planning: “one person who used the service required support from staff for moving and handling...there was no assessment and risk management guidance in place in relation to the use of the hoist”
criticalGovernance: “The provider did not demonstrate that there was a viable quality assurance process in place in order to continuously assess and monitor how the service operated”
criticalConsent / capacity: “The provider had not obtained any documentation to indicate that the relatives had the legal authority to sign on behalf of their family members”
moderateStaff training: “the mandatory training programme for staff was noticeably overdue and the registered manager did not have an effective system in place to monitor that staff had attended training”
moderateRecord keeping: “care staff who provided people...with an hour each morning for personal care wrote one or two sentences about the care and support they provided”
moderateIncident learning: “We did not find suitable evidence that the provider was working in a manner that consistently promoted continuous development, innovation and a culture that learnt from mistakes”
minorPerson-centred care: “the care and support plans did not reflect the standard of person-centred work that staff undertook, which was documented in other records”
minorSupervision / appraisal: “bi-monthly one to one supervision from the independent consultant...these sessions were primarily concentrated on her role managing the day centre”
Strengths
· Relatives reported staff were very kind, gentle and patient, with long-standing care workers building trusted relationships over several years.
· People received care from consistent, regularly allocated staff enabling stable and reliable service delivery.
· Cultural, linguistic and faith backgrounds were matched between people and care workers where possible, including support for religious practices.
· Staff understood safeguarding responsibilities and knew how to report concerns internally and externally.
· People were supported to participate in meaningful community activities, cooking, arts and leisure pursuits.
Quality-Statement breakdown (18)
safe: Risk assessment and risk managementRequires improvement
safe: Safeguarding people from abuseGood
safe: Staffing consistency and reliabilityGood
safe: Safe recruitment practicesGood
safe: Medicines managementRequires improvement
safe: Infection controlRequires improvement
effective: Mental Capacity Act and consentRequires improvement
Mooncare Limited was rated Requires Improvement overall following a January 2015 inspection, with two regulatory breaches identified: unsafe recruitment practices (only one unverified reference per staff member) and inaccurate record-keeping including conflicting policies and inappropriate language in supervision notes. While the service was praised for its caring, culturally responsive staff and consistent service delivery, significant gaps remained in staff training for learning disability needs, Mental Capacity Act understanding, medicines guidance, and care plan personalisation.
Concerns (9)
criticalStaffing levels: “Recruitment records showed that staff had only one reference each, which was not always checked by the provider to guarantee its authenticity.”
criticalRecord keeping: “This was a breach of regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17.”
moderateConsent / capacity: “The care co-ordinator and care staff did not demonstrate a good understanding of the Mental Capacity Act 2005 (MCA).”
moderateMedication management: “There was no guidance for staff in the provider's medicine policy and procedure, in the event of such an incident occurring.”
moderateCare planning: “Care plans did not consistently reflect the personalised care described by relatives. There was limited information about people's likes, dislikes, interests and background.”
moderateStaff training: “Staff had limited opportunities to attend training about the needs of people using the service, for example training to update their knowledge about developments within the learning disability field.”
moderateGovernance: “We found that the policy for staff development and training was out of date and we were presented with a second safeguarding policy and procedure that was inaccurate and contradicted the first one.”
minorComplaints handling: “The complaints form did not advise people about how their complaint would be managed, for example there was no information about length of time for investigation.”
minorPerson-centred care: “Risk assessments were not always person centred and focused upon people's identified needs and wishes.”
Strengths
· Relatives were very positive about the quality of care and the caring attitudes of the staff, describing staff as 'very caring', 'kind and lovely' and 'friendly'.
· Staff understood safeguarding principles and how to report abuse concerns, with a whistle-blowing policy in place.
· People received care from consistent staff they knew well, meeting cultural and gender preferences.
· The service met people's nutritional needs and cultural preferences including halal food, religious practice and language matching.
· The registered manager conducted regular monitoring visits and telephone calls to relatives, and staff felt well supported.
Quality-Statement breakdown (16)
safe: Recruitment practicesRequires improvement
safe: Risk assessmentsRequires improvement
safe: Medicines guidance for staffRequires improvement