Montgomery House

We found the following examples of good practice.

People were supported by staff who were provided with the necessary PPE required to carry out their role safely. PPE was readily available throughout the home at designating donning stations.

The home appeared clean and hygienic and cleaning was ongoing throughout the inspection. The home was uncluttered and well ventilated. When someone tested positive for COVID-19, their rooms were deep cleaned using a fogging machine.

People who had tested positive for COVID-19 self-isolated where possible. Where they were unable to do so due to their cognitive and mobility needs, staff encouraged people to distance and clear risk assessments were in place to mitigate risk.

People were admitted to the home in line with current admissions guidance. Additional control measures had been put in place to reduce risk such as ensuring the negative COVID-19 test result came directly from a person's GP and requesting further tests were undertaken if an admission was delayed.

Staff were well supported by the provider. Staff had access to an employee assist programme and the provider’s human resources department if they needed additional support. Staff were also paid full pay if they were absent from work due to COVID-19.

A thorough corporate risk assessment was in place specific to COVID-19 that gave clear guidance on how to deal with a COVID-19 outbreak.

The provider had a good understanding of when and how to access local infection prevention and control (IPC) resources when they needed advice and support. Positive feedback was received from professionals who had supported the service with IPC.

Montgomery House is a large nursing home providing personal and nursing care to 74 people aged 65 and over at the time of the inspection. The service can support up to 90 people.

The home is divided in to five separate units. Three units delivered nursing care and two units delivered personal care under the residential care model. People had access to a communal activities room, a hairdressing salon and secure outside space. The home is situated on a main road and is next door to a large medical practice and leisure facilities.

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

Governance systems were in place, but we noted a few areas of required improvement that the provider needed to address. We identified some omissions of information which the provider remedied during the inspection but had not identified via the auditing systems in place. Staff appeared clear on their roles and responsibilities however we received feedback that questioned the approachability of certain staff members in the team.

People told us they were happy with the care received and achieved positive outcomes.

People were protected from harm by staff who had been trained in safeguarding. Risk assessments were person centred. People were supported by sufficient numbers of staff and received their medicine as prescribed. People were protected from the risk of infection and accident and incidents were monitored and reports were completed and reviewed by the management team.

People’s needs were assessed before they moved in and throughout their time at the service. Staff received training and were supervised on a regular basis. People had access to a balanced diet and regular fluids. 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; the policies and systems in the service supported this practice.

The building was adapted to meet people’s needs and decorated in a homely way.

People had access to health care services and the provider worked with numerous other agencies to support people to receive consistent care. People were treated with kindness and respect. People were involved in decisions about their care. People’s dignity was protected, and they were supported to maintain their independence.

People had access to meaningful activities and were enabled to develop new friendships. People had access to a complaints procedure and complaints were fully investigated.

End of life care was delivered in line with national guidance.

The service sought to continually improve and worked with in partnership with others. People, staff, families and other stakeholders had the opportunity to engage with the service.

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 17 July 2018). We found that the provider was in breach of Regulation 17 (Good Governance). At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

Montgomery House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Montgomery House is registered to provide nursing and personal care to a maximum of 90 people. It provides a service to older people and younger adults who may have dementia, learning disabilities or autistic spectrum disorder, mental health needs, physical disability or sensory impairment. At the time of our inspection 75 people were living at the home.

Montgomery House accommodates people across five separate units, each of which has separate adapted facilities. Two units specialise in providing care to people living with dementia, one of which is nursing. Two units support people who require nursing care and one unit provides residential care.

A registered manager was in post and present during our inspection. 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.

At the last inspection in June 2017, we rated the service as Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

The provider’s quality systems had not ensured records relating to people’s care, medicines and safety were always accurately maintained. Risks to people who used the service were assessed but these did not always give information on how the risk was to be safely managed and records were not always accurately maintained. Environmental risks were not always minimised and we found areas of the home that should have been kept secure for people's safety were not. This gave people access to areas with equipment and substances which could pose a risk to their health and safety. Food fridge temperatures were not monitored as per the provider’s procedures and this meant the provider could not be confident that foods were fit for consumption.

There were not always sufficient staff to meet people’s needs and to help keep them safe. Agency staff were used to cover shortfalls in staffing levels. However, staff were kept busy and could not always ensure people received a person centred approach to their care and support. As a result people did not always feel confident with the staff that supported them.

People did not always feel listened to when they raised concerns about their health. Not all staff understood people’s specific needs, despite receiving the training they needed.

Staff did not always demonstrate positive interactions and engagement with people and people felt they were too busy to spend quality time with them.

People's experiences of the support they received to eat and drink differed throughout the home. Staff did not always maintain accurate records of what people had to drink in line with their care plans. This placed people at risk of not having enough to drink to promote their health.

People and their relatives were able to express their views on the service and to participate in care planning and reviews. Staff worked with outside professionals to help ensure the effectiveness of care provided.

Staff asked people’s permission before they helped them with any care or support. Staff respected people's right to make their own decisions and supported them to do so. Where people were unable to make their own decisions systems were in place to ensure decisions made were in their best interests.

Staff understood their individual responsibility to protect people from potential abuse. The provider had safe recruitment systems in place to ensure staff employed were suitable to work with the people who lived at the home. Measures were in place to protect people from the risk of cross infection. Systems were in place to ensure lessons were learnt from accidents and incidents.

People had support to participate in social and recreational activities, although the opportunities for them to do so were limited.

People and relatives had the opportunity to talk about their wishes regarding end of life care.

People’s and relatives concerns and complaints were responded to and used to help improve the service. Their views and opinions were sought through various methods, including meetings. The provider had procedures in place to ensure complaints were recorded, investigated and responded to.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulations 17 Good governance. You can see what action we told the provider to take at the back of the full version of this report.

The home is a new build and this was the first inspection of the service. There was a registered manager 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. The registered manager was away from work and was not present at this inspection.

The systems for assessing the quality of the service were not consistently used or reviewed by the provider to ensure lessons were learnt and improvements made.

There were varying opinions about staffing levels from staff, people and relatives. The provider had assessed people's dependency levels and provided some agency staff when the service fell short of that needed to meet people’s needs.

We found that people may not always be protected against the risks associated with abuse. Care staff understood what abuse was and how this was to be reported. Referrals had been made to the local authority, but not consistently.

People were protected against the risks associated with the unsafe management of medicines. There had been an error and management had responded to this and medicines were available as prescribed.

People were protected against the risks associated with meeting their nutritional needs. People were assessed for nutritional risk and appetising meals were provided.

People were able to make choices and decisions and staff supported them to do this. Healthcare professionals visited when required and clear records were kept of the visits. There was evidence of communication from the mental health team and their guidance was followed.

People were supported by staff that were trained and had access to training to develop their knowledge. Most people were treated with kindness and care. We observed most staff engaged with people in a positive way and they were caring when they supported them. Relatives felt welcomed in the home and told us the staff were kind but could do more to engage with people to get to know them well.

People had some activities to choose from. The provider intended to make better links with the local community so people could socialise outside the home.

Staff meetings were starting to be held. Resident and relative meetings were yet to start. People had not been able to formally contribute to the running of the home.