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Inspection carried out on 5 December 2017

During a routine inspection

Mon Choisy is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Mon Choisy accommodates 22 people in one adapted building. At the time of the inspection there were 28 people living at the service.

When we last inspected the service on 30 November 2016 and 5 December 2016. We found that the provider was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have effective governance systems and procedures in place and had failed to identify some of the concerns we found during our inspection.

We also found the provider to be in breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014). This was because the provider had not reported important events that happen in the service to CQC. At this inspection we found that the provider had made significant improvements to address our concerns.

We saw evidence that arrangements were in place to formally assess, review and monitor the quality of care provided at the home. The registered manager was aware of their responsibilities and had reported appropriately to CQC about notifiable events.

There was a registered manager in post. 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 people were safe living at Mon Choisy. Staff demonstrated they understood how to keep people safe and we noted that risks to people's safety and well-being were managed through a risk management process. We observed people's needs were met in a timely way by sufficient numbers of skilled and experienced staff. People were supported by staff who had been trained in the Mental Capacity Act 2005 and applied it’s principles in their work.

The provider had a robust recruitment process in place which helped to ensure that staff employed were of good character and suited to the roles they were employed for. People's medicines were managed safely and kept under regular review. Infection control measures were in place to help reduce the risks of cross infection.

Staff told us, and records confirmed they had effective support. Staff received regular supervision

(one to one meetings with their manager) and yearly appraisals. People were supported appropriately to eat and drink sufficient amounts to help maintain their health and well-being. People's health care needs were taken care of and they had access to a range of healthcare professionals. Where required, appropriate referrals were made to external health professionals such as G.P’s or therapists.

People and their relatives were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Staff members, including the management team, were knowledgeable about individuals' care and support needs and preferences. Visitors

were welcomed at all times and people were supported to maintain family relationships.

The provider had systems in place to receive feedback from people who used the service, their relatives, and staff members about the service provided. People were encouraged and supported to raise any concerns with staff or management and were confident they would be listened to and things would be addressed.

There was an open and inclusive culture in the home and people, their relatives and staff felt they could approach the management team and were comfortable to speak with the registered manager if they had a concern.

Inspection carried out on 30 November 2016

During a routine inspection

This inspection took place on 30 November 2016 and 5 December 2016. It was an unannounced inspection.

Mon Choisey is registered to provide accommodation for up to 28 older people who require personal care. At the time of the inspection there were 21 people living at the service.

At the previous inspection on 19 October 2015 we found that people’s care plans did not always contain information guided by the principles of the Mental Capacity Act 2005 (MCA). This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

We also found that the registered manager had not taken reasonable steps to mitigate the risks to the health and safety of service users receiving care. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the home had made some improvements to address the areas of concern and start bringing the service up to the required standards.

The service 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.

The service had introduced mental capacity assessments for people who may be deemed as lacking capacity to make certain decisions. These capacity assessments included information that was guided by the principles of the MCA. However, staff did not always follow the principles of the MCA.

Appropriate contingency plans were not always actioned in the event of an untoward event that impacted on the service..

People received their medicine as prescribed. However, staff did not always follow the providers protocols when administered 'as and when required' medication.

Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks.

The registered manager had not always notified CQC of reportable events. Audits were conducted to monitor the quality of service. However, these audits were not always effective and did not identify the concerns we found.

There were sufficient staff to meet people’s needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People were confident they would be listened to and action would be taken if they raised a concern. People told us the service was responsive and well managed.

People received person centred care. People were cared for by a service that understood the importance of getting to know the people they supported. People had access to meaningful activities.

People told us they enjoyed the food provided by the home. Where people required special diets these were provided by a chef who clearly understood the dietary needs of the people they were catering for.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision.

We found two 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.

Inspection carried out on 19 October 2015

During a routine inspection

This inspection took place on 19 October 2015. It was an unannounced inspection. This was the first inspection of this service since a new provider had taken over the running of the service in June 2015.

Mon Choisey is registered to provide accommodation for up to 28 older people who require personal care. At the time of the inspection there were 22 people living at the service.

The service 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.

Staff had completed safeguarding training and understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. However, people were not always protected from avoidable harm. Thickeners for drinks were not always stored safely and areas of the home that presented risk were not secured properly and were accessible to people living at the home. There were enough staff to meet their needs, staff were not rushed in their duties and had time to chat with people.

People’s care plans did not always contain information guided by the principles of the Mental Capacity Act 2005 (MCA). Staff had completed training in relation to MCA but were not always able to understand the principles underpinning it. The adaption and decor of the service did not always meet people’s needs. We observed parts of the home where people were living with dementia were not decorated in a way that followed good practice guidance for helping people to be stimulated and orientated. Meals looked wholesome and appetising and people told us they enjoyed the food. People had regular access to other healthcare professionals.

Throughout our visit we saw people were treated in a caring and kind way and staff were friendly, polite and respectful when providing support to people. Relatives we spoke with were complimentary about the care that staff provided. Staff gave people the time to express their wishes and respected the decisions they made.

People were assessed and care plans were regularly reviewed and staff were knowledgeable about the people they supported. There were regular meetings for people where they were encouraged to comment on the service and information was shared. People knew how to make a complaint, at the time of our inspection all complaints had been logged and responded to.

There were a range of audits in place to monitor and improve the quality of the service. Where the audits had identified actions to be taken, these actions were then used to develop the service and make improvements. Staff, people and their families spoke highly of the management team. However, risks to people were still present.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we took and what action we told the provider to take at the back of the full version of the report.