Montrose Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were consistently recorded, reviewed and scrutinised. The registered manager had oversight of recorded incidents to determine whether changes to people’s support needed to be made. When identified, lessons were learned, discussed and communicated widely to support improvement during regular one to one supervision and staff meetings. Staff understood their responsibilities to report any concerns. Staff felt supported, encouraged and confident to raise concerns and report incidents and near misses. Openness and transparency about safety were encouraged. Staff told us, “If I have any concerns, I can raise this with my managers or seniors” and “I have a lot of experience but in this environment, you are always learning.”

There was a service improvement plan which covered all aspects of the service. This meant management could monitor timescales for actions and ensure completion of improvements.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked with people and those close to them to establish their plan of care and comprehensive individual transition plans, prior to the person moving between services, to eliminate any risks and to ensure the person received continuity of care. Pre-assessment paperwork was always completed involving people, relatives and healthcare partners prior to people moving into the service and shared with staff. Assessments of needs were communicated with staff when people moved into the service or returned from a hospital stay via daily handovers.

The registered manager told us they always visit people at the hospital when they need hospital admission. They told us about a care home in the close neighbourhood which had been damaged by fire last year. Five people had been admitted to Montrose Care Home following this event. The registered manager told us, “I spent days with the manager of the home and met with the families to aid emergency admissions and ensured that the transition was smooth.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives confirmed they felt the service provided by Montrose Care Home was safe. Comments from relatives included, “[My loved one] is safe; it has never occurred to me that [they] aren’t. Staff are aware of any problems [my loved one] has; I have never had any worries” and “[My loved one] is very safe, happy and healthy. I see [my loved one] few times a week and when I can’t visit, I don’t worry.”

The provider established effective safeguarding systems, policies and procedures and managed safeguarding concerns promptly, using local safeguarding procedures whenever necessary. There was a consistent approach to safeguarding and matters were always dealt with in an open, transparent and objective way. Where required, investigations were thorough.

All staff had received safeguarding training and demonstrated a comprehensive awareness and understanding of their roles and responsibilities. Staff knew how to recognise the signs and symptoms of abuse and who they would report concerns to both internally and externally. They told us they felt confident the management would listen and act if they raised concerns.

The provider followed principles and requirements of the Mental Capacity Act (MCA) where people were deprived of their liberty, whether under the Deprivation of Liberty Safeguards (DoLS) or through an order by the Court of Protection. There was a clear understanding of DoLS, they were used appropriately, only when it was in the best interest of the person and with minimal restrictions. Where people had a DoLS in place, conditions to their authorisations were being met.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people’s health, safety and welfare were identified, for example, risks associated with people’s mobility, swallowing difficulties and malnutrition. These risks were assessed before they started to use the service and added to as needed. Risk assessments were created and maintained within the provider electronic recording system, updated regularly and as things changed. Relevant health and safety concerns were included in people’s care plans.

Staff told us they were given enough information about people’s risks and how to keep people safe when providing their care. Comments from staff included, “Care plans and risk assessments are up to date providing enough information to support residents and meet individual needs. For example, we have a detailed care plan in place that offers guidance on how to support a resident with hand contracture.”

People and their relatives felt involved in managing risks, and risk assessments were person-centred, proportionate and reviewed regularly. The majority of relatives including people’s legal representatives, told us they were, when appropriate, involved in creating and reviewing people’s care plans. Comments included, “They have a resident of the day every month. When it was [my loved one’s] day, they rang and asked if there was anything I wanted to discuss. They regularly review [their] care plan” and “I was involved in completing [my loved one’s] care plan and they tell me if there are any changes; they involve me.”

The provider embedded a proactive approach to anticipating and managing risks to people. People were enabled to take positive risks to maximise their control over care and support. They were also actively involved in managing their own risks along with their relatives, friends and others important to them. Restrictions were minimised so people felt safe but also had the most freedom possible – regardless of disability or other needs. The registered manager told us, “One of the residents insisted on attending medical appointments independently. We found that outcomes of their appointments were not always communicated to staff. A communication book has been put in place so that information is shared effectively between the healthcare professionals and staff. Same resident went to Devon in the summer with [their] friend who drove them there. We supported [their] independence and [they] took a train on the way back.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider took all possible action to assess and reduce the risk of injury caused by people’s living environment and liaised with other organisations to do so whenever needed. Effective arrangements were in place to monitor the safety and upkeep of the premises, bringing in professionally qualified people to complete the necessary environmental and equipment checks. The provider completed health and safety checks and risk assessments for risks such as legionella and moving and handling equipment. Fire checks and evacuation drills were completed and staff had training to ensure they had the skills to support people in an emergency. Staff were clear about their responsibilities regarding premises and equipment. We observed staff using equipment correctly to meet statutory requirements and support people to stay safe.

The environment permitted people to be able to move around freely, and communal areas were being used actively. The registered manager told us that redevelopment and upgrading of the environment was ongoing, including all bathrooms and people’s bedrooms. A new maintenance lead had been recently appointed. The registered manager acknowledged the challenges of refurbishing and updating the home but stated that areas for improvement had been identified and the provider was proactive in making changes.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People expressed they were happy with staff supporting them. People and most relatives felt there were sufficient staff on duty. They told us about high turnover of staff. Comments included, “The staff are great. There have been a lot of staff changes recently and they are good staff. The high turnover could be disconcerting for older people, but I expect it is the same everywhere. Staff I speak to are brilliant and feedback is excellent.”

The registered manager told us the home went through a period of instability following new ownership and departure of the previous manager. They told us, “The staff here are one of the best I've ever worked with. When I first started, we dealt with the conflict and performance plans were in place. They all left by themselves and staff are more settled now. The risks here is that the senior staff have been here a long time, if those left that would have been a problem.” Recruitment was still ongoing and vacancies had been covered by the regular agency staff.

There were enough competent staff on duty when we visited. Staff had the right mix of skills to make sure that practice was safe, and they were able to respond to unforeseen events. The service regularly reviewed staffing levels and adapted them to people’s changing needs. Staff told us there was enough staff on duty and they felt supported and received appropriate training and supervisions to enable them to fulfil their roles. Comments included, “I feel there is enough staff at Montrose, but I do feel like we rely on agency staff more frequently. I do also understand it's hard to recruit and finding that right person to fit the role.”

Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were protected as much as possible from the risk of infection because premises and equipment are kept clean and hygienic. They were supported to maintain their own personal hygiene in line with their needs and preferences.

The provider had a contingency policy in place should there be an outbreak of an infectious disease at the home. Infection prevention and control was at the core of the service and staff had received training with regular updates. Staff understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises and their own personal hygiene, including hand hygiene. Housekeeping staff told us they conducted daily cleaning schedules and checks to ensure processes were being followed and all areas were being cleaned. During the site visit we saw cleaning taking place. Cleaning records demonstrated what was being cleaned. We observed the service was clean and free from malodours.

Personal Protective Equipment (PPE) such as disposable gloves and aprons were available throughout the service. All staff were trained in infection prevention and control (IPC), and we observed them using personal protective equipment (PPE), such as gloves, masks and aprons, appropriately.

Managers at the service had oversight of IPC and carried out regular audits and checks of all aspects of infection control. The provider’s IPC policy was up to date. IPC procedures were robust, in line with the providers policy.

The provider mostly made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines records showed that they were not always given as prescribed for people. For example, we reviewed Medicines Administration Chart (MAR) for a person who had been prescribed a short course of antibiotics to treat an infection. Information on how to administer this medicine recorded by staff on the MAR did not include the prescriber’s instruction on the medicine’s label, which stated it should be administered on an empty stomach 1 hour before food or 2 hours after. Staff had been administering this medicine around mealtimes, which meant the treatment to clear the infection was less effective and the person was at an increased risk of health deterioration. We raised this with the provider, and they immediately contacted medical professionals for advice and planned extra training for staff to ensure specific instructions for medicines administration from the prescribers are always followed.

The provider had medicines management policy and procedure in place. However, staff did not always follow it and did not always keep complete and accurate records following application of topical preparations like creams, ointments and lotions. We reviewed Topical Medicines Application Record (TMAR) on the provider’s electronic recording system which contained multiple gaps in recording. This meant people could potentially miss topical medicines or receive multiple doses of medicines, both outcomes potentially causing harm. We raised this with the provider, and they took immediate action to rectify this. The registered manager told us they are implementing new electronic recording systems for administration of all medicines includingtopical preparation. We will review effectiveness and sustainability of the improvements made at our next inspection.

People’s wishes and preferences about how they like taking their medicines were clearly recorded in their care plans. We observed staff giving medicines safely and in a kind and caring way, taking time with people, and asking if any ‘when required’ medicines were needed. We observed people’s individual preferences for how they liked to take their medicines were respected by staff.

There were suitable arrangements for ordering, storage and disposal, including for medicines which needed cold storage and extra security. Bottles of eye drops and creams had dates on to show when they were opened and when they expired. This meant staff knew how long they could administer the medicines.

When medicines were prescribed to be taken ‘when required’, there were personalised protocols to guide staff when these might be needed. These included steps to take before resorting to the use of medicines. When these medicines were administered, staff recorded the reason why and the outcome. This meant it was easy for the nurses to monitor, ensure they were not being overused and could seek advice from people’s GP if needed.

Staff told us they had training, and competency checks to make sure they gave medicines safely. They were able to describe how medicines errors or incidents were recorded and followed up, and they knew the procedure to follow if people refused to take their prescribed medication. Medicines incidents or errors were reported and investigated.