Archived: High Mount

High Mount comprises of 2 single storey buildings that are situated in a cul-de-sac close to community amenities. Each building has 4 bedrooms, shared accessible bathrooms, communal living spaces and a shared garden.

We expect health and social care providers to guarantee people with a learning disability and autistic people, respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People were not always safe at High Mount. This was because the provider did not always ensure that risks were assessed, monitored, and managed to minimise the likelihood of harm.

People’s hydration and nutritional needs were not always met which put people at increased risk of poor health outcomes. People’s care plans were not always updated to reflect changes in need which meant care given did not always meet current needs.

Right Care: Health professionals’ directions were not always followed which resulted in people not accessing health care services and not always receiving the care they needed to promote well-being. This meant people were exposed to continued risk of harm.

People were not always supported by enough staff, this meant care was not always person centred to maximise people’s choice and control.

Environmental and equipment risks were not always identified and where they were, the provider failed to always act effectively to safeguard.

Right Culture: The provider failed to ensure the governance systems in place were always effective in delivering high quality care and support. Systems did not always identify or monitor effectively, to ensure risks were mitigated against, and, where increased concerns were identified through audit processes, no effective actions were taken to make the changes needed.

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 requires improvement (published March 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when, to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating has changed to Inadequate based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for High Mount on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

People’s experience of using this service:

People living at the home appeared happy however we identified a number of concerns that the providers governance systems had not identified.

Records were not consistently being completed to indicate safety checks had been made and that certain policies and procedures in the home were not being followed by the staff team. We found that people's risk assessments did not highlight what was a high risk and that reviews of people's care did not always identify necessary changes.

People received their medicine on time, although not all medicines were stored securely.

We received mixed feedback on whether there were sufficient staff to meet people’s needs and complete all the tasks required.

People’s care plans were reviewed monthly however we found reviews did not always account for changes which occurred.

People’s capacity to make decisions was assessed however more clarity around specific decisions was need as well as a review of the applications made to deprive people of their liberty.

People’s privacy was not always protected.

People were supported by staff who knew how to recognise and report abuse.

People were supported by staff who had been trained. Some staff still needed to complete courses specific to people’s individual needs.

The registered manger reviewed accident and incident forms and shared lessons learnt.

People were supported to have a balanced diet.

People had access to healthcare.

People were treated well and staff understood people’s protected characteristics.

People were supported to express their views and accessible information was increasing in the home.

People were engaged in activities although people’s daily records did not always provide detail of what the activity was.

People had access to a complaints process.

People’s end of life wishes had been considered.

Staff felt supported by their manager and regular team meetings were held.

The registered manager had a continuous improvement plan and added actions to it as and when identified.

Rating at last inspection: At the last inspection dated the 23 March 2017 the home was rated as good

Why we inspected: The inspection was prompted in part by notification that someone who used the service had died. The circumstances surrounding the death are still subject to further enquiries and as a result this inspection did not examine those circumstances. However, the information shared with CQC about the death have indicated potential concerns about the management of risk in relation to health needs. This inspection examined those risks.

Enforcement: We consider the service to be in breach of Regulation 17(2)(a) Health and Social Care Act 2008(Regulated Activities) Regulations 2014. Action we told the provider to take is at the end of this report

Follow up: We will continue to monitor the service and the required improvements.

Rating at last inspection.

At the last inspection, in July 2014, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good

People continued to receive care which protected them from avoidable harm and abuse. Staff met people’s needs in a safe way and were available when people needed and wanted support.

People received care and support that was effective in meeting their needs. Staff had received training which gave them the skills and knowledge to support people’s specific needs. Staff respected people’s right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions staff followed the law in ensuring decisions made were in their best interests.

People were treated with kindness and compassion by staff that knew them well. They were kept involved in their own care and staff made sure they had choices in all aspects of their daily life. Staff respected people’s privacy, treated them with dignity and encouraged them to be as independent as they could be.

People’s care and support continued to be individual to them. Staff responded to changes in people’s needs which helped to ensure they got the care they needed. People were supported to spend their time how they wanted to and were encouraged to maintain their social interests within the local community. People had opportunities to give feedback on their experiences of the care they received.

Staff continued to work for the benefit of the people who lived at the home and kept them involved in what happened. There had been a change of registered manager since our last inspection and the management of the home continued to support a positive and open culture. The provider had systems in place that continued to be effective in assessing and monitoring the quality of the service provided.

Further information is in the detailed findings below.

We found that people gave consent for day to day activities in a number of ways according to their ability. We found staff were clear about their role and responsibilities in relation to the Mental Capacity Act. We saw that when appropriate staff participated, in multi-agency 'Best Interest' decision meetings.

Care records were well organised and comprehensive and provided information to ensure people received safe effective care. Risk assessments were carried out ensuring risks were identified and action taken to minimise risk.

We saw that appropriate steps had been taken to ensure people were protected from the risks relating to infection. We saw that the accommodation was clean and in the main well maintained. There was good access for people with a mobility disability.

People who lived in this service had varying abilities in communicating.

Some of the people who lived in this service were unable to talk with us. Because of this we looked at records, talked with staff and observed the way that the care was provided.

However, some people were able us that they were well looked after. They said that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect.

Many people were able to make it clear to us that they liked living at High Mount. Some said such things as 'I like it here' and 'It's nice'.

People told us that they felt able to raise any issues with the managers or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw that staff were always available when people needed help. People told us that staff were friendly and always acted professionally.

The service's management held regular meetings with the people who live in the home to find out what they thought about how their care was delivered.