Archived: Mont Calm Sandgate Road

Updated 5 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 9 and 11 December 2015 and was unannounced. The inspection was carried out by two inspectors.

This inspection was brought forward and undertaken as a result of concerns received by the Commission. Therefore the provider was not asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Prior to the inspection we reviewed information we held about the service. This was limited as the service had only been registered since 28 September 2015, but included notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

We spoke with one person who was able to tell us about their experience of living at the service, two relatives, the provider, the acting manager and seven members of staff and an agency staff member undertaking a shift at the service.

Most people were not able to tell us about living at Mont Calm Sandgate Road. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also carried out general observations of staff carrying out their duties, communicating and interacting with people to help us understand their experiences. We reviewed people’s records and a variety of documents. These included seven people’s care plans, risk assessments, medicine administration records, accident and incident records, daily reports made by staff, policies and procedures, staff meeting minutes, the staff rota’s and quality assurance surveys.

We contacted two social care professionals before and after the inspection that had had recent contact with the service and received their feedback.

Updated 5 February 2016

This was the first inspection of this service since it registered under Mont Calm Residential Care Home Limited on 28 September 2015. The inspection was undertaken on 9 and 11 December 2015, and was an unannounced inspection.

The service is registered to provide accommodation and personal care to 20 older people who may have dementia. The premises are a detached house situated on one of the main roads going in to Folkestone. The service has 18 bedrooms all of which have a wash hand basin and two have ensuite facilities. Bedrooms are spread over three floors and the first and second floors can be accessed by the use of a passenger lift. People had access to two assisted bathrooms and a dining room, lounge and conservatory. There is a street parking available nearby. Sixteen people were living at the service at the time of the inspection.

The registered manager had resigned prior to our inspection. However at the time of writing this report the Commission had not received an application to cancel their registration. 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. At the time of the inspection the day to day running of the service was being undertaken by an acting manager. The service lacked leadership and staff were unclear about their roles and responsibilities particularly in relation to safeguarding, the Mental Capacity Act 2005 and notifying outside agencies about events.

People received their medicines when they should. However we found shortfalls relating to medicine management. Some risks associated with people’s care and support had been assessed, but some risks still required assessing and more detailed guidance was needed to ensure people remained healthy and safe. There was no analysis or learning from accidents and incidents leaving a risk of further occurrences.

People benefited from living in a satisfactory environment although not all areas were cleaned to an adequate standard and some practices did not promote good hygiene. Some equipment had not received regular checks or servicing to ensure it was safe. The service needed to take advice from the fire safety officer and to check smoking legislation in relation to the building.

People did not have their needs met by sufficient numbers of staff. Staff rotas were not based on people’s needs or the environment in which people lived. Training records were not available to evidence that staff had appropriate training and knowledge to meet people’s needs. Staff had not had support and opportunities for one to one meetings with a manager, to enable them to carry out their duties effectively.

People were not always supported to maintain good health as referrals to health professionals were not made or were not made in a timely way.

Two people did not have a care plan and those in place were not personalised sufficiently to enable staff to deliver personalised care to meet people’s needs and in line with their wishes and preferences. They did not always detail people’s skills in relation to tasks and what support they required from staff, in order that their independence was maintained.

There were some institutionalised practices and people’s privacy and dignity was not fully respected. However staff were kind in their approach to people.

Menus did not reflect people’s likes and dislikes. We were unable to ascertain whether people had a varied diet, but there were examples of this not being the case. People had limited opportunities for interaction and activities.

People or visitors did not have access to an up to date complaints procedure. There were no effective systems for monitoring the quality of care provided or assessing and mitigating risks within the service. Records were not accurate or available during the inspection. Policies and procedures required review to ensure staff had clear guidance.

People were protected by safe recruitment procedures. The provider had already made some changes to staffs practices, which resulted in people receiving a choice about the time they wished to get up. Staff felt the provider was supportive and were confident that they would change things for the better. A staff meeting had identified that some shortfalls had already been identified prior to the inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.