Archived: Montagu Court Residential Home

Updated 21 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 14 and 15 April 2015 and was unannounced. The inspection team consisted of one inspector, a specialist professional advisor, whose specialism was in the care of older people and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We looked at previous inspection reports and notifications received by CQC. Notifications are information we receive from the service when a significant events happen, like a death or a serious injury. We spoke with the local authority case managers who had met with some of the people living at the service before our inspection.

During our inspection we spoke with all nine people, 1 person’s relatives, six staff and the registered provider. We looked at the care and support that people received. We looked at people’s bedrooms, with their permission; we looked at care records and associated risk assessments for four people who needed a lot of care and support. We observed medicines being administered and inspected nine medicine administration records (MAR). We looked at management records including six staff recruitment files, training and staff support records, health and safety checks for the building, and staff meeting minutes.

We last inspected Montagu Court Residential Home in November 2014. At this time we found that accidents and incidents were not analysed so patterns and trends were not picked up that may reduce further accidents and incidents from happening. Changes in people's needs were not always reflected in their care plans and risk assessments. The culture within the service was one of mistrust between the staff and the management team. Staff did not feel supported or listened to and felt undervalued by the provider. Staff did not receive regular one to one meetings and had not received appraisals. Audits of different aspects of the service had not always completed. We found the same issues and shortfalls at the inspection of 14 and 15 April 2015.

Updated 21 January 2016

This inspection was carried out on 14 and 15 April 2015 and was unannounced.

Montagu Court Residential Home provides accommodation for up to 30 people who need support with their personal care. The service provides support for older people and people living with dementia. The service is a large, converted property. Accommodation is arranged over four floors. A shaft lift and stair lifts are available to assist people to get to the upper floors. The service has 20 single bedrooms and five double rooms, which couples can choose to share. There were 9 people living at the service at the time of our inspection.

A registered manager had not been employed at the service since August 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the care and has the legal responsibility for meeting the requirements of the law. 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. As the provider is an individual he is not required to have a registered manager unless he is not going to be in day to day charge and manage the service.

We last inspected Montagu Court Residential Home in November 2014. At that inspection we found the provider had not taken action to meet regulations that they were not meeting at our inspections in December 2013, March and June 2014. The regulations breached related to the care and welfare of people who use services, supporting staff, and assessing and monitoring the quality of service. We are currently in the process of taking enforcement action against the provider.

The service lacked leadership and direction. The provider had been managing the service since the acting manager had left in January 2015. A nurse advisor had been employed as a consultant to support the provider and visited the service approximately once a week. The lack of leadership and oversight by the provider had impacted on all areas of the service. Staff were demotivated and did not feel supported by the provider. They lacked confidence in the provider to respond to concerns and issues and because of this they said that they no longer raised their concerns with the provider.

The provider did not operate a system to make sure there were enough staff available to meet peoples’ needs at all times. Staff did not have time to spend with people and people received little interaction from staff during the day. Cover for staff sickness and vacancies was provided by other staff members. Staff had taken on additional responsibilities for management tasks as they recognised that if not, the management tasks would not get completed and people would be left at risk. Senior staff had taken it on themselves to manage people’s medicines and people were receiving their medicines effectively. This had increased staff’s workload. Some staff told us they were tired because of the number of hours they were working each week.

Staff knew the possible signs of abuse; however they did not know how to report possible abuse. Guidance was not available to staff about how to respond to safeguarding concerns and possible abuse. Staff had struggled to obtain information about how to report a recent allegation of abuse.

Emergency plans, such as emergency evacuation plans were not detailed and specific about the support people needed to remain safe. Staff did not have the skills and experience to keep people safe in the event of a fire. Action had not been taken to minimise the risks to people from the building and equipment. Bath equipment and the garden both posed risks to people.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff were unaware of their responsibilities under Deprivation of Liberty Safeguards (DoLS). The provider did not have arrangements in place, as the managing authority, to check if people were at risk of being deprived of their liberty and apply for DoLS authorisations. Staff assumed that people were able to make decisions for themselves and supported them to do this.

Staff recruitment systems did not protect people from staff who were not safe to work in a care service. The provider had not obtained information about and checked staff’s previous employment. Disclosure and Barring Service (DBS), criminal records checks, had been completed.

Staff were not supported to provide quality good care. Staff had completed basic training but had not retained all of the information they had been given. Staff did not have opportunities to develop in their role, learn new skills and keep up to date with best practice. Staff did not have the opportunity to meet with a senior staff member of a regular basis to discuss their role and practice and any concerns they had. Staff were not clear about their responsibilities and were not sure who they were accountable to for the care they provided.

Changes in the care people needed had not been assessed and care had not been planned to keep them safe and well. This included changes in people’s mobility and the amount they ate and drank. Staff tried to meet people’s needs in the best way they could but there was a risk that the care was inconsistent and was not the best way to meet people’s needs.

People had choices about the food they ate but told us that they did not particularly like the food.

Food was prepared to meet some people’s specialist dietary needs but additional calories were not added to foods to support people at risk of losing weight. People had not always been referred to appropriate health care professionals when they lost weight.

People were offered choices in ways that they understood. Staff listened to people and responded appropriately to support them and reduced any anxiety they had. Most staff treated people with respect and maintained their privacy and dignity. People told us they felt that some staff did not like them.

People were not supported to continue with interests and hobbies they enjoyed. A programme of activities was on display but not all of the activities happened.

People and their relatives were not encouraged and supported to raise concerns and complaints about the service. Information about how to make a complaint was displayed; however, this was not written in a way that people could easily understand.

The provider was not aware of the shortfalls in the quality of the service we found at the inspection and did not understand the risks these posed to people. They described the shortfalls to us as ‘minor misdemeanours’. Systems were in place to check the safety of the building but not the quality of the care people received. The provider had not obtained information from people and staff about their experiences of the care.

Records were kept about the care people received and about the day to day running of the service. Some records were not accurate and did not provide staff with the information they needed to assess people’s needs and plan their care. Systems were not in place to make sure that records were retained securely and records could be located promptly when they were required.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action and cancelled the provider's registration.