Moundsley House

We looked at 7 quality statements under the Safe key question: learning culture, safeguarding, involving people to manage risks, safe environments, safe and effective staffing, infection prevention and control and medicines optimisation.

People and their relatives told us they felt safe living at Moundsley House. However, people’s individual risks and environmental risks were not always assessed and mitigated.

People told us there were enough staff to care for them and we saw there were sufficient staffing levels on both days of our assessment to meet the needs of the people who used the service.

We looked at 2 quality statements under the Well-Led key question: Capable, compassionate and inclusive leaders and Governance, management and sustainability. We found concerns in relation to risk management. Safety concerns identified at this assessment (detailed in the safe section of this report) had either not been identified by the provider or had been identified but not mitigated to reduce the risk of harm or injury to people. These concerns resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The concerns identified were discussed with the provider at the time of our assessment and steps were taken to start addressing these issues.

The provider was in the process of implementing new governance checks, processes and policies to improve oversight, quality and safety. Time was needed for these to be embedded and sustained.

People and relatives told us they felt the service was well managed and communication was good.