Archived: The Mount Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of 2 legal regulations in relation to meeting people’s nutrition and hydration needs and gaining people’s consent.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective. They did not check and discuss people’s health, care, wellbeing and communication needs with them.

The provider failed to review people's care plans to ensure these continued to reflect their current needs. For example, when people had fallen their care plans had not always been updated to reflect this and what actions were put in place to reduce the risks. Care plans did not always accurately reflect some people’s dietary requirements to ensure staff had access to updated and consistent guidance on how to meet people’s needs.

The provider did not always ensure when reviews of people’s care were undertaken this was done in consultation with people and their representatives. Records showed monthly reviews were undertaken but this was completed by staff and did not reflect people had been involved. A relative told us, “The staff do usually tell us about changes in [person] care, but we have never seen a care plan or been asked to discuss their care plan”.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The provider failed to ensure people’s support plans included all their needs, including health, personal care, emotional support, social interests, and activities and cultural, religious, and spiritual needs. People's needs were not always assessed, and care and support were not always delivered in line with current standards. The provider failed to ensure people were consistently involved in their care planning and the information recorded was accurate.

For people who required enhanced monitoring or support with repositioning in relation to their skin integrity and hourly safety checks, there was a lack of evidence this had been consistently provided. For people whose fluids were being monitored due to being at risk of dehydration, there was a lack of evidence to demonstrate their fluid targets were being met or monitored. The provider failed to carry out checks or monitor the completion of these records to ensure people's care and support achieved effective outcomes.

Where people were assessed as requiring specialised diets, we found these needs were not suitably met. The choice of meals, pudding and snacks on offer were very limited and did not meet individual needs and known food preferences. We found some people declined their meals or were asleep during mealtimes, and alternative choices were not always made available. This was a concern for people who were losing weight and required food supplements due to the risk of malnutrition. Two people were observed to be given food which was not in line with their assessed needs which placed them at risk of choking.

Where people were unable to make verbal choices regarding their mealtime choice, pictorial menus were not in place nor were they visually shown the options to give them the opportunity to choose at mealtimes. This meant people unable to communicate their preferences were not given the same options as those who were.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The lack of effective leadership and accurate records meant information was not always shared with other services and health professionals in a timely way. Where incidents had occurred, this information had not always been shared with partner agencies to share known risks. For example, when people had fallen, or where people were declining personal care and food, and were at risk of self-neglect.

Feedback from partner agencies confirmed communication could be improved to enable them to support the home more effectively to manage individual risks. We found regular support was provided by people’s GP practice and weekly contact was maintained to enable staff to discuss any medical concerns. However, records were not always completed of the discussions held and the outcomes.

Staff told us and records confirmed a handover was completed before staff started their shift. These did include some key information about people’s needs and any concerns staff had about people. For example, where people may not have eaten or drank much.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

The provider had not ensured care records and risk assessments were reflective of the support people required with their health needs. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing. For example, where assessments had been completed and recommendations shared about people’s dietary and nutritional needs, this information was not always available and had not been accurately updated on people’s electronic records. This meant staff were not consistently supporting people in accordance with these placing people at risk of harm.

Records were not always available to support people had access to and received regular routine health checks such as chiropodist and dentist. Due to the lack of records, the new manager had arranged for a chiropodist to visit, and they came during our assessment. The new manager advised the records had been changed over from paper to electronic records and some information had not been added to the new system. Paper records of such visits could not always be located to confirm who had received check-ups.

Records demonstrated staff had either not received training or refresher training to support people with their specific health conditions, such as diabetes, strokes, heart failure and supporting people with suicidal expressions or distressed behaviours. This meant staff were not always equipped with the skills to support people to manage their health and wellbeing.

The provider did not routinely monitor people’s care and treatment to continuously improve. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider failed to ensure systems to review people’s care were effective to improve outcomes for people. For example, action and learning was not always implemented when people had fallen. Monitoring of people’s skin integrity, fluid and food fluid intake was not effective. Records of people’s needs were not always updated in response to changes in their needs. This meant there were missed opportunities to monitor risks and improve outcomes for people.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The provider was not consistently working within the principles of the Mental Capacity Act 2005 (MCA) and people’s rights under the MCA were not always protected. We identified shortfalls in this area on our last assessment and the provider had not made the required improvements. Some people had equipment monitoring their movements installed for their safety. However, a capacity assessment had not been completed to assess if they could consent to this. Where people lacked capacity, best interests meeting with their representative had not always been undertaken.

Some people had Deprivation of Liberty Safeguards (DoLS) authorisations in place. However, we found for 3 people these had expired, and a reassessment had not been requested. Some people were being deprived of their liberty and a DoLS application had not been applied for. This meant some people were being unlawfully deprived of their liberty. Action was taken to address this when we brought this to the provider’s attention.

Staff did not always support people in a manner that respected and promoted their rights. We observed occasions where some people stood up to walk out of the communal lounge who were asked by staff where they were going and asked to sit back down.

The training records showed staff had either not completed training in relation to consent, MCA and DoLS or they needed refresher training. However, staff we spoke with could tell us what this legislation and the associated principles meant for people using the service.

People told us their consent was obtained before staff provided support. One person said, “The staff do always ask before they support me, they are good like that.” A relative told us, “They always ask [person] if they can do something. They always get consent”.