Mountfield

Mountfield is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 46 people. Mountfield is a purpose-built care home specialising in support for people living with dementia. Accommodation is provided across two floors.

People’s experience of using this service and what we found

Improvements had been made to promote people’s safety and deliver good quality care. However further improvements were still needed in some areas.

The assessing of risks to people was more detailed so that staff could support people safely but some information in these records was contradictory. Security of the premises still required minor improvements. Infection prevention and control was much improved, and the premises were very clean. Medicines were managed safely but further changes could be made to ensure information for topical creams was clear for staff to follow. Staff had a good understanding of safeguarding and how to report concerns.

The manager had a plan in place to further develop the environment for people living with dementia to help people orientate around the home, promote independence and reduce confusion. Care records were much more comprehensive, but the information presented was at times contradictory and not always person centred in the way it was written. Staff training had improved which led to staff feeling confident in supporting people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service this practice.

Staff were kind and caring. They treated people with respect and promoted their independence. Relatives had reported recent improvements to the way they were involved in their loved one’s care.

Improvements to activities provided and interest areas were underway. We saw that people were stimulated to be involved in activities to promote independence, reduce social isolation and deliver enjoyment. Complaints were managed appropriately. Improvements needed to be made in collating and recording the wishes of people for care at the end of their life.

The new manager and management team had made good progress since the last inspection to improve the safety and quality of care delivered to people. Relatives we spoke to told us of recent improvements in communication. Where we identified further improvements were required, the manager had identified this and was developing a plan and timeline to implement these.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (Published 7 January 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 7 January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Mountfield is a residential care home providing personal care and accommodation to 21 people aged 65 and over at the time of the inspection. The service can support up to 46 people. Mountfield is a purpose-built care home specialising in support for people living with dementia. Accommodation is provided across two floors.

People’s experience of using this service and what we found

People had been put at risk of harm. Actions to assess and mitigate risks to people had not been taken, this included risks relating to people's care needs and the environment. Infection control risks had not been assessed and measures to reduce the risk of infection were not in place. This put people at an increased risk of infection. The premises were not being safely managed. Equipment and exits had not been adequately maintained or secured.

Full collaborative assessments of people’s needs had not taken place. People’s needs had not been thoroughly assessed and pre-admission processes were not robust. Staff did not always support people in line with best practice and guidance. This had contributed to a lack of person-centred care within the service. This included the care planning and support provided to meet individual needs, such as end of life care, cultural needs, and family contact.

Processes and systems in place did not promote a person-centred culture. Effective systems to ensure feedback was actively gathered and used to inform the evaluation and improvement of the service were not in place. Quality monitoring systems were in place but had failed to ensure standards of care and regulatory requirements were met. The registered manager did not have a good oversight of the service being provided and how people were being supported.

We have made two recommendations relating to systems and application of MCA and DoLS and the provider’s responsibilities under duty of candour.

Safeguarding systems had not always operated effectively to ensure safeguarding concerns were identified or reported. Reflective learning from incidents was not taking place and incidents were not being used to drive improvement. Whilst most areas of medicines were being managed safely we found improvements were required in the administration of topical medicines.

Training was provided to staff, however from concerns identified throughout the service it was clear that this learning was not fully embedded. Whilst systems were in place to monitor people’s nutrition and fluid intake these were not being used effectively to ensure people’s intake was sufficient.

Individual interactions between staff and people in the service were kind and caring, but this was compromised by interactions that had become system based and task driven. People were not fully involved or supported to express their views about their care.

A complaints system was in place but this was not always operated effectively to capture complaints and ensure these were investigated thoroughly.

Following our inspection visit the provider took responsive action to address the most immediate and concerning risks.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: This service reopened in January 2020 and this is the first ratings inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety relating to pressure area care and incidents. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by notification of a specific incident. Following which, a person using the service sustained a serious injury.

The information CQC received about the incident indicated concerns about the management of falls from height. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement: We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, the premises and equipment, person-centred care, and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe and did not have any concerns. The provider had a safeguarding policy and the staff we spoke with understood their responsibility to report any signs of abuse or suspected abuse.

The manager and deputy manager had been trained and understood their obligation to apply the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions. No person living in Mountfield had been assessed as needing this safeguard in place.

We saw evidence that staff had been provided with training in relation to mental capacity and safeguarding vulnerable adults. This meant that staff had been provided with the information they needed to help ensure people were safeguarded.

Medicines were stored correctly in locked cupboards and refrigerators as necessary. People's Medical Administration Records (MARs) contained all of the required information with no gaps in the records. The staff who administered the medicines had received the appropriate training and there was an effective procedure in place in case a medicine error occurred.

Systems were in place to help ensure staff learnt from incidents and accidents. We saw evidence that a full investigation was undertaken on each event along with actions to reduce the risk of a repeat occurrence.

All of the staff were up to date with their mandatory training. The service's training schedule highlighted when people's refresher training was due.

There were effective procedures in place to manage and mitigate foreseeable emergencies. During our inspection we observed the management of a person who had become unresponsive. We were assured that the management was appropriate and protected the welfare of the person concerned.

We saw evidence that the provider's audit schedule was effective. This included regular auditing of the quality of the service, staffing and health and safety.

Is the service effective?

We saw evidence that the care and support people received reflected their needs. Care and support was evidence-based and included nationally recognised screening tools. Plans of care and risk assessments were regularly reviewed and updated in order to reflect any changes in people's needs.

People who used the service were able to access suitable nutrition and hydration including special diets during meal times. All of the people we spoke with told us that the food was 'excellent' and they were supported to eat and drink appropriately. We observed that nutritional and fluid intake was monitored where appropriate.

We saw evidence that the provider had systems in place to help ensure competent staff. These included ensuring that all staff received a meaningful annual appraisal and were able to access training and education appropriate to their roles and responsibilities. We noted that all staff had received training in relation to dementia care. It was evident that this training was effective during our observation of staff caring for and supporting the people who used the service.

Is the service caring?

All of the people we spoke with who used the service and their relatives were satisfied with the care and compassion they received. One person said, 'All the staff are lovely and look after me well." One relative said, 'There are enough staff on duty to care for people. I feel the staff have the appropriate skills to care for people and I have never had any problems."

We observed staff caring for people in a caring, respectful and dignified manner. It was evident that staff understood the needs of the people who used the service and encouraged them to be involved in making decisions about their care and support.

People's care plans were person-centred and had been written with the person or their relatives as appropriate.

Is the service responsive?

We saw evidence that the care and support given to people responded to their individual needs. This included evidence that people's emotional needs were being met. There was detailed documentation in people's care plans regarding their interests, preferences and situations that could cause distress. We observed staff interacting with people in a positive manner and noted that the support given met their emotional needs. There was a 'reminiscing' room that contained activities and items that were suitable and engaging for people with dementia.

The environment of Mountfield was designed to help meet the needs of people living with dementia. This included extensive, secure gardens along with numerous communal areas that allowed people to choose where they wished to sit during the day. One area was considered the 'quiet lounge' for people to relax or read. Other communal areas had chairs arranged in groups to encourage socialising.

There was information available to people who used their service and their relatives that explained how to make a complaint. The manager explained the complaints' procedure to us and we saw evidence that the provider took account of complaints and comments to improve the service.

Is the service well-led?

All of the relatives, staff and visiting general practitioner (GP) spoke positively about the registered manager. The GP said, 'I have no concerns about this home. Everyone is safe and you don't hear people shouting out in distress. The staff and the manager are excellent and people are well cared for."

It was evident during our inspection that both the manager and deputy manager were knowledgeable about each person who used the service. We observed positive interaction between the managers and the staff, and between the mangers and the people living in Mountfield.

We observed a positive culture within the service, and the staff we spoke with told us how much they enjoyed working at Mountfield. One staff member said, 'I am very happy working in the home and feel very well supported." It was evident that there was effective team working and that there was a balanced culture of reasonable blame and accountability.

The manager told us that they were supported to try new ways of working to improve the effectiveness and efficiency of the service. This included the design and implementation of the medication rooms. These were air conditioned to maintain the correct temperature at which medicines should be stored, and there were individual cupboards for people's medicines to ensure the safe administration of medicines at the correct time, as prescribed.

The service had quality assurance systems in place to assess and monitor the quality of the service people received. We noted that there were action plans in place to address any identified shortfalls in the standard and quality of service provision.

Staff gave support to people in ways which encouraged their independence. We saw care plans which were individualised and included people's life histories. We saw people engaging with staff and each other. People told us that they were happy living in Mountfield and family members said that they were pleased with the care. This showed us that care was personalised and that people received care that helped them to be active and to enjoy their time.

The provider had up to date policies in place to minimise the risk of abuse. Staff received regular training on safeguarding and understood what they should do if they witnessed a possible safeguarding incident.

On the day of our inspection the home was staffed with sufficient, appropriately skilled staff. We saw that every new staff member was given an induction programme. We also noted that staff were regularly assessed on their skills, for example in giving medications.

The provider's complaints policy was current and clearly laid out the steps people needed to take should they wish to make a complaint. Family members we spoke with told us that they felt confident that they could raise concerns directly with the manager if necessary. One person told us "We've nothing to complain about."