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Mountside Residential Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 14 August 2018

This inspection took place on the 11and 13 July 2018 and was unannounced.

We previously carried out comprehensive inspections at Mountside Residential Care Home in October 2016 and November 2017. At these inspections we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service received an overall rating of ‘requires improvement’. This was because systems to improve the service were not effective, Care had not been assessed, to ensure it was person centred, appropriate, met people’s needs and reflected their preferences. People’s capacity to make everyday decisions had not always been assessed and therefore the care provided was not always in accordance with the code and conduct of the Mental Capacity Act 2005. Care and treatment had not always been provided in a safe way and staff had not received appropriate training and supervision; to ensure they were competent to carry out their role and adequately supported. At the inspection in November 2017 we took enforcement action because there were no effective systems and processes in place to ensure the service met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found seven breaches of regulation. Following the inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that improvements had been made. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mountside Residential Care Home on our website at www.cqc.org.uk.”

We found significant improvements had been made in relation to meeting the breaches of regulation but there were still areas of improvement to make to ensure that safe, effective person centred care was delivered and that the quality assurance systems were fully embedded in to practice. The overall rating for Mountside Residential Care Home has remained as ‘requires improvement’ as this was a focussed inspection. We will review the overall rating at the next comprehensive inspection, where we will look at all aspects of the service to ensure sufficient improvements have been made.

Mountside is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide support to a maximum of 52 people and 49 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

Mountside Residential Care Home had a registered manager. 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.

Improvements had been made to the provider’s quality assurance framework; however, these improvements were not yet embedded or sustained. The registered manager and provider were also not proactive in identifying how ongoing improvements could be sustained. Shortfalls in the provision and delivery of care had not always been identified by the provider’s quality assurance framework. We have identified this as an area of practice that needs improvement.

Whilst the provider had arrangements in place for the management of risk to people’s health and well-being, we found some areas of practice that placed people at risk at of not receiving safe care. This was because care plans and risk assessments for people whose needs had changed significantly had not been updated with guidance for staff to follow to deliver safe care. Food and fluid monitoring charts for those people who were not drinking and eating well had not been consistently completed and therefore the risk of dehydration and weight loss had not been mitigated. Accidents and incident reporting had been completed but there was no management overview or audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure lessons were learnt not in place and preventative measures had not been taken. We have identified this as an area of practice that needs improvement.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person said, “I am very happy here, I feel safe.” A visitor said, “I totally trust the staff here.” When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights.

The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff spoken with had an understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation. Staff supported people to eat and drink enough to maintain their health and referred people to other healthcare professionals when a need was identified.

Staff were caring and kind. They knew people well and this enabled them to support them in a person centred way. People told us that staff were very kind and looked after them well. The atmosphere in the home was warm and friendly and conducive to building and maintaining relationships with others in the home as well as with family and friends.

People's diversity was respected and staff responded to people’s social and emotional needs. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices. Staff worked with healthcare professionals to ensure people could remain at the home at the end of their life and receive appropriate care and treatment. Activities in line with people’s preferences were provided. People told us, “We get a lot of activities, really good entertainers visit.” People and staff were positive about the culture of the service, staff and relatives felt the staff team were approachable and polite. The staff team worked in partnership with other organisations at a local and national level to make sure they were following current good practice. The provider attended local care meetings to share experiences.

Inspection areas

Safe

Requires improvement

Updated 14 August 2018

Mountside Residential Care home was not consistently safe.

Risks to people's health and safety were not always monitored and updated to ensure safe consistent care.

Staff had a good understanding of safeguarding and how to report concerns. Staff recruitment practices were safe and ensured people were protected from unsuitable staff.

There were sufficient staff deployed to meet peoples needs.

Effective

Requires improvement

Updated 14 August 2018

Mountside Residential Care Home was not consistently effective.

Not all staff had received the necessary training to deliver effective care to the people they supported.

Consent to care and treatment was sought in line with legislation.

People were supported to access healthcare support. People's individual needs were met by the adaptations made at the home and the design of the service.

People were supported to eat and drink enough to maintain a balanced diet.

Caring

Good

Updated 14 August 2018

Mountside Residential Care Home remains good.

Staff provided the support people wanted, by respecting their choices and enabling people to make decisions about their care.

People’s dignity was protected and staff offered assistance discretely when it was needed.

People were enabled and supported to access the community and maintain relationships with families and friends.

Responsive

Requires improvement

Updated 14 August 2018

Mountside Residential Care Home was not consistently responsive.

Care plans were not consistently updated to reflect changes to peoples health needs.

People were involved in planning their own goals and identifying what support they needed to return to independent living.

Feedback from people was sought and their views were listened to and acted upon.

A complaints procedure was in place. People and visitors knew how to raise a concern or make a complaint but also said they had no reason to.

Well-led

Requires improvement

Updated 14 August 2018

Mountside Residential Care Home is not consistently well-led.

Quality assurance and monitoring systems were used to identify areas to drive improvement. However, there were areas where further improvement was needed to ensure changes were part of day to day practice.

Staff were aware of their roles and responsibilities and felt all of the staff worked well together as a team.

Feedback about the service provided was consistently sought from people, relatives and staff.