Mountside Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Overall, the culture of the service was positive and one where learning was part of everyday practice.

Staff explained that the registered manager and their colleagues helped them learn and improve practice when things went wrong. For example, following a safeguarding concern, the outcome and lessons learned were discussed during staff meetings, supervision sessions and daily handovers.

The management team told us they investigated accidents and incidents and used the learning to improve practice. For people who experienced repeated falls, improvements included sensor mats and crash mats. They also monitored skin tears and pressure damage to help prevent recurrence. This included checking pressure-relieving equipment and mobility aids, such as hoist slings, to ensure they were the correct size and in good working order.

The provider told us they used learning from accidents and incidents at other services within the group to improve oversight of care and ensure people's continued safety. The service had a service improvement plan in place which detailed plans for ongoing improvements.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The management team worked with other health and social care professionals to make sure that people transitioned into the service smoothly. People moved on from the service only when they themselves chose to move, sometimes to be closer to loved ones or if the service could no longer meet their needs.

The registered manager told us they held meetings to discuss people’s changing support needs with the appropriate health professional and where appropriate the hospice team. Staff told us of meetings that took place when there were concerns about needs being met or a person became unhappy or anxious. These meetings involved relatives and all necessary professionals and made sure that the best outcomes were achieved for people.

People told us they were supported with transitions and moves. A person said, “We are looking for a place closer to my family, but they have been lovely here.” Another person told us, “I am settling in, they are very kind, I came in here from hospital and after losing my loved one, they have been so supportive.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Our observations found that people were comfortable with staff, we saw positive interactions, that assured us they felt safe and at ease. People approached staff throughout the site visits and staff engaged with them in a kind, supportive way. This included staff from all roles, including maintenance and housekeeping staff.

People and their relatives told us that Mountside Residential Care Home was safe. One person said, "Very safe here, they know how to look after me.” Relatives' comments included, “[Person] is safe here, I am able to relax knowing they are safe, I visit a lot and I have no concerns" and “I have no concerns at all. The staff are kind I can talk to any of them if I was worried. Any concerns I have had, I have spoken to staff and received immediate action.” One staff member said, "Training was really interesting, it reminded you of how vulnerable residents are." Another said, "I would take it to the senior or manager, unless it was an accident then I would ring emergency call bell. Would report it."

Staff confirmed that they had read the policies as part of their induction and refreshed their knowledge at yearly safeguarding training. Training records showed staff had completed safeguarding training. Staff were aware of most of the signs of abuse and how to report safeguarding concerns. On discussion with the area manager, it was agreed to provide further guidance and support in recognising financial and emotional abuse to build staff confidence in identifying abuse. They were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority.

There was a system in place for recording safeguarding concerns which helped management have oversight over this. The management team had appropriately made safeguarding referrals to the local authority when required.

Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored.

People were supported by staff who knew them well. Staff supported people with kindness, respect and followed good practice guidance when assisting them.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff received training in the principles of the MCA and understood their role and responsibility in upholding those principles. The registered manager kept an overview of all DoLS applications and those that are completed, pending and those that were refused. We found that some peoples capacity documentation was not very clear and, in some areas, contradictory. This was fully discussed during the feedback session and would be reviewed as a priority.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people well and were able to discuss their support needs and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed.

Staff told us, “Residents have care plans and risk assessments which we can read, we also have daily meetings to discuss any changes, who needs extra support or who has appointments or visitors planned.”

Additional checks were in place for people at risk of falls. These included sensor mats, person location checks, appropriate footwear checks, and ensuring people had the appropriate walking aids and were wearing their glasses if needed.

We spent time with people and staff both in communal areas and with permission in peoples' bedrooms. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against people’s weight. Staff checked these daily and recorded these checks on the persons’ care documentation. People who were at risk from falls, had sensor mats that alerted staff the person was up and at risk. Call bells were in peoples' rooms, and there were risk assessments in place for those who could not use a call bell, and we saw that staff checked them regularly.

Care plans and risk assessments gave staff clear guidance on minimising risk. For people at risk of dehydration or malnutrition, records evidenced close monitoring and the actions taken, including fortifying food and providing supplements. People who lived with diabetes had detailed care plans and risk assessments that provided staff with guidance to manage their health safely.

We observed equipment being used appropriately to reduce people’s individual risks, such as walking aids and wheelchairs. People were supported with the correct equipment and assisted by staff in a safe way.

The management team analysed accidents and incidents. Where additional support was required, referrals were made to services such as the in-reach team, falls team and GP.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The premises were a mixture of old and new, and before admission consideration was given to people’s mobility and mobility aids to ensure peoples safety. People had access to both internal and external spaces which were safe and promoted independence. At the time of the assessment, one passenger lift was awaiting repair, the impact of this on people was managed effectively in the short term. In the event of a medical emergency, a contingency plan was in place.

Whilst the environment was safe, the décor was tired and needed upgrading. However, this had been identified and there was a redecorating and upgrading plan in place. Care equipment we saw was in good working order and documentation to support regular servicing was seen. There was no clutter, and the home was accessible for people with mobility needs and safe for people to walk around if they chose.

Processes ensured the environment was safe and well maintained. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. Premises and health and safety risk assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing levels were based on people’s needs and reviewed regularly. Rotas showed consistent staffing levels, with relief staff covering vacancies, sickness and holidays. Staff numbers and deployment met people’s needs and preferences, supported by records showing that their care and social needs were met. The provider ensured staff were skilled and experienced and received effective support, supervision and development. Staff said, “We get lots of training both online and face to face, also our clinical lead and nurses are always happy to show us things,” and “We get really good training and I have supervision regularly.” Training and supervision records were up to date and monitored.

Our observations during the visits, showed us that staff were visible and available to support people’s requests for support and company, and took time to engage with people.

People received timely care, people we spoke with did not have any concerns regarding staff numbers. People told us, “I think staff numbers are ok, never had a problem,” and “lots of staff around.”
Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The premises provided people with a clean, and well-maintained environment. There were no unpleasant odours noted. People’s rooms were cleaned regularly by housekeeping staff and people commented positively, with no-one reporting any problems with the standard of cleanliness of the environment and equipment.
People told us, “Nice and clean,” and “They (housekeepers) are good and friendly and chatty as well.” A visitor said, "Well-kept, mostly clean and welcoming, the improvements are happening so that’s good."

Staff told us they are well resourced for cleaning and infection control. One said, “Personal protective equipment (PPE) is not an issue, we have enough and also cleaning products and equipment.” We saw housekeeping staff undertaking cleaning in all parts of the home. People’s laundry was managed well, and the laundry room was clean and well organised, and people were well dressed. The housekeeping staff understood their role and followed appropriate procedures to keep the home clean. All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed by the infection control lead to ensure compliance with the procedures and policies of the home. Staff were trained in the use of personal protective equipment (PPE) and of the importance of good hygiene practice. The manager told us they ensured staff continued to follow Public Health England guidance to reduce risk of infections.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff supported and involved people to manage their medicines and followed best practice for administering medicines. One person told us, “I manage some of my medicine, and staff support me.” Staff documented medicines clearly in care plans and made sure medicines accompanied the person between healthcare settings.

There were a number of occasions where people refused medicines. Refused medicines were placed in plastic bags by staff with the person’s name on but not the date, time or reason for refusal. This was taken forward by the registered manager immediately to ensure staff identified trends and consulted the GP in a timely way.

Not everyone could share their experiences regarding medication, but one person said, “I rely on the staff to give me my medicine, they keep me informed of changes.” One family member we spoke with said, “I know they have regular medicine reviews and any changes; they tell us.”

The management of medicines were very well organised, with minimal extra stock and all medicines no longer required were managed safely and returned as per their pharmacy’s procedures. Protocols were in place for ‘as required’ (PRN) medicines, including pain relief. These were linked to pain charts and pain care plans.

Some people had been prescribed just in case medicines to be used at the end stage of their life.

Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely. All discrepancies and medicine errors were investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed.