Archived: Montagu Court Residential Home

There were 11 people using the service at the time of the inspection. Some of the people living in the service were unable to tell us about their experiences. We observed interactions between people and the staff.

The service had a manager in post; they were not yet registered with the Care Quality Commission (CQC). They were in the process of applying for 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.

We are currently taking enforcement action against the provider.

Throughout the inspection we set out to answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them, the provider, the manager and a consultant who had been employed by the service to support the manager in making improvements.

Is the service safe?

The service was safe. Recruitment processes were safe. There were procedures in place to make sure all staff employed by the service had undergone thorough safety checks before they started working at the home.

The environment at the service continued to improve and work was on-going. Regular safety checks were carried out so that the service was safe for people to live in. There were emergency plans in place for each person to make sure staff took the appropriate action in the event of a fire.

People's care needs and the skills and qualifications of the staff were taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service.

Staff knew how to raise concerns and complaints to out-side agencies like the local safeguarding team or the CQC.

Is the service effective?

The service was not fully effective. Accidents and incidents were not analysed so patterns and trends were not picked up that may reduce further accidents and incidents from happening.

When a person had specific physical or health care needs, the staff contacted healthcare professionals from outside the service and made sure that appropriate support and treatment was made available.

Staff received training to support people's individual needs. Staff were aware of the personal care and support that each person needed.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People told us the staff were polite and caring.

People got on well with staff. They were at ease with them. Staff took the time talk with people and explain the support they were going to give. Staff involved people with their care and encouraged them to be as independent as possible.

Is the service responsive?

The service was not responsive to all people's needs. The provider had not taken action to ensure each person's care was safe and met all their needs. Changes in people's needs were not always reflected in their care plans and risk assessments.

If people had any concerns they approached the staff and they were listened to.

People's preferences, likes and dislikes were taken into consideration in all aspects of their care.

Is the service well led?

The service was not well lead. The culture within the service was one of mistrust between the staff and the management team. Staff did not feel supported or listened to.

Staff told us that they felt undervalued by the manager and the provider. Staff did not receive regular one to one meetings with the manager and had not received appraisals.

There were systems in place to audit different aspects of the service, but some of these were not always completed. Audits of the care plans and other systems used at the service had been not been completed to assess the quality of the care being provided. The service had not identified that there were shortfalls in the care planning and risk assessments.

On the first two days we spent time talking to staff, people using the service, their relatives and observing the interactions and practices in the home. We also had discussions with the provider, the acting manager and looked at some of the care records. We also had information from health and social care professionals who had visited the service recently.

Throughout the inspection we set out to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them, relatives, the provider, the acting manager and health and social care professionals.

Is the service safe?

The service is not safe.

When people had accidents the most appropriate and safe action was not taken by staff to make sure they received the treatment they needed.

One relative said, 'All I can say is that it is adequate here'. When I am visiting I make sure my relative gets what they need but I don't know what happens if I am not here'.

Assessments had not been undertaken to make sure people receive safe care. One person had bedrails on their bed. There was nothing in their care plan about this. There was no evidence in place to show how and why the decision to have bedrails had been made. There was no risk assessment to give staff guidance on how to use the bedrails safely. There was no consent or agreement to their use.

The environment at the service had improved and work was on-going. Regular safety checks were carried out so that the service was safe for people to live in.

Recruitment processes were not safe. This was because there were not robust procedures in place. Not all staff employed by the service had undergone thorough safety checks before they started working at the home.

People's care needs and the qualifications, skills and experience of the staff were not taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service. This meant that people could not be sure their needs would be met by experienced qualified staff.

Systems were in not in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that people were at risk of receiving unsafe care and support. The service did not learn lessons from previous identified shortfalls and had not improved.

Is the service effective?

The service is not effective.

The provider had not taken action to ensure each person's care was safe and met their needs. Care was not consistently planned and delivered in response to people's changing needs.

People's care and welfare needs were not being fully met. This meant that they were at risk of not receiving the treatment, care and support they required to remain safe and as healthy as possible. When people were prescribed supplement drinks to help them maintain weight they had not received these. When people had conditions like diabetes there was inaccurate and incorrect guidance in place. This placed people at potential risk of harm.

Some staff did not have the knowledge, skills and competencies to carry out their role effectively and safely.

Is the service caring?

The service was caring.

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and said that staff were polite and caring.

A relative told us, 'My relative is always up, clean and well dressed. They make an effort to make sure their clothes match'.

Another relative said, 'The carers here are excellent. They are caring. My relative is always well looked after and I visit the home a lot'.

Is the service responsive?

The service was not always responsive to the needs of people.

We were told by staff and some visitors that the provider of the service was not approachable. If people voiced their concerns or ideas they felt that they were not listened to. They felt they were powerless to promote changes at the service.

People, relatives and staff told us that there were not enough staff available to meet their needs and we found that people's needs were not always met in a consistent or timely way. We found that many of the staff did not have the skills, experience and qualifications to meet people's needs and the provider had not taken action to support staff to develop their skills.

Staff said, 'We haven't got time we would like to spend with people. It's 'get a task done' and then move on to the next thing'. During the inspections we observed that staff spent as much time as they could with people. They chatted to them while doing other things and involved them in what was happening at the service. However, staff appeared rushed.

When staff rang in sick or there were unexpected emergencies there were no robust systems in place to make sure there were enough staff available to give people the care and support that they needed. There were no procedures for staff to ensure that staff shortfalls were covered.

People and their relatives told us that they sometimes had to wait for care and support. One relative told us, 'Staff are often stopped in the middle of doing something to go and do something else. People are sometimes left waiting to use the bathroom or staff have to stop giving them a drink'.

Is the service well led?

The service was not well led

Some systems for quality assurance processes were in place; however they did not have an impact on improving the service and the outcomes for the people living at the service. Staff told us they were unclear about their roles and responsibilities and that they felt they did not have the support they needed from the management team.

Audits of the care plans and other systems used at the service had been not been completed to assess the quality of the care being provided. The service had not identified the shortfalls in the care plans found at the inspection. Therefore the systems in place to audit the care plans and risk assessments was not effective to make sure people were receiving the care they needed.

The senior management team knew about many of the shortfalls at the service but no action was taken to address these. They did not take responsibility for things that happened in the service and did not implement changes to address the shortfalls and concerns.

We found that people's privacy, dignity and independence were not always respected. People were not always treated with compassion and consideration.

Although people's needs were assessed and some care plans had been updated, care was not always given to people in the way they preferred. Personal care needs were not always recorded and people were not getting the personal care they needed. There were no bathrooms available for people to use and the showers were not suitable for most people's needs. On the last day of the inspection one bathroom had been repaired and was operational. This was the only available bathroom for 20 people using the service to use.

The environment was not well maintained and not only posed a risk to people's health and safety but compromised their well-being and dignity.

People's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care. There was a lack of monitoring and auditing of systems and of staff practice. When issues had been identified, for example, necessary repairs to the environment, little or no action had been taken.

Staff said, 'We are a really good team but we find it frustrating that we have not got what we need- soap, towels, sheets etc.'

One person said, 'The staff are alright. They have a lot to do.'

Staff had attended training but their competencies had not been checked. There was a lack of induction and recruitment checks of new staff.

Activities were very limited as was community involvement and access. Visitors told us, 'There is not much to do here, not much going on' and 'Look at the plants, they are dead. It needs painting and there are no pictures up, it's a bit dismal.'

When we asked people using the service if they had enough to do one person told us, 'On and off, but no not really' another person said, 'There is nothing to do.'

Some people and their relatives told us that they thought they received the care and support they needed to remain well and healthy. However, we found that although people's needs were assessed, care and treatment was not always planned and delivered in line with their individual care plan. Some care plans had not been updated and completed when a care need or a risk was evident. This meant that staff had no guidance to follow about how to support people's needs and reduce potential risks.

Staff did not always receive the support and supervision they needed to undertake their roles effectively and safely.

We found that people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not up to date.

People who used the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way. Some people and their relatives told us that they liked the home and the staff were polite, respectful and caring. They said they were satisfied with the service. One relative said, 'Mum can't speak but I know she is happy here and they are all very kind to her'.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

People received their medicines safely and when they needed them. We saw that staff asked them if they were comfortable or needed anything for pain.

The views of the people who used the service were listened to and acted on. People told us they did not have any complaints but would not hesitate to speak to the manager or staff if they had any concerns and they would be listened to.

We found that people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not up to date or could not be located.