The Mount Residential Home

The Mount is a residential care home providing personal care and accommodation for up to 18 people some of whom may have Dementia. The service was supporting 15 people at the time of the inspection.

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

Systems to monitor the quality and safety of the home were either not in place or were not effective in identifying shortfalls. The providers governance systems had failed to identity the shortfalls we found during this inspection in relation to management of medicines, risks, and records to ensure staff had clear information on how to meet people’s need and preferences.

Risks to people were not consistently well managed and left people at potential risk of harm. Staff did not have clear information about known risks and how to manage and reduce these. Medicines were not always administered safely, and storage of cold medicines was not always monitored.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Some staff training was not up to date and not all staff followed safe practices when supporting people. People were not always consulted about the home to ensure their preferences were considered. Improvements were required within the environment as certain areas had an odour and needed redecoration.

People were supported by staff that understood how to protect people from abuse. People had access to routine healthcare checks to monitor their healthcare needs. Staff felt supported in their role. Systems were in place to support people to maintain contact with their loved ones. The manager was described as approachable, open and transparent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 29 March 2019).

Why we inspected

The inspection was prompted in part by a notification of an incident following which a person using the service sustained an injury and died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and falls management. This inspection examined those risks. We undertook a focused inspection to review the key questions of safe, effective and well led only.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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.

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

Enforcement

We have identified breaches in relation to the management of risk and medicines, consent and to the overall governance of the service.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Mount is a care home that provides nursing and personal care for older people, some of whom are living with dementia. At the time of the inspection, 14 people lived at the service. The home was established over two floors, with a range of communal areas included dining spaces, a large garden and smaller lounge spaces.

People’s experience of using this service:

People told us they felt safe and well looked after in the home and this was supported by the views of relatives. Staff knew and understood the risks to people and ensured that steps were taken to reduce the level of risk as much as possible.

People received their medication at the right time and there were sufficient staff on duty to keep people safe and ensure their needs were met.

Staff were recruited safely to ensure they were suitable to work in the home and were well trained and supported by the provider. People’s health needs were closely monitored and staff ensured people saw external health professionals when they needed to.

The provider was working in line with the principles of the Mental Capacity Act 2005 and people’s consent was obtained before care and support was delivered. Where people could not make decisions for themselves, the service ensured decisions were made in people’s best interests.

People were supported by caring staff who took time to get to know people and allowed people to maintain their independence. There was a clear complaints policy in place and people could choose whether to take part in the activities that were on offer.

Improvements were required to some audits and checks to make sure errors and gaps found at the inspection were identified. People and staff were happy with the way the service was led and managed and the registered manager led by example in offering warm and personalised care to people.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement (report published 24 November 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook this focused inspection on 09 October 2018 to check the provider had addressed our concerns and to confirm they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports’ link for The Mount Residential Home on our website at www.cqc.org.uk.

The Mount is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Mount accommodates 18 people in one adapted building. At the time of the inspection there were 12 people living at the home.

A registered manager was working at the home and had recently been appointed. 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 ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

People felt safe around staff that understood how to protect them from abuse. People and their families knew the staff supporting people and felt comfortable around them. Staff knew how to report concerns both within the home and to external organisations like the CQC if needed. The registered manager understood their responsibilities in reporting issues of concern.

Staff understood people’s identified risks of harm or injury. Risks were also detailed in care plans for staff to refer to. People were able to access support from staff people were familiar with when needed. Recruitment processes were robust, and all background checks were completed before staff commenced work at the home.

Staff understood the importance of reducing the risk of infection spreading and had access to protective clothing such as gloves, aprons and alcohol gels. Staff understood how to record accident and incidents which were passed to the registered manager for review and action as appropriate.

Since our last there had been a number of changes in the overall management of the service. The register provider was in the process of embedding new systems to monitor and review people’s care. A number of long standing staff had left, and this allowed the registered manager to start afresh and develop their own systems to drive forward improvement. The registered manager had also worked collaboratively with the local authority to ensure monitoring and recording of people’s care was accurate. The registered manager was also improving systems for reporting progress on developments within the home and to the registered provider.

The Mount accommodates 18 people in one adapted building.

A registered manager was working at the home but was absent as they had been suspended at the time of the inspection. 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.

Although relatives told us they felt their family members were safe, we could not be assured that practices within the home ensured all concerns were recorded and escalated appropriately. Practices within the home did not ensure the appropriate stakeholders were notified of accidents and incidents as these occurred. Learning from accidents and incidents was also not always shared that might reduce the risk of reoccurrence. Risks assessments whilst completed did not always contain all of the information necessary to care and support people in accordance with their needs. Recruitments process had not always been completely followed and there was a risk that staff recruited might not have been suitable for working at the home. People received support to take their medicines which were stored appropriately.

Changes in staffing and within the management team meant that staff did not always receive the correct level of supervision and training. People were involved in making decisions about their care and their consent was appropriately obtained by staff when caring for them. People who could not make decisions for themselves were supported to have a decision made about their care and support which was in their best interest. Staff understood the MCA but did not know which people had restrictions on their liberty in place. People accessed help from a number of different healthcare professionals and were supported to maintain a healthy lifestyle. People were offered choices in their meals and could make day to day decisions affecting their care.

People liked the staff supporting them. People needs were not always understood by staff. Care records were being updated to reflect people histories. People’s families were involved in planning their care where this was appropriate. People’s preferences for end of life care planning had not consistently been discussed and recorded although relatives felt comfortable speaking with staff and making their views known.

People’s choice of hobbies and interests were not always known and supported by staff that were occupied with day to day care tasks. People understood they could complain if they needed to and the process for doing so.

The registered manager had been at the home for a number of years and had been supported by staff who had also been there for some period of time. The registered manager had recently been absent from the home and a number of long standing care had left in recent weeks and this had caused anxiety and instability within the home. The registered provider had not always challenged practices within the home and had relied on the registered manager to guide them about the home and how it was ensuring people received appropriate care and that all practices within the home were based on best practice. The registered provider did not have systems in place to review the quality of people’s care. We found the registered provider did not have oversight of staffing, recruitment, notifications submitted to the CQC, training and supervision as well as quality assurance. They were unable to demonstrate how they assured themselves people receive high quality care that was monitored routinely because systems did not exist. The registered manager had not always worked in partnership with other stakeholders to ensure practices within the home appropriate especially with respect to reporting incidents that should have been reported.

You can see what actions we told the provider to take at the back of the full version of this report.

We carried out an unannounced comprehensive inspection of this service on 15 December 2016. At that inspection, we rated the service as ‘good’ overall with ‘requires improvement’ in the question ‘safe’ which related to some concerns regarding the administration of medication. After that inspection we received concerns in relation to staffing levels and induction for new staff, lack of access to information for staff regarding people’s care needs, unlawful restrictions on people living at the home and inappropriate manual handling techniques. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Mount Residential on our website at www.cqc.org.uk.

The service is registered to provide accommodation and personal care to a maximum of 18 older people who may have a diagnosis of dementia. At the time of this inspection, there were 17 people living at the home.

There was a registered manager. 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.

People were supported to take their medication but errors were found in the recording of medications which had not been identified in medication audits.

People felt safe in the home and were supported by staff who were aware of the risks to them and how to support them safely. Staff were provided with the information they required to support people safely and effectively.

Staff were provided with the information and tools required in order to ensure the correct manual handling guidelines were followed correctly.

A number of staff had recently left the service, but the majority of shifts were covered by existing staff with support from the registered manager. Efforts were being made to actively recruit new staff.

People were free to move around the home and their movements were not restricted. For those people who were being deprived of their liberty, applications had been made to the local authority. Staff obtained consent from people prior to supporting them and understood the importance of offering people choices.

New staff received an induction that provided them with the information and support they required and prepared them for their role.

The Mount Residential Home is registered to provide accommodation and personal care to a maximum of 18 older people who may have a diagnosis of Dementia. At the time of the inspection there were 18 people living at the home.

There was a registered manager in post who was present during the inspection. 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.

People were given their medications in a safe way but there were errors found in the recording of medications. People were supported by staff who knew how to identify abuse and manage risks to keep people safe. Staff were recruited safely and there were sufficient numbers of staff available to support people.

Staff received appropriate training and support to enable them to support people effectively. People’s rights had been upheld in line with Mental Capacity Act 2005. People were supported to have choices at mealtimes and access healthcare services where required.

People were supported by staff who were kind and treated them with dignity. People were supported to make their own choices and maintain their independence where possible. There were no restrictions on family visiting people.

People were involved in their care and staff knew their care needs well. There were activities available for people and the complaints procedure was clearly displayed should they wish to complain.

People and staff both spoke positively about the leadership at the home. There were systems in place to monitor the quality of the service. People were asked to feedback on their experience of the service. The provider had displayed their previous ratings and had returned their Provider Information Return (PIR) within the timescales given.

The Mount Residential Home is registered to provide accommodation for 18 older people with Dementia. At the time of our inspection, there were 17 people living at the home.

The home had a registered manager. 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.

People and their relatives told us they felt safe. Staff had a good understanding of how to protect people from abuse.

The registered manager analysed accidents and incidents and used this to make changes to the service where required to ensure that people were safe.

People told us, and we saw that, there were suitable amounts of staff on duty to meet people’s needs.

People were given their medication safely and as prescribed by their doctor.

Staff were given training and supervision to equip them with the skills and knowledge required to meet people’s needs.

Mental capacity assessments had not been completed to assess people’s capacity to make decisions. Staff were not aware of Deprivation of Liberty safeguards within the home.

People were given sufficient amounts of food and drink that met their dietary requirements.

People were supported to maintain their health and well-being by accessing a range of healthcare professionals.

Staff had a kind and caring approach and treated people with dignity.

People were not always involved in the planning and review of their care.

People were aware of how to make complaints and we saw that complaints made were investigated and resolved.

People spoke positively about the leadership at the home and felt the home was well-led.

Quality assurance audits were completed monthly by the registered manager but these were not always effective.