Background to this inspection
Updated
12 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 07 and 08 January 2019. The first day of our inspection was unannounced. The inspection was carried out by two inspectors and an expert by experience on the first day and one inspector on the second day. An expert by experience is a person who has personal experience of using or caring for someone who lives with dementia.
Prior to the inspection we reviewed the records held on the service. This included the Provider Information Return (PIR) which is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed notifications. Notifications are specific events registered people have to tell us about by law. The service had not been requested to send the Commission an updated PIR prior to this inspection.
During the inspection we spoke with 15 people and three relatives / friends of people. We reviewed eight people’s records in detail. We also spoke with eight staff, this included five care staff, the registered manager, provider and head of care. We reviewed four staff personnel records and the training records for all staff. Other records we reviewed included the records held within the service to show how the registered manager reviewed the quality of the service. This included a range of audits, a newsletter, questionnaires to people who live at the service, minutes of meetings and policies and procedures.
During the inspection period we received further feedback from six family members.
During and following the inspection we spoke with the Nominated Individual regarding future plans for the service and changes to the governance systems to ensure compliance with the Health and Social Care Act 2008. .A Nominated Individual a person that the provider nominates to act as the main point of contact with the Care Quality Commission (CQC). A Nominated Individual has overall responsibility for supervising the management of the regulated activity, and ensuring the quality of the services provided. We also received further information from the registered manager on action taken since the inspection in relation to medicine management and governance.
Updated
12 February 2019
Keychange Charity (known as “The Mount”) 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.
The Mount is registered to provide residential care and accommodation for up to 28 older people who may also be living with dementia. At the time of this inspection, 28 people were living at the home.
The service had 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. At the last inspection in February 2018, the service was rated Good overall with Requires Improvement in the key question of Well Led.
At this inspection we found the rating of Good had not been sustained.
Medicine management required improvement and governance systems needed to be more robust. We found the laws which protect people’s human rights were not always followed and best interest assessments were not always completed where required. We also found improvement was required to the range of activities available for people to reduce social isolation and improve well-being.
The service had a management structure in place, and quality assurance systems in place to help identify where improvements were required. However, these had not always been effective. Staffing vacancies and sickness within the provider’s management structure had meant there had been increased pressure on the remaining management team. Although there was a quality assurance system in place, and these had identified the issues we found during the inspection, these had not been followed up to ensure improvement and compliance.
Feedback from people about the leadership team within the service was good. The provider, registered manager and head of care knew people well. Regular one to one feedback was sought from people and their relatives to ensure they were involved in the development of the service. Feedback was listened to, and the provider spoke to us during the inspection informing us of the changes which would be made.
Improvement was required to the management of medicines to ensure the systems in place were safe and people had their medicines as prescribed. During the inspection we found the medicine keys were not kept securely and prompt action had not been taken when one person’s medicines had been out of stock. Most people’s medicine records we reviewed were not accurate, particularly in relation to people’s skin creams. This meant we could not be confident people had received their skin creams as prescribed to maintain their skin integrity. Where people had medicines “as required” (PRN) we found there were not robust protocols in place to ensure consistency in administration and guidance where these medicines had a variable dose. The registered manager listened to feedback and took prompt action to improve these areas.
Staff understood the need to seek consent from people and when to provide care in their “best interests” however, the Mental Capacity Act 2005 (MCA) was not followed in full. Some people who lacked capacity and were unable to consent to their care and treatment, required care to keep them safe which was restrictive, for example bed rails and pressure mats to monitor their movement. However, we found the decision specific mental capacity assessments were not in place, which meant people’s human rights may not always be protected.
There were systems in place to monitor accidents and incidents, however during the inspection period we found not all staff were following procedures to report incidents. The home was well kept and hygienic.
People had access to some group and individual activities and events they could choose to participate in. These were provided by staff, for example board games. People could choose to participate in bi monthly outings and activities in the local community but there were long periods of time people had little stimulation other than the television.
The service had links with some local community groups and institutions for example the local church. In the past there had been links with nursery children and a local scouts group but these had not been sustained.
People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff.
Assessments were regularly undertaken to review people's needs and any changes in the support they required. Any needs in relation to the Equality Act 2010 were specified in care plans and if required, assessments detailed any support people required in relation to the Accessible Information Standard (AIS). The Accessible Information Standard aims to make sure that people who have a sensory loss, disability or impairment get information they can access and understand.
When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded where appropriate. Staff had received training in this area.
Staff were aware of people's communication methods and provided them with any support they required to communicate in order to ensure their wishes were identified and they were enabled to make informed decisions and choices about the care and support they received.
The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the registered manager and provider.
People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.
Staff were supported through training, supervision and appraisal. Staff worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them. Professional feedback was positive.
People enjoyed the meals available to them and were appropriately supported with eating and drinking. However, we found improved documentation and communication was required if people needed monitoring of their food / fluid or support with their meals.
The home was dementia friendly and met the needs of the people living there. Staff could demonstrate how well they knew people. People and their relatives were positive about the care provided.
People were treated with privacy and dignity and supported to be as independent as possible whilst any differences or cultural needs were respected.
We recommend the provider seek guidance on the Mental Capacity Act and best practice in this area and also recommend guidance is sought in providing activities for people with dementia. In addition, we recommend that the provider has an effective system that assures themselves that there are sufficient numbers of staff effectively deployed to meet people’s needs.