Archived: Keychange Charity The Mount Care Home

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.

When we completed our previous inspection on 16 and 17 May 2017 we found concerns relating to how people were being kept safe, the effectiveness of people’s care, the level of responsiveness to people’s needs and how the service was being well-led. We placed the service in ‘special measures’ as we rated the service as Inadequate overall and in the safe and well-led domains of the report.

Following the last inspection, we added a condition to the provider’s registration that they had to report to us each month. In this report they had to inform us how they were acting to put our concerns right, monitoring this and what they had learnt to prevent this from happening again in the future. We also met twice with the provider, registered manager and other staff from Keychange Charity.

When a service is in special measures we expect the provider to seek out appropriate support to improve the service from its own resources and from other relevant organisations. Where we are able to, we will signpost providers to improvement support agencies if this is necessary. We inspect within six months of the date the inspection report placing the service into special measures was published.

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

This inspection was a comprehensive inspection that looked at all areas of the service again to check the service had addressed the concerns from May 2017. We found people’s care at The Mount had significantly improved in all areas and maintained a Good rating in caring. They have been judged to be Good overall with Requires improvement in Well-led. This is due to the need to demonstrate the changes are permanent and they can sustain this.

The Mount is a care home registered with us to take a maximum of 28 older people. They live in a building adapted to take people with limited physical ability. On the days we inspected 25 people were living at the service.

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.

There was registered manager employed to run the home. 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. They were supported by a deputy manager.

The registered manager and provider had put new systems in place to oversee the running of the service and check its quality. Two quality assurance managers were employed to visit The Mount and all of the provider’s services to drive quality improvements across Keychange Charity.

The way checks of the service or audits were organised needed further attention to ensure these checks took place when required by the provider or in line with legislation (i.e. the gas safe check). The registered manager reflected on this during the inspection and started to plan how they were going to put this in place.

People felt safe at the home and with the staff who supported them. Staff were trained in safeguarding so they could keep the people living there safe. Children were protected when they visited by staff understanding how to keep them safe. Staff knew how to recognise and report abuse. Staff were encouraged and supported to blow the whistle on poor practice.

People’s medicines were managed and administered safely. A family member said, “The staff are always on top of the medicines; they are always given on time.”

There were systems and processes in place to minimise risks to people. These included a robust recruitment process. There were adequate numbers of staff available to meet people’s needs in a timely manner.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

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 staff who were kind and caring. Where people found it difficult to express themselves, staff showed patience and understanding. Keychange is a Christian organisation whose values state, “We say “welcome to everybody.” Staff were trained to put this ethos into practice.

The service was responsive to people’s needs and they were able to make choices about their day to day routines. People had access to organised and informal activities which provided them with mental and social stimulation. We found some aspects of this that could be improved; the registered manager was already looking into this.

People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. The staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the end of their lives.

People said they would be comfortable to make a complaint and were confident action would be taken to address their concerns. The registered manager and provider treated complaints as an opportunity to learn and improve.

People were protected by staff who followed safe infection control processes and procedures. A family member said, “Staff are always in and out cleaning and, staff wear PPE when required.”

We last inspected the service on the 14 and 15 June 2016. This was a comprehensive inspection completed within six months of the previous inspection as the service was rated inadequate and special measures had been applied. The inspection in June 2016 found some improvements had been made but the service was rated as Requires Improvement. There remained a rating of Requires Improvement in the responsive and well-led sections of the report. There was a breach of regulation as people’s care records were not always complete and contemporaneous. We received an action plan that said the registered manager would put this right by the end of October 2016.

The Mount provides residential accommodation for up to 28 older adults who may be living with dementia. A number of the people have a high level of independence. Nursing care is provided by the community nursing team. When we inspected 23 people were living at the service.

A registered manager was employed to manage the service. 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. The registered manager was on holiday when we inspected and in the following days. A member of staff was in charge in the absence of the registered manager.

Robust leadership and governance from the registered provider had not continued since the last inspection. Quality assurance systems including auditing of parts of the service was inconsistent and did not ensure the service was able to meet the requirements of the regulations, or ensure a quality service to people.

Some records such as those around complaints and monitoring staff training were not available for us to review. We were told these may have been kept by the registered manager in a form that was not accessible by senior managers.

People’s medicines were not always being managed and administered safely. Staff were signing that they had given medicines before they had administered them, not when they had observed people had taken them, which is unsafe practice. People’s medicine administration records and stock of medicines were not accurate. People’s prescribed creams were not being managed to ensure they were used and recorded as given accurately.

Risks to people were not always assessed, reviewed and monitored appropriately to ensure people remained safe and free from potential risk. People were not assured to be safe in the event of a fire. Personal emergency evacuation plans (PEEPs) were in place but everyone’s needs had not been assessed in respect of being able to safely evacuate if needed. Action on a fire risk assessment in December 2016 had not taken place. This detailed a number of concerns that would affect people’s safe evacuation. We have referred our concerns to the fire service.

People were not being protected from risks posed to their health and safety. Water temperatures, window restrictors and heated surfaces were not being checked to make sure they were safe. This included not checking the water of baths or showers before people were bathed. Since our inspection, this has now been addressed and we have been told new audits are now in place to keep people safe. Staff were not always following safe infection control procedures. This was especially so in respect of the laundry when soiled washing was left on the floor. Equipment did not have a cleaning programme to prevent cross contamination.

People’s capacity to make decisions was not assessed in line with the Mental Capacity Act 2005 (MCA). People did not have specific assessments in place which advised what they could decide by themselves and how they could be supported by staff. Decisions had been made in respect of people’s care without detailing if this had been in people’s best interests.

Records of how people’s care was planned had not been updated for some time. People’s needs had not been updated when needed. For example, when one person had a fall, the care plan had not been updated to reflect this. The admissions process lacked detail and was not robust enough to ensure the service was able to meet people’s needs quickly. One person’s records had been lost. The records had to be rewritten but prior to this the history of this person was reliant on staff memory, meaning that staff could not be sure they were delivering person centred care.

The service was moving to an electronic care planning system. There was no timescale to when the care plans and risk assessments were being transferred. Staff responsible for care were enthusiastic about the new system as they could access handover and daily records easily. They also used this to record hydration records. Staff felt this had given them more time to spend with people.

Staff were recruited safely but all the information required was not immediately available. This was due to records of people’s checks not being filed. The records were found and added to the files we reviewed. There were enough staff to meet people’s needs however; 15 percent of staffing was from an agency. Some people commented they found this difficult as they did not always know the agency staff but the service tried to ensure the same staff came often to promote consistent care.

People told us they felt safe living at the service and were cared for by staff who were kind and respectful. Family were also positive about the staff and felt their loved ones were well cared for. Everyone said staff ensured their dignity and independence were maintained. People felt staff would support them to be in control of their care for as long as they could. Staff spoke about the people they looked after in caring tones. People, family and staff felt they could make suggestions about the service and how care was given. Staff made sure people were not isolated and would check to make sure people in their rooms were alright and did not need anything. People at the end of life were supported to be pain free and pass away knowing they were loved.

People received enough food and fluids to meet their needs. They enjoyed the variety and choice of food offered. Kitchen staff worked well together and with people to seek any alternative to help people eat what they liked or wanted. People could see their GP and a range of health professionals as needed. People and their family were happy people’s health needs were met.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We have found breaches of the regulations. We are considering our actions in line with our enforcement policy. We will publish a supplementary report at a later date which will show what action we have taken.

The Mount can accommodate a maximum of 28 older people who may be living with dementia. The service provides residential care without nursing. Nursing care is provided by the community nursing team. When we visited, 18 people were living at the service.

A registered manager had not been in post since November 2015. However, a manager was employed and had submitted applications to us to become the registered manager for the Mount. 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 previous comprehensive inspection on 13, 14 and 15 October 2015 we judged the service to be inadequate, it was placed into special measures, and we told the provider to take action to make improvements to people’s care and treatment and ogvernance of the service. On 1 March 2016 we completed a focused inspection to check action had been taken in relation to these aspects and found improvements had been made.

This inspection was a comprehensive inspection and reviewed the service in full, including those areas where we had asked the provider to take action following our inspection in October 2015. Namely, person centred care, the need to ensure people’s consent was sought in line with the Mental Capacity Act 2005 (MCA), safeguarding service users from abuse and improper treatment, staffing, ensuring fit and proper persons were employed and telling us of specific incidents required by law. The provider had sent us an action plan which said all these areas would be put right by the end of February 2016 and these actions have been completed.This inspection found there were sufficient improvements made to take the provider out of special measures.

People told us they felt their needs were being met by staff. People’s needs were being assessed to ensure they were personalised and reflected people’s current needs. However, the records were not always updated or recorded how people’s needs were being met. People had risk assessments in place to mitigate risks associated with living at the service. However, associated care plans required more information to give staff clear guidance regarding how to meet people’s needs. People’s risk of falls were being reviewed on an individual basis. People’s end of life and future wishes were not always recorded however, staff were doing this on a person by person basis to help people discuss the topic when they felt comfortable with doing so.

The administration of medicines was safe. The provider had reviewed their quality assurance processes since the inspection in October 2015. The service had a new local management team in place. Several temporary managers from the company had supported staff make the required changes to the service over recent months. Staff and people spoke well of the new management team and were hopeful this would be a positive time for the Mount. The new manager had a clear vision about the quality of care people should experience. Systems had been put in place to measure the quality of the service.

People were looked after by staff who treated them with kindness and respect. There were sufficient staff to meet people’s needs safely. Staff were recruited safely and understood how to recognise abuse. Staff felt confident in raising safeguarding concerns and felt they would be listened to and action taken. Staff understood how to whistle blow if their concerns were not heeded. Staff had undertaken training in many areas and a system of supervision and appraisal introduced. Staff felt they had the training necessary for their role. Staff said they could approach the new manager and deputy as needed if they required support and guidance.

People were asked for their consent before care was given. The manager was aware of their responsibilities in respect of the MCA. Staff responsible for assessing people had received training in the MCA. People were asked for their consent by staff before commencing any care task.

People’s health needs were being met. People saw their GP or district nurse as needed. People were supported to ensure they had regular health assessments and saw the optician, dentist and chiropodist as required. Where the person needed further assessment this was discussed with the person and their GP.

People liked the meals provided and had enough to eat and drink. People were spoken with and their GP contacted if people presented with any concerns related to their diet or weight. Kitchen staff were knowledgeable of people’s likes, dislikes and health needs. Creative ways were considered to support people to eat who had poor appetites.

People’s complaints and concerns were picked up early and reviewed to resolve the issues involved. Activities were provided to keep people physically, cognitively and socially active. Staff were looking for other ways to encourage people to be active while living at the service. Staff were keen to ensure people in their rooms were not isolated.

We found a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We completed an unannounced, focused inspection on the 1 March 2016 to check the provider had complied with the warning notices. This report only 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 Keychange Charity The Mount Care Home on our website at www.cqc.org.uk.

The Mount can accommodate a maximum of 28 older people who may be living with dementia. The service provides residential care without nursing. Nursing care is provided by the community nursing team. When we visited, 19 people were living at the service.

There had been no registered manager since November 2015. 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. The Mount was being managed by two managers on a job share basis. Both these managers were registered managers for two of Keychange Charity’s other services in the South West. The provider had appointed a manager who was due to start in April 2016.

People said they were happy living at The Mount and told us the changes made at the service had added positive value to their lives. For example, one person told us how nice it was to use the lounge and meet with people who they were getting to know and looked forward to meeting each day. Staff told us the changes were good and they felt valued as part of the staff team. People we were concerned about last time told us their needs were being addressed and they had choice in how their needs were met by staff. Staff and managers were open in saying the changes were a “work in progress”, but felt they were on the right road to improving the service and the lives of people living there.

People’s medicines were administered safely. Staff had received up to date training in the safe administration of medicines and were having their competency checked. Systems had been put in place to ensure medicines were managed in a safe way.

People had up to date risk assessments in place to mitigate the risks of living at the service. Risks assessments of the inside and outside of the building were being developed. People had risk assessments in place which were personalised and identified their own unique circumstances. People were involved in managing their own risks.

Staff were following safe infection control practices. Staff had received up to date training and guidance. Personal protection equipment and hand washing facilities were available to staff. An audit had been completed to monitor practice and keep people safe.

Systems were in place to ensure people’s needs could be met in the event of an emergency. People now had personal emergency evacuation plans (PEEPS) in place. The provider was in the final stages of developing a contingency plan to ensure staff could keep people safe in the event of an emergency.

People were happy with the amount they had to eat and drink and had a choice of what they wanted to eat and when. People said the food was flavourable and they were happy with the portion sizes. Where there were concerns about people not eating enough, drinking enough or losing weight, staff took action to ensure people did not become malnourished or dehydrated. People were offered drinks at several times in the day. The recording of people’s food and drink intake were in place where there was a concern. However, these were not always complete. The managers were taking action on this and feeding back to staff the importance of keeping accurate records.

People’s health needs were met and clearly recorded. People’s records demonstrated contact was had with people’s GP, district nurse and other health professionals as required. People were involved in making decisions about their care and treatment. Advice from health professionals was followed and people’s records were updated as required.

People had care plans in place which were personalised and reviewed. People were involved in saying how they wanted their care delivered.

There was evidence of leadership and governance in place. Keychange Charity were addressing the issues identified at our last inspection and had put processes in place to monitor the service and its progress. This included the Trustees and senior management team taking a more active role in ensuring the service improved.

Audits were in place locally to monitor the service. People and staff were involved in feeding back about the service and felt listened to.

Whilst improvements have been made the service continues to be in ‘Special measures’. We will review this at the next comprehensive inspection.

As part of this inspection we spoke with five people who use the service, two visitors, the deputy manager, the registered manager from one of the providers other homes, three care staff and a community nursing assistant who worked with the district nursing team . We also reviewed records relating to the management of the home which included, six care plans, daily care records and medicine administration records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at The Mount. Staff we spoke with had a good understanding of people's needs and the assistance they required. There were processes in place to support learning from incidents. The deputy manager informed us there had been a reduction in falls which they thought was due to increased staffing levels and training for staff.

During our inspection we saw most risk assessments had been completed and action had been taken to reduce risks. However, the provider may find it useful to note some risk assessments we reviewed had gaps in information and this could result in action not being taken to reduce risk.

On the day of our visit we reviewed four medicine administration records (MARs) and saw on each of these there were a number of gaps where staff had not signed to say medicines had been taken or refused. It was not possible to determine if people had received the medicines they required and therefore people were at risk. An audit had been undertaken in the home three weeks before our visit. This had shown staff were not always signing MARs and we were concerned the problem had not been resolved.

We also saw records used to monitor the movement of medicines from one storage cupboard to another were not always signed. It was difficult to be sure how accurate these records were because we were told there had been no audits of medicines undertaken until three weeks prior to our visit when a small sample of MARs had been audited. A compliance action has been set for this and the provider must tell us how they plan to improve.

People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure people in care homes are looked after in a way that does not inappropriately restrict their freedom. The deputy manager told us no one at The Mount was subject to such a safeguard.

Is the service effective?

People told us they felt happy about the care they received and it met their needs. The assessments and care plans we reviewed gave sufficient information to ensure necessary care was given whilst enabling people to be as independent as possible. One person said 'The care is good. Staff help me to do as much as I can myself; staff help me as I need'.

We spoke with a community nursing assistant who worked with the district nursing team. They told us 'District nurses are contacted appropriately and staff will ring for advice if they need to; staff follow advice and suggestions we make'.

We asked staff if they received training when they had to care for a person with care needs not familiar to them or if they had to use new equipment. Each told us they would receive this training and this was confirmed by the deputy manager. Care assistants we spoke with told us they felt they had received the necessary training to meet the needs of people living at The Mount.

Is the service caring?

The service was caring because during our visit we observed staff treating people respectfully. We saw people being offered choices such as what they would like for their meal the following day and these were carefully explained to them by staff. People were not rushed. For example we saw staff taking time to help a person transfer from their wheelchair to a chair. Throughout the process they explained to the person what was happening and encouraged the person to do as much as they were able. The atmosphere was calm and relaxed.

People we spoke with said they felt they were treated respectfully, were happy, and felt involved in their care. One person said 'Staff ask me what I want and I can speak my own mind, they respect the choices I make. If I ask for fruit they will give me fruit. I like to stay in my own room. They have things downstairs but I like to stay upstairs in my room and I can do this. Staff treat me with respect and when I have a bath they maintain my dignity'. Another person said 'It is very nice, very friendly, very helpful; all is OK. We have a television in our room it is a very nice home'. A third person said 'I am happy here; if I wasn't I would go somewhere else'.

Is the service responsive?

The service was responsive because people's needs were assessed before moving into the home to ensure their needs could be met at The Mount. We saw there were regular reviews of care plans. For example in one care plan it was recorded a pressure relief cushion and air mattress had been provided where the person was assessed as at risk of pressure sores.

Staff we spoke with told us there was good communication within the team with thorough handovers at each shift and good written information. There were clear processes for reporting any concerns about changes in the person's health and good support from the GP and other professionals. We saw reference to specialist services in care files. For example in one file we saw the community psychiatric nurse team should be contacted if changes in the person's mental health were observed.

Is the service well-led?

The registered manager's post at The Mount was vacant at the time of our inspection. A deputy manager had been appointed approximately eight weeks prior to our inspection. We were informed by the deputy manager interviews for the registered manager's post were scheduled a few days after our visit.

The service was well led because staff we spoke with had a good understanding of what was expected of them. All care assistants we spoke with told us they felt well supported and had easy access to speak with the deputy manager if they needed to. Regular staff meetings were being set up and all staff had appraisals booked for the two weeks following our inspection.

There were processes in place to keep the deputy manager and staff up to date with current practice and guidance. One senior care assistant we spoke with said 'New information is put up in the staff room and we have had quite a lot of training; we also keep up to date by doing our research. I am now the nutrition champion and I have a responsibility to keep up to date and share this knowledge with staff'.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences. One person said 'They (the staff) get me up when I'm ready and no rush'.

Staff we spoke with were clear about the actions they would take should they have any concerns about people's welfare.

We looked at care records for four people. We spoke with staff about the care given to these four people, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity had been assessed to determine whether they were able to make particular decisions about their lives.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home.

We saw that the home had a complaints procedure available. We found the provider managed complaints appropriately.