28 August and 1 September 2015
During a routine inspection
This was an unannounced inspection that took place on 28 August 2015 and 1 September 2015.
The last inspection took place at Mont Calm Margate in December 2013 which found that staffing levels were suitable for the needs of the people using the service. In September 2013 we carried out an inspection and found that improvements were needed with regard to the environment, infection control and supporting staff.
The provider has been in receivership since January 2014 and the receivers have a management company acting as their agents and managing this service.
Mont Calm Margate is situated on the outskirts of Margate. Accommodation includes twenty five single rooms, five of which have en-suite facilities and three double bedrooms that people can choose to share. The service provides accommodation and personal care for up to 31 older people some of whom are also living with dementia or other mental health conditions including schizophrenia. At the time of our visit there were 30 people living at the service.
A new provider was in the process of purchasing the service and had applied to register with the Care Quality Commission (CQC) as the provider for this service. A registered manager was not working at the service. A manager was in day to day control and had applied for registration. A registered manager is a person who has registered with CQC to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The manager understood her responsibilities and accountabilities so people, their relatives and staff were confident in the way the service was managed. However, the manager lacked some knowledge in some areas, including the Mental Capacity Act (MCA) 2005, for example, and was aware that she needed to develop her skills She was keen to access further advice and support to help further develop the service.
The environment, fixtures and fittings had not been maintained in places and areas of the environment were not clean. Systems to keep the environment clean were in operation but were not robust. Health and safety audits were carried out.
Medicines were managed safely to ensure people received their prescribed medicines at the times they needed them. Creams prescribed to people were not always stored safely.
There were systems and processes to monitor the quality of the service. Regular audits and checks were carried out. Most of these were effective and addressed any shortfalls, although the infection control audit had not identified areas of the service that were not clean.
Staff understood the principles of the MCA, although these were not always followed. Some people’s assessments were not carried out in accordance with the MCA code of practice and some decisions were made on people’s behalf without ensuring this was in their best interest. However, when a person needed support to make a complex decision about their healthcare needs, appropriate support was obtained.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Applications had been made to the proper authorities to ensure that people were not deprived of their liberty unlawfully.
People were protected by safe recruitment procedures and appropriate checks were undertaken when new staff were employed to make sure they were suitable to work with people using the service. Staff received the training they needed to provide safe and effective care. People felt staff ‘knew what they were doing’. Staff were given support and supervision and told us they received the support they needed. There were sufficient numbers of suitably skilled and experienced staff on duty to meet people’s needs and ensure they received consistent care.
There were effective communication systems and staff shared appropriate information about the people they were caring for. Staff had up to date information about people’s needs. Risk assessments were centred on the needs of the individual person and gave staff clear guidance about how to reduce risks to people. Care plans contained individual detailed information about people’s likes, dislikes and preferences. The care plans took into account what people could and could not manage for themselves and detailed what support they needed from staff to remain safe and keep as independent as possible.
Staff were responsive to people’s needs and offered support in an unobtrusive manner and encouraged people to do things for themselves rather than take over. People told us staff helped them stay independent and that staff were ‘kind and caring’. Staff treated people with dignity and respect and listened to what people had to say.
Care staff supported people to do things they enjoyed and to take part in different activities. Outside entertainers, such as singers, visited the service. Plans were in place to expand the activities programme with the support of an activities coordinator. People’s religious and cultural needs were taken into account.
People received appropriate health care support and were referred to health care professionals if any concerns were identified. People’s weights were managed to ensure they stayed stable. People were offered and received a varied, healthy and balanced diet. Special diets were well catered for and people were supported discreetly by staff if they needed assistance at meal times. People told us they enjoyed the meals and staff knew about people’s likes and dislikes.
Although the complaints procedure was not easily accessible, people were supported to make a complaint or raise a concern. People and their relatives knew who they could speak to and any complaints were acted on and actions taken to address the concern.
There was an open and transparent culture where staff put people at the centre of the service. Staff told us, “Everything we do is about the people who live here” and “This is people’s homes and we are here to make sure it is a happy and safe home”. People and their relatives were given opportunities to say what they thought about the service. A relative said, “I am involved and included in decisions”. People told us they felt involved and staff listened to what they had to say.
People were protected from the risk of abuse. Staff knew how to keep people safe and who to report any concerns to. Staff felt able to have a say and raise any concerns if they felt they had to.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
We have made recommendations that further advice is sought to consider the layout of the environment to ensure it meets the needs of people living with dementia and the manager is supported to further develop her skills.