Archived: Montague House

Montague House is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

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

People told us they felt safe at the service and like living there. However, we found that people were not always safe. People’s medicines were not managed safely or in line with good practice. Risks to people were not always updated or considered when changes were made to support. Staff understood their responsibilities to safeguard people from abuse. Until recently there had not been enough staff to keep people safe, staffing numbers had been increased as requested by the local authority safeguarding team.

The registered manager had been absent from the service for some time at the time of the inspection. A large amount of information could not be found or was incomplete. Audits had not been completed and staff recruitment and training files were incomplete. Staff did not always have the training they needed to support people. The provider had relied wholly on the registered manager to keep oversight of the service and was unaware of any of the issues identified at this inspection. Staff told us the deputy/acting manager was supportive and open to ideas, however this had not been true of the registered manager.

Systems were not in place to gain feedback from people about the service. People told us they would tell staff if they were unhappy but records relating to complaints could not be found. People were treated with care by staff who knew them well and who tailored their interactions to each person. People could have visitors at any time and enjoyed taking part in a range of activities.

People received care based on their needs and preferences, however care plans did not always contain the most up to date information. People had access to healthcare as required. There was a choice of food available and it was offered in a way which met people’s 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.

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 good (published 06 July 2018.).

Why we inspected

The inspection was prompted due to concerns received about safeguarding concerns and allegations of financial abuse. A decision was made for us to inspect and examine those risks.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe management of medicines, management of risk, management of complaints, staff training and the overall management of the service.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Montague 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.

Montague House is a privately-owned care home providing long and short term residential care for up to 19 older people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the day of the inspection there were 17 people living at the service, some of whom were living with dementia.

At the last inspection in April 2017 the service was rated ‘Requires Improvement’. There was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. We asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-Led to at least ‘Good’. At this inspection we found that improvements had been made and the breach in Regulation had been met. Risks to people were assessed and staff had guidance to follow to reduce risks to people in the least restrictive way.

The registered manager worked at the service each day and was supported by a stable and established staff team who had been recruited safely. A registered manager is a person who has registered with CQC 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 Montague House. They were protected from the risks of abuse, discrimination and avoidable harm. Staff completed training about how to keep people safe and had guidance to support people to stay as safe as possible. Risks to people were assessed, identified, monitored and managed. People had their medicines when they needed them and these were administered by staff who were competent to do so. The registered manager monitored accidents and incidents to make sure people were referred to health care professionals when needed.

People were supported by staff who knew them well. Staff kept their skills and knowledge up to date and met with the registered manager on a one to one basis to discuss their performance and personal development.

People were protected from the risks of infection. The service was clean and tidy and regular checks were made to make sure the environment and any equipment was safe and well maintained.

People and their relatives were involved in planning their care and support. People’s needs were assessed before they moved into the service to make sure staff could meet their needs. They were offered the support of an advocate if they required additional support to help them make decisions about their care. Each person had a care plan which had been written with them and their relatives. These gave staff the guidance they needed to make sure they provided the support in the way people preferred.

People were encouraged to eat healthily and were offered a choice of home-cooked meals. Staff worked with health care professionals to make sure people stayed as healthy as possible.

People had access to private space, communal areas and the garden and visitors were welcomed at all times. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by a caring, kind and compassionate staff team. Staff spoke with people and each other in a respectful way. People’s privacy, dignity and independence were respected and promoted. Records were securely stored to protect people’s confidentiality.

People were encouraged to keep active and people enjoyed staying busy. They enjoyed a range of activities. People told us they did not have any complaints but felt confident the right action would be taken if they had a concern.

People’s preferences for their end of life care were recorded to make sure their wishes could be followed. The staff team worked with health care professionals to make sure people were supported to have a comfortable, dignified and pain-free death.

People, relatives, staff and health care professionals felt that the service was well-led. The registered manager promoted an open and fair culture where people’s, relatives, health care professionals and staff views and opinions were valued. There was a culture of inclusiveness.

The leadership of the service was visible. The registered manager understood their responsibilities and notified CQC according to guidelines. Checks and audits were completed to monitor the quality of service and, when needed, action was taken to drive improvements. The staff team worked with health care professionals to promote joined up care. The most recent CQC report was displayed in the service.

Montague House is a privately owned care home providing long and short term residential care for up to 19 older people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the day of the inspection there were 10 people living at the service, some of whom were living with dementia.

The service was run by a registered manager with the support of a deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 present on the day of the inspection.

We carried out an unannounced comprehensive inspection of Montague House in September 2016, the service was rated ‘requires improvement’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and we asked the provider to take action to make improvements. We issued requirement notices relating to the cleanliness of the service, mitigating risks, deployment of staff, consent, deprivation of liberty, a lack of activities and a lack of effective auditing systems. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the breaches met. However there were still areas for improvement.

People told us that they felt safe living at Montague House. Staff knew how to recognise and respond to abuse and understood the processes and procedures in place to keep people safe. People received their medicines safely and on time. Medicines were stored safely. The service was clean.

Risks to people had been identified, however the registered manager had not consistently provided staff with clear guidance on how to provide the right support to keep people safe and minimise risks. Staff had been given guidance from a health professional and were changing the risk assessments.

The provider had recruitment and selection processes in place, which were followed, to make sure that staff employed were of good character. There were sufficient staff on duty during the day. However, we recommend the provider review their staffing levels along with people’s levels of dependency to make sure people are safe, particularly at night, in an emergency.

Staff completed training and had one to one supervision meetings with the registered manager or deputy manager. There were some gaps in staff training and refresher courses had been booked to cover these.

There were assessments in place to establish whether people had capacity or not to make decisions. When required meetings were planned with the relevant people to make sure decisions were made in their best interest. People were offered choices about what they wanted to do and how they wanted to spend their time.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

People’s health was monitored and staff worked with health and social care professionals to make sure people’s health care needs were met. People had enough to eat and drink and had a choice of home cooked food. People told us they were happy living at Montague House and staff respected their privacy.

Staff interactions were positive. Staff spoke with people in a kind and caring way. Staff knew people well including their likes and dislikes.

Staff were responsive to people’s needs. Assessments were carried out before people moved into the service. People’s care plans were reviewed by staff to ensure they reflected the care and support people needed. However, people and their loved ones were not consistently involved with these reviews. The registered manager and deputy manager had booked additional training to support them in writing care plans in a better and more individual way.

People took part in a variety of activities within the service. However people’s views on the quality of the activities offered varied. There was a complaints policy in place and people’s relatives said they knew how to complain if they needed. People’s relatives could visit when they wanted to and there were no restrictions on the time of day.

People knew the staff and registered manager by name and told us they could rely on them to provide the right support. Audits were being completed and recorded. When shortfalls were identified, and action was needed, the registered manager had noted who was responsible for taking action and when it needed to be completed.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We last inspected Montague House in September 2016 when a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At this inspection improvements had been made, however we found one continued breach of regulation. You can see what action we have asked the provider to take at the end of the full report.

Montague House is a privately owned care home providing long and short term residential care for up to 19 people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the day of the inspection there were 13 people living at the service, some of whom were living with dementia.

The service was run by a registered manager with the support of a deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 present on the day of the inspection.

At the last inspection in December 2015, the service was rated ‘requires improvement’, there were breaches of regulations and we asked the provider to take action to make improvements. The breaches of regulations related to the need to gain people’s consent, staff supervision, involving people in their care, the lack of activities, involvement in the community and a lack of effective audit systems. The provider had taken action to involve people in the planning of their care. The registered manager had begun to meet with staff to hold one to one supervision meetings. However, action had not been taken to make sure that care was provided with people’s consent. The provider had not supported people to be involved in the community and take part in meaningful activities. Audits had not been completed regularly and had not identified the shortfalls found at this inspection. These were continued breaches.

Some areas of the service were unclean and unhygienic. Risks to people were not consistently identified and assessed and guidance for staff was not always provided on how to minimise risks to people.

There were not enough staff to give people the care and support they needed. Staff were often too busy to spend time with people. There were long periods of time when people had no interaction from staff.

The registered manager and staff had not assessed people’s capacity for either day to day or more complex decisions. Staff did not always act in accordance with the Mental Capacity Act 2005.

People were being deprived of their liberty without consulting with or referring to the relevant authority. No assessments had been completed to check if any restrictions in place were the least restrictive possible and in the person’s best interest.

We observed some positive interactions between staff and people. However, staff did not consistently promote people’s dignity and treat them with respect. When staff told people they would be back to support them, they did not always return to assist them.

Staff did not engage with people. Staff did not support people to be involved in the community as much or as little as they wished and to take part in meaningful activities. People told us they had nothing to do except sleep or watch the television.

There was a lack of regular and effective auditing and monitoring. Audits were not completed regularly or effectively. People, relatives, staff and health professionals were not asked their views about the quality of the service. Shortfalls identified during the inspection had not been identified by the registered manager or provider.

People told us that they felt safe living at Montague House. Staff knew how to recognise and respond to abuse and understood the processes and procedures in place to keep people safe. People received their medicines safely and on time. Medicines were stored safely.

The provider had recruitment and selection processes in place to make sure that staff employed were of good character. Staff completed training and had one to one supervision meetings.

People’s health was monitored and staff worked with health and social care professionals to make sure people’s health care needs were met. People had enough to eat and drink and had a choice of home cooked food. People told us they were happy living at Montague House. People told us staff respected people’s privacy.

Each person had a descriptive care plan which had been written with them. People said that staff were generally responsive to their needs. There was a complaints system and people knew how to complain. People’s relatives could visit when they wanted to and there were no restrictions on the time of day.

There was a lack of structured quality assurance systems and processes. Breaches of regulations had not been identified by the provider. The views of people were not being sought on a regular basis or being used to drive improvements at the home..

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We last inspected Montague House in December 2015 when a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At this inspection further and continued breaches of regulation were identified. You can see what action we have asked the provider to take at the end of the full report.

People told us that they were asked to give consent and were involved in the decisions about the care and support they received.

People told us that they received the care and support they needed to remain well and healthy. Records showed how people's needs were supported. We saw records that showed that the service worked closely with health and social care professionals to improve people's health and well-being. One person commented, 'I'm as safe here as I will ever be. I am well looked after here'.

We observed that the provider had provided an environment that was suitably designed and adequately maintained. The home was generally clean and free from unpleasant odours.

We found that there were enough skilled and experienced staff to meet people's needs.

The provider generally informed and reported significant events that occurred to the Care Quality Commission (CQC).

We met and spoke with some of the people who use the service and everyone we spoke with expressed that they were very happy living at Montague House. We observed interactions between the people and the staff and also people's reactions to the staff. We observed how people responded and reacted with the staff and we observed to see if people indicated they were happy, bored, discontented, angry or sad.

People told us that they had the care and support they needed to remain well and healthy. They said were involved in decisions about their care and support. We were told, 'I've got everything I want here. They wouldn't let me have my cabinet at the old place but I can here. I've had a lot of support from staff.'

People said they liked living at the service and felt safe. One person told us, 'I feel safe here because the staff are good.'

Staff engaged with people in a warm and positive way and supported people where needed.