Background to this inspection
Updated
9 September 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.
This inspection took place on 28 July 2015 and was unannounced.
Our inspection team consisted of two inspectors and one expert-by-experience who carried out interviews with people using the service. Our expert by experience had experience of services such as residential and supported living services, shared services and domiciliary care services.
Before the inspection we looked at previous inspection reports and notifications about important events that had taken place at the home, which the provider is required to tell us about by law. The provider completed a Provider Information Return (PIR). This 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.
During our inspection, we spoke with four people, two support workers, one team leader, a manager and the registered manager. We also contacted other health and social care professionals who provided health and social care services to people. These included community local authority care managers and commissioners of services.
We observed people’s care and support in communal areas throughout our visit, to help us to understand the experiences people had. We looked at the provider’s records. These included two people’s records, care plans, health records, risk assessments and daily care records. We looked at two staff files, a sample of audits, satisfaction surveys, staff rotas, training records and policies and procedures.
At our last inspection on 3 September 2013 we had no concerns and there were no breaches of regulation.
Updated
9 September 2015
We inspected this home on 28 July 2015. This was an unannounced inspection.
The Mount & The Olives is registered to provide personal care and support for up to nine people with learning disabilities. It does not provide nursing care. Care and support is provided 24 hours per day. At the time of our inspection, eight people lived in the home, seven were fairly independent, requiring minimal support and one person had advanced stages of dementia, and required more support.
There was a registered manager at 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. The registered manager was the provider. The provider also had a manager in post who is not the registered manager, who perform similar role as that of the registered manager.
Prior to this inspection we received information of concern in relation to care practices at the home. This included no records of how finances were spent, no safeguarding records, no behaviour support plans or support plans that had been cross referenced with risk assessments. In addition, concerns had been raised about a lack of consistency of records, an inconsistent approach to recording of incidents and accidents, incidents not being reported to the local authority and notifications had not been sent to the commission to tell us about incidents and accidents in the home.
During our inspection, people made complimentary comments about the service they received. People told us they felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us.
People told us they felt safe. The Mount & The Olives had a safeguarding policy. However, they did not have a copy of the local authorities safeguarding adult’s policy, protocols and guidance. This meant that staff did not have access to the most relevant guidance to refer to if required, in order to keep people safe.
Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. The home did not have all associated risk assessments in place to identify and reduce risks. These risks involved when meeting people’s needs such as behaviours that challenge, and details of how the risks could be reduced. This meant that staff were unable to take immediate action to minimise or prevent harm to people based on specified guidelines.
People did not have individual personal emergency evacuation plan (PEEP) regarding necessary information to know about what to do in an emergency. We have made a recommendation about this.
The provider did not follow safe recruitment practice. Essential documentation was not available for all staff employed. Gaps in recruitment had not been explored to check staff suitability for their role.
All staff had completed National Vocational Qualification levels in health and social care. However, staff had not received training relevant to their roles such as dementia, Deprivation of Liberty Safeguards (DOLS) and challenging behaviour.
Staff were not supported through individual one to one supervision meetings and appraisals.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. However, they had not fully complied with its processes in meeting people’s needs. We have made a recommendation about this.
There were no evidence of menu planning with the involvement of people in the home. We have made a recommendation about this.
The complaints procedure was out of date and did not provide information about all of the external authorities people could talk to if they were unhappy about the service. There was no complaint log in the home. People told us they would speak to the manager if they wished to complain. We have made a recommendation about this.
Effective systems were not in place to enable the registered manager to assess, monitor and improve the quality and safety of the service or identify and manage all the risks to people’s safety. Shortfalls had not been identified by the registered manager and actions had not been taken in a timely manner to improve the quality of the service.
People’s support plans contained information about their personal preferences. The support plans were not person centred and were not on individual needs. People and those closest to them were not involved in regular reviews to ensure the support provided continued to meet their needs.
Staff encouraged people to undertake activities. However, activities were not diverse and varied to enable choices to people. They were not provided with sufficient, meaningful activities to promote their wellbeing. Staff spent time engaging people in conversations, and spoke to them politely and respectfully. We have made a recommendation about this.
Staff meetings and residents meetings did not take place in the home. People’s feedback was not sought and used to improve the care.
Safe medicines management processes were in place and people received their medicines as prescribed.
Staff were cheerful and patient in their approach and had a good rapport with people. The atmosphere in the home was generally calm and relaxed and there were lots of smiles and laughter.
The registered manager (Provider), manager and staff that we spoke with showed genuine concern for people’s wellbeing.
People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time.
During this inspection, we found some breaches of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.