Montrose Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people’s needs were met through good organisation and delivery.

This service scored 68 (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 made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People received person‑centred care that reflected their individual needs, preferences and life histories. Staff took time to understand what mattered to each person and used this knowledge to shape daily routines, activities and approaches to support. Care plans were detailed and personalised, ensuring people were treated as individuals rather than as a set of tasks. This approach helped people feel valued, respected and in control of their care. The managers promoted a person-centred approach, and senior staff were assigned to complete monthly care reviews with people. The provider used a ‘Resident of the Day’ system and regular surveys to ensure people’s voices and treatment choices were regularly reviewed. Any changes in people’s needs were responded to and reflected in relevant electronic recording systems.

People and their relatives confirmed they were actively involved with decisions about the care and support which they received. Comments included, “They listen when I make suggestions, the staff in the office always take things onboard” and “I always feel listened to.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Comprehensive assessments were undertaken before people moved into the service and people’s needs were fully reviewed to ensure their suitability for admission to the service, and to facilitate a smooth transition from one service to the other. Staff worked closely with external professionals to maintain consistent support, share relevant information and ensure people experienced seamless transitions between services. Care plans were regularly reviewed and updated so that support remained aligned with people’s changing needs.

Care provision was well‑coordinated, and systems were in place to ensure continuity and integration across health and social care services. Staff made sure the multi-disciplinary team were involved when required. We reviewed records of people having regular input from other services; for example, speech and language therapy records were present and clear, there was input from the community mental health team, local GP surgery and frailty team. Staff worked hard to co-ordinate people’s appointments, making sure other professionals were aware of the person’s treatment and ongoing needs. Staff followed any guidance requested, and provided information and feedback to professionals when needed, such as the effect of medication changes.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider ensured people’s care plans and records captured ways that met their needs for meaningful communication and decision-making. This enabled people to be active participants in their care if this was their wish. The home was compliant in meeting the Accessible Information Standard, (AIS). Person centred care plans detailed people’s individual communication needs, such as language, sensory aids such as glasses or hearing aids, and any additional resources that staff might use to help with communication, for example pictures, large font prints or technology. One person who was registered blind, had access to technology provided by the Royal National Institute for Blind People such as digital loudspeakers to listen to the tele-guide, church studies and newspapers.

People were given clear, accessible information to help them understand their care, make informed choices and remain involved in decisions about their support. Staff took time to explain care interventions in a way that suited each person’s communication needs. Families and representatives were kept updated about changes in health, care plans and reviews, ensuring they felt informed and involved. Information about the service, daily routines and upcoming events was shared openly, helping people feel confident and included in the life of the home.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider had a policy and procedure in place that set out the steps someone would need to take if they had a complaint, and information on how to complain was available to people and their relatives. For people who could not verbally communicate or understand written documents, we found evidence there were appropriate advocates involved in their lives. Residents’ meetings were held regularly to support people to be actively involved in shaping the service.

People and their relatives we spoke to told us they knew how to but didn’t need to make an official complaint. However, they felt confident in the service taking appropriate actions should they raise a concern or complaint, which included looking into the issue thoroughly, communicating what was happening, being open about what had been found out and what the outcome was. The provider worked with people to agree solutions to concerns raised, and to measure the impact of the changes made. People, their relatives and others important to them confirmed they had meaningful involvement in service development and improvement through regular meetings and open communication. Relatives told us: “I have never complained but if I needed to, I’d go to the manager. I have confidence in the manager, when something needs doing, [they] do it” and “I have not needed to complain but I am absolutely sure I would be listened to. Any minor concerns I have raised so far have been listened to.”

All complaints received or concerns raised were used as opportunity to improve the service and the quality-of-care people received. Any lessons learned after a complaint had been shared with the whole team via handovers, staff team briefs, staff meeting and staff supervisions to ensure improvements made were embedded within the home.

The provider mostly made sure that people could access the care, support and treatment they needed when they needed it. However, leaders and staff were not always fully alert to discrimination and inequality that could disadvantage different groups of people in accessing their service.

Leaders and staff did not always consider how living environments can keep people safe from psychological harm as well as physical harm, for example in relation to sensory needs of people living with dementia. Reasonable adjustments were not always made to ensure people had equal access to the service. Adaptations made did not always meet equality-related needs of people with diagnosis of dementia who lived there and did not always support their independence and wellbeing. For example, the decoration, signage and orientation aids were minimal, and further improvements were needed to help people orientate in their environment independently and enable them to fully participate in the life of the home. The provider told us they were aware of this and intended to make the environment more dementia friendly, which was included in the provider’s service improvement plan.

People's care records demonstrated that when they required support and intervention of external health care professionals, this was provided. Staff escalated health or wellbeing matters and sought advice as needed. Referrals to external health professionals were made in a timely manner for further assessment. People received additional health support from a range of external clinicians such as speech and language therapists, dieticians, tissue viability nurses, community mental health team or occupational therapists. This demonstrated that people had access to the care they needed.

The registered manager told us they established a positive working relationship with the local doctor’s surgery. GP visits were requested for all newly admitted residents. The frailty team visited the home weekly to review any concerns escalated by staff and the team’s pharmacist provided support with regular medication reviews.

We received positive feedback from people and their relatives about access to health professionals when needed.

Staff and leaders mostly listened to information about people who are most likely to experience inequality in experience or outcomes. However, they did not always ensure people’s care, support and treatment was tailored in response to this.

Staff and leaders did not always demonstrate a full understanding of the people who use their service that were most likely to experience inequality in experience or outcomes and did not always take effective steps to minimise barriers to inclusion and positive experiences. When the barriers were identified, action to prevent or minimise the inequality in experience or outcomes for people was not always prioritised. For example, reasonable adjustments for people living with dementia to address potential or actual discrimination within the service were not made, despite the service undergoing major redecoration and refurbishment. We found people’s equality-related needs were not always considered when the premises were adapted or decorated. The physical environment was not decorated or adapted to a consistent standard to meet needs of people living with dementia. Premises and facilities were not designed in an accessible way to promote people’s independence and wellbeing. The provider had not followed good practice guidance to assess how each person living with dementia could orientate themselves in their surroundings. Contrasting colours had not been used and people did not have photos or personalised items in memory cabinets to easily identify which room was theirs. All bedrooms had only numbers on the doors. There was no clear signage with both words and pictures around the home to show directions. This meant people could not orientate in their environment independently and had to rely on staff assistance. The provider told us they had resources allocated to help improve equality of outcomes in the service and expressed their commitment to address the barriers people may face.

Training in equality and protected characteristics was available to all staff to help them understand equality and identify / address discrimination. However, when we visited staff compliance with this training was 73%, with 6 out of date and 2 out of 19 staff members had not completed the training. Staff did not always demonstrate full understanding of the potential discrimination and inequality people who use the service may face and how to meet people's equality-related needs.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People were supported to make decisions about their preferences for end of life care and to express their wishes around advanced care. People’s advanced decisions and what mattered to them at the end of their life was recorded within electronic care plans under ‘Death and Dying’ section. These included people’s religious beliefs, cultural and personal preferences. For example, 1 person expressed the wish to have classical music played in their room for comfort, have their family present at the end of life and a wish to be naked when leaving Montrose Care Home with no clothing or jewellery on their body.

The service worked well with external health and social care teams including palliative care specialists and others, to provide dignified and pain-free deaths that were as comfortable as possible and to ensure any palliative care preferences and wishes were implemented and fully respected. Specialist palliative equipment and medicines were consistently available at short notice. Staff had received training in palliative care and understood the importance of people’s needs being met. Staff we spoke with showed empathy and understanding of caring for people at the end of their lives. Staff extended compassionate support to people’s relatives and others important to them when their loved one passed away. A relative told us, “My [relative] passed away last summer in difficult circumstances and staff were very supportive of us as a family including [my loved one]”.