The Mount Care Home

Updated 1 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors. An Expert by Experience made phone calls to relatives of the people living in the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Mount Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Mount Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post and supported us during our inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we looked at all the information we had collected since the last inspection of the service, including notifications sent us. A notification is information about important events which the service is required to tell us about by law. We reviewed the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke to the registered manager, the regional support manager, clinical lead, two senior staff, maintenance and housekeeping staff, head chef, and activities coordinator. We gathered feedback from 15 members of the staff team. We observed interactions between staff and people and spoke to 2 people who use the service. We reviewed a range of records relating to the management of the service, for example, records of cleaning, maintenance and premises, medicines management, risk assessments, accidents and incidents, quality assurance systems, and recruitment records. We looked at 6 people's care and support plans and associated records. After the site visit, we continued to seek clarification from the registered manager to validate evidence found and received additional documents and information to support our inspection. We sought feedback from health and social care professionals who engaged with the service and received 5 responses.

Updated 1 April 2023

About the service

The Mount Care Home is a care home providing personal and nursing care to up to 37 people. The service provides support to people with dementia, older people and younger adults. At the time of our inspection there were 19 people using the service.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met. The registered manager did not ensure consistent actions were taken to reduce risks to people and plans were not always in place to minimise those risks. Effective recruitment processes were not in place to ensure that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. The registered manager did not ensure that clear and consistent records were kept for people who use the service and the service management. The registered manager did not inform us about notifiable incidents in a timely manner. The registered manager did not ensure they maintained clear and consistent records when people had injuries, as per regulation and requirements to evidence they have acted in an open and transparent way. Care plans did not consistently contain information specific to people’s needs and how to manage conditions they had. Staff did not always have detailed guidance for them to follow when supporting people with complex needs.

We have made recommendations about the premises to ensure it was suitable for people living with dementia, to comply with the Accessible Information Standard and to bring the staff training provision in line with the current best practice guidance on ongoing training for social care staff. We have made a recommendation about keeping clear and accurate records in line with the Mental Capacity Act 2005.

Staff followed correct infection prevention and control processes. When incidents or accidents happened, they were investigated, with some discussions taking place about lessons learned, or themes and trends reviewed. We noted some forms did not always have full information recorded by the reviewing staff. People’s hydration and food intake was monitored and managed, but we noted some improvements to be made. There was an activities programme but there were periods when staff did not ensure people engaged in activities to avoid social isolation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service had to be improved to continue supporting this practice.

Staff deployment was managed effectively. People’s families and other people that mattered felt they were involved in the planning of their care. Relatives said they were kept informed about people’s health and welfare. Relatives were positive about staff being kind, caring and respectful. We observed that the interactions between people and staff were positive and caring. Staff upheld people's privacy and responded in a way that maintained people's dignity. Relatives felt they could approach the registered manager, senior staff or others with any queries or concerns and felt they had good communication and relationships with the service. The relatives felt the home had a positive atmosphere and they were always made welcome and supported as family members.

The registered manager appreciated staff’s work, contributions and efforts to ensure people received the right care and support to meet their needs. Staff felt they could approach the management team for support and advice. People and relatives felt people were safe living at the service. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately by the registered manager.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection

This service was registered with us on 15 September 2021 and this is the first inspection. The last rating for the service under the previous provider was good, published on 18 October 2017.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Enforcement and Recommendations

We have identified breaches in relation to quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning and support; management of medicines; duty of candour and recruitment at this inspection. We have made recommendations about the suitability of the environment for people living with dementia; meeting the accessible information standard; assessing, reviewing and recording mental capacity and ongoing staff training to reflect the latest best practice guidelines.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.