Mountview

Mountview is a care home providing residential care for up to 10 adults with learning disabilities or other complex needs. At the time of the inspection there were 9 people living at the home.

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

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.

Right Support

The model of care and setting maximised people’s choice, control and independence. 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.

People were supported with their medicines and able to take part in activities in their local area. Risk which was identified was recorded and monitored to keep people safe. The home was kept clean and tidy and staff followed infection control procedures.

Right care:

People received care which was person centred and promoted their dignity, privacy and human rights. Staff were kind and compassionate. Each person had an individual care plan detailing their preferences and how to support them if they were in distress. People also had access to a range of health and social care professionals. One healthcare professional said, “The staff responded to my request to work on someone’s mouthcare, gradually improving this step by step.”

People were kept safe by suitably recruited staff who had received the necessary training to perform their roles well. A recent safeguarding concern had been reported regarding 2 staff. This had been dealt with appropriately by the registered manager and provider.

Right culture:

The ethos, values, attitudes and behaviours of leaders and support staff ensured people using the service led confident, inclusive and empowered lives. The environment was welcoming. People, where possible, and those important to them, including advocates, were involved in planning their care and support. People’s care and the need to keep them happy and healthy was the priority for staff. Quality assurance checks were in place to continually review the service provided and make any changes as necessary.

We received a few negative comments regarding communication which the registered manager was made aware of to address.

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 6 July 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on recent concerns we had received about the care and treatment people received at the home.

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.

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

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mountview is a residential care home providing personal care and accommodation to people with a learning disability and/or autism.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a larger home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. However, the building fit into the local residential area and other larger domestic homes of a similar size and design. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

Staff understood how to minimise risks and keep people safe without restricting them. Medicines were managed safely and people lived in an environment that was homely and clean.

People were supported by well trained staff who understood their needs and preferences. People’s healthcare needs were assessed and were appropriate healthcare specialists were involved in people’s care. Staff had worked together to research and develop a sensory room which people enjoyed spending time in.

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.

Staff were very fond of people and made sure people were treated with dignity, respect and patience. A family member said, “Mountview wouldn’t be the place it is without the staff, they really are lovely and manage the care very well.”

Some care plans were very detailed and specific to people’s needs. Others needed some further explanation about people’s communication needs. The registered manager and deputy manager acknowledged this and prioritised the review of care plans. People were supported to maintain community links and develop new friendships. No complaints had been received since the last inspection.

A range of audits were used to assess the quality of the service and to identify any improvements that were needed. Action plans, identified what improvements were needed and progress was closely monitored.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

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 23 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Our last comprehensive inspection of this service was in August 2015 where one breach of Regulations under the Health and Social Care Act 2008 was identified, namely Regulation 12, Safe care and treatment. At this inspection we found improvements had been made and the provider was now meeting legal requirements.

A registered manager was in post who had been registered with the Commission since April 2016, in line with the requirements of the provider's registration. 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.

Each person that we spoke with told us, or indicated (where they were not able to communicate with us verbally), that they felt safe and comfortable in the presence of staff. Policies and procedures were in place to protect vulnerable adults from harm and abuse. Staff were trained in safeguarding and they were aware of their own personal responsibility to report matters of a safeguarding nature.

Risks that people were exposed to in their daily lives and their environments had been appropriately assessed and measures put in place to mitigate these risks. Positive risk taking was promoted throughout the service and risk assessments were appropriately drafted, reviewed and updated.

Health and safety checks and the servicing of equipment within the home was carried out regularly to support people to remain safe. Any accidents or incidents that occurred were investigated and measures put in place to prevent repeat events. Emergency planning had been considered and guidance was in place for staff to follow should a range of eventualities occur.

Staffing levels were appropriate at the time of our visit and ensured that people's needs were met. Recruitment procedures were robust and enabled the provider to recruit staff of the correct calibre and skill sets to support the people in receipt of care from the service. Vetting checks were carried out to ensure that staff were not barred from working with vulnerable people. Training, supervision and appraisal of staff was carried out regularly. Staff said they felt supported in their roles.

The management of medicines was safe and people received the right medicines they needed, at the right times.

People's care was person-centred and appropriate to their needs. Their general healthcare needs were met. Evidence was available to demonstrate that people were supported to access routine medical support, such as that from a dentist or optician, as well as more specialist support, such as that from a speech and language therapist should this be required.

Staff displayed an in-depth knowledge of people and their needs. They relayed information about people's needs and steps they took to support them, which tallied with our own observations and documented information held within people’s care records. People's nutritional needs were met and managed well. Where necessary, food and fluid charts were used to monitor that people ate and drank in sufficient amounts to remain healthy.

Staff and people enjoyed good relationships and staff treated people with dignity and respect. People were supported to live as independently as possible and social inclusion and community involvement was promoted.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken and records about such decision making were maintained.

Care records were well maintained and regularly reviewed. Pre-admission assessments and detailed care plans and risk assessments were available to staff so that they had the information they needed to support people appropriately.

A complaints policy was in place and other feedback channels existed for staff, people, relatives and external healthcare professionals to express their views. These included meetings and surveys. The registered manager was well thought of amongst the staff team and had an in-depth knowledge of the service and people in receipt of care.

Quality assurance systems were in place although these could have been more detailed in places. The provider had overlooked the submission of some notifications, related to other incidents, in line with Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We have made a recommendation about this and are dealing with this matter outside of the inspection process.

The premises had been improved and provided a warm, comfortable, personalised and clean environment.

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance. Staff received adequate supervision or appraisal.

We saw people were relaxed and there were good interactions between people who used the service and staff. We saw staff consulted people before they provided care and support.

We found people's needs were assessed and care was planned in line with their needs. One person told us, "I am happy here.' Care plans were regularly updated and contained clear information about individuals' care.

The premises were in need of improvement but did provide a warm, comfortable, personalised and clean environment.

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance. Staff did not receive adequate supervision or appraisal.

People were asked their views about the service provided and these were taken account of. The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service was maintained.

During our inspection we spoke with three members of staff and looked at the care records for three people. We found that people were involved in decisions about their care whenever possible and their privacy and dignity was respected.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. One staff member said, "We tend to know who likes what so we can accommodate their needs but we always ask, we don't assume, we work on different ways of communicating."

We saw the building was well maintained and designed to be accessible to all people.

Appropriate checks were undertaken before staff began work.

The service had a complaints system in place and staff confirmed they were happy in dealing with any complaints. One staff member said, "I would do a number of things, I could write it down and pass it to the manager, refer them to the manager or if I thought I could rectify it then I would do my best to help them."