Montague House

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

At our last assessment, the provider was in breach of the legal regulation related to safe care. At this assessment we found improvements had been made and the provider was no longer in breach.

This service scored 69 (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. The provider completed reviews following incidents, maintained oversight of accidents and falls, undertook medicines reviews and facilitated reflective discussions with staff. Staff described a positive culture where concerns could be raised, and management demonstrated a willingness to learn when issues were identified.

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

People had access to a range of healthcare professionals including GPs, district nurses, tissue viability nurses, dietitians, speech and language therapists, community mental health teams and specialist clinicians. Referrals were made when concerns were identified and staff worked with external professionals to support people's health needs.
 

Systems were in place to protect people from the risk of abuse. We identified some incidents which should have been considered from a safeguarding perspective. Staff had appropriately intervened and taken action to support the people involved at the time of the incidents. However, staff had not always recorded incidents in a way that identified potential safeguarding implications. In response, the provider reviewed the incidents, made referrals retrospectively where appropriate and reviewed safeguarding processes with staff.

The provider had safeguarding systems in place including safeguarding trackers, staff training, investigations and supervision discussions. Staff understood their responsibilities and people and relatives generally told us they felt safe living at the service. A person told us, "I feel very safe and comfortable." A relative said, "[My relative] is very safe there, they have complex needs and get great care." Where people were deprived of their liberty, appropriate authorisations had been sought.
 

Records did not always demonstrate people had been repositioned in line with their assessed needs. People are repositioned when they are unable to do so themselves to reduce the risk of skin breakdown and pressure damage. In response to our concerns, the provider provided assurance that people had not experienced harm as a result of this. Staff were reminded of recording expectations, care plans were reviewed and additional monitoring arrangements were introduced.

However, people had risk assessments in place covering areas including falls, mobility, nutrition, skin integrity and health conditions. There was evidence risks were regularly discussed and reviewed, and staff demonstrated a good understanding of people's individual needs. A relative told us they felt, "completely comfortable with the care and safeness here." A staff member said, "Residents have access to a wide range of trips and experiences, and each outing is carefully risk assessed to ensure people can participate safely."
 

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 environment was welcoming and appropriately maintained. The provider had recently completed a redesign of the service which created separate residential, nursing and dementia communities. The environment for people living with dementia incorporated therapeutic colour schemes and engagement areas designed to support people's wellbeing and reduce distress. Staff demonstrated a good understanding of how the environment was used to support people living with dementia and promote independence. A person told us, “I like my room, it’s very pleasant.”
 

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.

Overall, relatives and staff told us there were enough staff available to meet people's needs. A relative said, “The staff come quite quickly when [My Relative] needs them.’’ Staff described strong teamwork and told us management responded appropriately when staffing gaps occurred. Planned staffing arrangements included support for activities, wellbeing programmes and therapeutic interventions, demonstrating a focus on supporting people's quality of life as well as meeting care needs.

Staff were appropriately trained, received regular supervision and support, and were recruited safely. Staff were also supported to develop their knowledge and skills through additional training and qualifications.
 

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.
Infection prevention and control systems were in place, and staff had received appropriate training. The environment was generally clean and well maintained. People had access to clean communal areas, lounges and dining spaces. A person told us, "It's like a hotel room, it's lovely and clean and quiet, just as I like it."
 

The provider generally made sure medicines and treatments met people's needs, capacities and preferences. Staff administered medicines safely and demonstrated person-centred approaches during medicines rounds. Medicines were stored securely and stock balances reviewed during the inspection matched electronic records. The provider operated electronic medicines systems and maintained medicines audits, controlled drug checks, pharmacy involvement, competency assessments and medication reviews. Additional competency checks had been introduced following previous medication incidents, demonstrating learning and improvement.

We identified some areas where medicines oversight and documentation could be strengthened. These included topical creams not always being clearly labelled with opening dates, a small number of expired district nursing supplies being stored on site and some inconsistencies within medicines documentation and self-administration records. The provider had already identified some of these issues and commenced reviews and corrective actions during the inspection. There was no evidence people had experienced harm as a result of the concerns identified.