Mountfield House Care Home

Mountfield House Care Home is a care home providing accommodation and personal care to a maximum of 14 people over the age of 65 years in one adapted building. At the time of our inspection there were 13 people using the service.

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

People were not always protected from environmental risks because there were no effective systems in place to identify, monitor or mitigate risks. We were mostly assured the provider was meeting key principles for infection prevention and control at the service, including for COVID-19. However, some areas required attention to ensure cleaning could be carried out effectively. The provider's quality assurance procedures had not been effective in identifying the shortfalls we identified at the inspection.

People received their medicines when they needed them. People felt safe living at the home and with the staff who supported them. Staff had been trained to recognise and report any signs of abuse. The provider’s staff recruitment procedures helped to protect people from harm. Risks associated with people’s care were assessed and there were plans in place to mitigate risks.

The provider regularly sought the views of people, relatives and staff. Staff morale was good, and staff told us they felt well supported. Staff received the supervision and support needed to carry out their role effectively. The provider worked in partnership with other professionals to ensure good outcomes for people. The provider was aware of their legal requirement and of their responsibility to be open an honest when things go wrong.

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

The last rating for this service was good (published 10 March 2020).

Why we inspected

We received concerns in relation to the management of risks relating to the care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement

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 and will take further action if needed.

We have identified breaches in relation to safety and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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

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.

Mountfield House is a residential care home providing personal care to up to 14 people aged 65 and over. There were 13 people receiving support at the time of the inspection. The home accommodates 14 people in one adapted building.

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

Improvements had been made since the last inspection. People’s preferences about when to get up were respected and improvements had been made to the governance and oversight systems to ensure care was safe and effective.

People told us they felt safe. Staff knew how to identify and report concerns for people’s safety. Risks were assessed and managed to reduce the risk of avoidable harm. Staff had been recruited safely. Where things went wrong, learning took place and changes were made to reduce the likelihood of reoccurrence.

People’s needs and preferences were assessed prior to them moving in to the home. Staff received training relevant to their role which helped them provide effective support. People received enough food and drink, according to their individual preferences and support to manage their health needs.

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.

People described staff as kind and felt they knew them well. People were supported to make their own decisions and felt staff listened to them and respected their choices. People were encouraged to remain as independent as possible and staff respected their privacy.

People’s needs had been assessed and were reviewed regularly. Staff supported people to take part in activities or follow their own individual interests. People knew how to raise a concern about their care. People’s choices for end of life care had been discussed with them and recorded, so their wishes would be respected.

This had driven improvement in care planning, risk assessment and the monitoring of medicines administration. People, relatives and staff spoke positively about the management of the home. People, relatives and staff were given opportunities to share their feedback about the home and suggestions were welcomed and used as a way of improving the care provided. The provider was open and honest throughout the inspection and had used the findings from the last inspection to make improvements.

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 19 February 2019) and there were two breaches of regulations. We imposed conditions on to the provider’s registration which required them to submit monthly reports about how they were assuring the governance of the service. They complied with these conditions and demonstrated to us people were no longer at risk from poor governance.

The provider also completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

There was a registered manager in post who was also the registered provider. 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 our last inspection on 18 October 2016 we rated the provider as ‘good’. At this inspection we found that improvements were required and the service is now rated as ‘requires improvement’.

Staff had not recognised an incident between two service users as meeting the criteria for reporting and therefore the correct process had not been followed. Lessons were not always learnt when things went wrong.

People’s preferences were not met in relation to what time they got up. People were not encouraged to follow their individual interests and people told us that they would like more to engage in. Staff had not always been responsive in relation to people’s foot care needs.

The provider’s audits in place did not identify the shortfalls we did during our inspection. There was no oversight of delegated roles and responsibilities. People’s care plans were not reflective of their current needs and had not been reviewed following incidents.

There were enough staff to meet people’s needs. People told us they felt safe. The home was clean and tidy and staff wore personal protective equipment (PPE) as required.

People were supported by staff who had the skills to meet their needs. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and sought consent people supporting people. People’s nutritional needs were met. People had access to professionals when required.

People were supported by kind and caring staff who knew them well. People’s privacy and dignity was maintained. People were encouraged to remain as independent as possible.

People and relatives knew how to raise concerns with the registered manager and felt comfortable doing so. We saw that complaints were dealt with appropriately.

People, relatives and staff spoke positively about the registered manager. People’s feedback was sought and acted on. Staff told us they felt supported.

We found the provider was not meeting the regulations around person centred care and the overall governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection 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.

People told us they felt safe living at the home. Staff knew what action to take if they had any concerns about people’s safety. People’s individual risks were assessed and staff knew how to manage these risks when providing care. The registered manager responded appropriately to issues regarding medicines. People told us there were enough staff available with the appropriate skills to support their needs. Staff received training and felt they had the skills to meet people’s needs. The provider had safe processes in place to recruit new staff and carried out pre-employment checks.

Staff obtained consent from people before they provided care. Staff understood people’s rights and choices when supporting them .People told us they enjoyed their meals and had sufficient to eat and drink. People told us they had access to healthcare professionals when needed. People said staff discussed their care needs with them. They said staff were kind and friendly. Staff supported people’s independence. People were involved in group and individual activities. People felt listened to and able to raise concerns they may have.

Staff understood their roles and responsibilities and felt supported by the registered manager. Systems were in place to monitor and improve the quality of the service people received.

People made positive comments about the service. One relative told us: "All the staff are spot-on and take action if they need to. I can't fault the care. I am satisfied that X is safe and that they love her". We saw that people were consulted about their care and their views reflected in the way that care was delivered.

People experienced care, treatment and support that met their needs and were encouraged to remain as independent as possible. One relative told us: "There has been a transformation since X was admitted.They previously had low motivation".

We saw that people had a positive dining experience and that food and drinks were available to them at all times with staff assistance if needed.

There was a system in place to ensure that people were protected against the risks associated with medicines. We found that people received medicines safely and as prescribed.

People were cared for by staff who were qualified, skilled and experienced to meet their needs. The majority of staff held a care qualification.There were enough staff on duty to meet people's care and welfare needs.

Care records contained accurate information about people's individual care needs. Risk assessments were in place and had been regularly reviewed. People were protected against the risks of unsafe or inappropriate care and treatment.

We found that improvements had been made in the way that people's care was planned and delivered. One person said, 'They look after me so well here, I am really happy.'

Arrangements were in place to safeguard people from harm.

Staff had received their mandatory training in a timely manner. One staff said, 'I am up to date with all the training now.'

Systems to monitor the quality of the service provided to people had improved.