Archived: Mountwood

Mountwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mountwood accommodates 39 people in one adapted building. There were 29 people living at the home at the time of our inspection.

The service did not have 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. A condition of registration is for the service to have a registered manager. The service has not had a registered manager in post since November 2017 and therefore we have applied a ratings limiter to the Well Led section of this report.

We last inspected this service on 27 and 28 March 2017 and found the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a requirement notice in respect of the breach. Following our inspection the provider sent us an action plan on 30 June 2017 to tell us about the actions they were going to take to meet these regulations.

During this inspection, we found that sufficient action had been taken to meet the requirements of the regulation the service had breached at the inspection in March 2017 however we identified a further two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had failed to ensure they had deployed sufficient numbers of staff to ensure people were safe and their care needs met.

The provider had failed to ensure that staff had received supervision or appraisal as is necessary to enable them to carry out the duties they are employed to perform.

People received their medicines safely, accurately, and in accordance with the prescriber’s instructions. Medicines were stored safely.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment. Staff understood their responsibility to safeguard people and the action to take if they were concerned about a person's safety.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People had access to and were supported with their healthcare needs, including receiving attention from GPs and routine healthcare checks.

People were comfortable and relaxed in the company of the staff supporting them.

Staff treated people with dignity, respect and kindness.

People were supported to maintain relationships with their friends and relatives.

We have made two recommendations to the provider in the responsive section of this report. The service seek to ensure people are not at risk from social isolation and recognise the importance of ensuring activities promote social contact and companionship. People with a disability or sensory loss are given information in a way they can understand.

We identified 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 the report.

Mountwood is a two storey building situated with its own secure garden situated on the outskirts of the town of Andover. The home comprises of 40 single rooms, 36 of which have ensuite facilities comprising of a sink and toilet. Access to the first floor is by a passenger lift and main staircases are accessible via user operated keypads. On the ground floor is a communal lounge with a separate activities room/lounge area, the home’s kitchen and a dining room as well as laundry facilities and a nurse’s station. On the first floor there is a joint lounge and dining area with tea making facilities available in a small kitchenette, a further nurse’s station and medicines room. To the front of the property is a secure garden area with raised flower beds, seating and bird tables to provide interest for people living and visiting the home.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 our previous inspection we found the provider had breached two regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). The provider had not maintained complete, accurate and contemporaneous records relating to people’s care, a breach of Regulation 17. The provider had also not ensured people who did not have capacity to agree to their care were appropriately assessed with any actions taken documented as being in their best interests, a breach of Regulation 11. The provider was served with a warning notice in relation to good governance which they were required to meet by 28 February 2017. We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we reviewed whether or not these actions had been taken and if the provider was now meeting the requirements of the HSCA 2014.

We found improvements had been made regarding both breaches, however, a continuing breach of Regulation 17 remained regarding the complete, accurate and contemporaneous completion of documentation. More time was also required to ensure the steps in place to appropriately assess people who were not able to make decisions regarding their care were integral in the home’s care delivery and assessment process.

We also made a recommendation at our previous inspection that the provider seek advice regarding environmental design which can support those living with dementia to mobilise independently. At this inspection we could see that appropriate signage was in place to allow people to orientate themselves independently around the home. Another recommendation made was for the provider to seek additional dementia friendly activities which would allow people living with dementia the opportunity to participate fully in meaningful interaction. At this inspection we saw that action was being taken to include people in more homely type activities such as housework tasks and this work was on-going to ensure people lived interesting and fulfilled lives.

At this inspection it was not always clear that people were receiving care which met their needs. Some people living at the home required regular repositioning in their beds to ensure their risk of acquiring a pressure ulcer were minimised. However, records relating to this aspect of care were not completed accurately which meant it was not always clear whether people were receiving the most appropriate care they required to maintain their health and wellbeing. Whilst improvements in care documentation had been made, more time was needed to ensure the newly employed nurses, who would be responsible for overseeing the completion of this documentation were inducted, settled and effective in their role.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People were supported by sufficient numbers of staff. When required the provider sought regularly used agency staff to support staff working at the home to ensure people received care from staff familiar with their needs.

People were supported by staff who had been through a detailed recruitment procedure to ensure they were suitable to deliver care. Staff had also received an effective induction into care delivery whist working at Mountwood. Staff were in receipt of regular training, received structured supervisions and told us they were able to express concerns at any time with the registered manager and felt supported as a result.

People were supported to receive their medicines as prescribed. Guidance had been provided to staff including agency nurses regarding the appropriate administration of medicines in a way other than prescribed, such as in the covert administration of medicines for example. Nurses responsible for administering medicines were subject to regular training to ensure they remained competent and safe to complete this role. Medicines were managed, stored and disposed of safely.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding.

People’s care plans and documentation was subject to regular review to ensure they remained accurate and provided staff with the most up to date information regarding the care people required.

People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these and the food was pleasantly presented.

The staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

People were appropriately assessed and supported when it was identified they no longer had the ability to consent to a course of care and treatment. We saw the requirements of the Mental Capacity Act 2005 (MCA) were followed appropriately. The Care Quality Commission (CQC) also monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications were accompanied by the appropriately completed MCA and best interest decision documentation.

Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

People told us they knew how to complain and all said they would speak with the registered manager and senior staff if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during participation in the completion of annual survey questionnaires and providing feedback to an independent survey company.

The registered manager and staff promoted a culture which focused on providing people with highly individualised care which met their needs. The provider’s values were displayed within the home but were not immediately known by staff. However, staff were able to describe how the registered manager wanted people to treat residents and they demonstrated they knew these standards. We could see these values were evidenced in the way care was delivered.

The registered manager had fulfilled the requirements of their role as they had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

We found a continuing breach of Regulation 17 of the HSCA and you can see what action we told the provider to take at the end of the full version of this report.

We told the provider they needed to take action and we received a report setting out the actions they would take to meet the regulations. At this inspection we reviewed whether or not these actions had been taken and the provider was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding two of the breaches identified concerning staff training and food allergies. However we found one continuing breach regarding the complete, accurate and contemporaneous completion of documentation and a new breach with regards to meeting the requirements of the Mental Capacity Act 2015 (MCA). We have also made two recommendations regarding the design of the environment and activities provided for those people living with dementia.

Mountwood is a home which provides nursing and residential care for up to 39 people who have a range of needs, including those living with dementia, epilepsy and the detrimental effects on people’s physical health following a stroke. At the time of our inspection 33 people were living in the home.

Mountwood is a two storey building with its own secure garden situated on the outskirts of the town of Andover. The home comprises of 40 single rooms, 36 of which have en-suite facilities. Access to the first floor is by a passenger lift and main staircases are accessible via user operated keypads. On the ground floor is a communal lounge with a separate activities room/lounge area, the home’s kitchen and a dining room as well as laundry facilities and a nurse’s station. On the first floor there is a joint lounge and dining area with tea making facilities available in a small kitchenette and a further nurses station. To the front of the property is a newly secured garden area with raised flower beds, seating and bird tables to provide interest for people living in and visiting the home.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. 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 home is run.

People were assisted to receive their medicines as prescribed. However people’s records in relation to these medicines were not accurately and fully completed which meant it could not be identified if people were receiving the care they required in order to keep them safe and manage their pain.

People were not always supported by sufficient numbers of staff. The provider was regularly using agency staff to support staff working at the home and had taken action to increase the number of staff employed. People were receiving the care they required however would sometimes have to wait to receive care. Records regarding the care people received were also not completed fully as a result of these staffing shortfalls.

People were supported by staff to make their own decisions regarding the day to day care they received. However documentation did not always show that people’s decisions regarding their care had been appropriately assessed and documented prior to care being delivered in accordance with the requirements of the MCA We could not always see that assessments and appropriate decision specific best interests meetings had been held before a course of care was delivered.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted. However these had not always been accompanied with the required appropriate MCA assessment and best interest decision documentation.

People’s care plans and documentation were not always subject to regular monthly review. Whilst appropriate risk assessments were in place for most people we could not always see that staff had been provided with the most up to date information regarding people’s care. Agency staff responsible for administering medicines did not always have the most accurate information available allowing them to support them in their role. People were at risk of not receiving the care they required to meet their needs and wants.

The registered manager was supported by a clinical lead who was responsible for overseeing the completion of documents and records specifically relating to peoples care. We could not always see the registered manager had been supported by the provider and the clinical lead to ensure that records were effectively and accurately completed for people living in the home. Quality assurance processes were also not always completed effectively. Processes did not always identify where information relating to people’s care was inaccurate or missing allowing appropriate action to be taken to ensure people received the care they required to meet their specific needs.

Staff provided care to those living with dementia, however, the environment did not always support people to move around the home safely and to remain independent. Corridors were well lit however flooring was not always appropriate to support those with limited eyesight. Continual changes in type and colour of flooring would not assist those with limited vision as a result of their condition to be able to move effectively around the home. Appropriate signage in communal areas was not always in place allowing people to orientate themselves independently around the home.

We have made a recommendation about having an appropriate environmental design to support those living with dementia to mobilise independently.

The provider sought to engage people in activities however we could not see that all the activities provided supported those living with dementia to fully participate in familiar and recognisable tasks.

We have made a recommendation about having additional activities to enable people living with dementia to participate fully.

Relatives of people living at the home told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People were supported by staff who had been through a thorough recruitment procedure to ensure they were suitable to deliver care. Staff had received an effective induction into care delivery. All new care staff were required to complete initial induction training and accompany experienced members of staff whilst they completed their role to see what was required of them. Regular supervisions were not always being completed in line with the provider’s guidance. However staff told us they were able to express concerns at any time with the registered manager and their colleagues and felt supported as a result.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding.

People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed or diabetic diet, received these and the food was pleasantly presented.

The staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

People told us they knew how to complain and all said they would speak with the registered manager and senior staff if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during participations in the completion of annual survey questionnaires and providing feedback to an independent survey company.

The provider’s mission statement regarding the quality of the care people were to receive whilst living at Mountwood were openly displayed within the home but were not immediately known by staff. However staff were able to describe how the registered manager wanted them to treat residents and they demonstrated they knew these standards of providing care which was respectful of people’s dignity. We could see these standards were evidenced in the way care was delivered.

The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to receive care themselves. The registered manager had fulfilled the requirements of their role as they had informed the CQC of notifiable incidents which occurred at the home allowing the CQC to monitor that appropriate action was taken to keep people safe.

We found a continuing breach and a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told th

We found at our visit in July 2013 that staffing levels had improved. All people who lived at Mountwood who were able to comment said that staff provided them with assistance when they needed it. We observed staff providing care and support in a timely way during our visit.

Staff said that they had enough time to carry out their role. Records we checked showed that staffing levels were consistent , with bank or agency staff employed to cover any shortfall in staffing numbers.

We visited in May 2013 to follow up actions on the warning notice. We found that significant improvements had been made in relation to our specific concerns.

We spoke with people who used the service and their relatives, most of whom continued to be satisfied with the service provided.

People told us that staff did not always respond to them quickly when they pressed their call bell. One person said that they were thirsty. Records showed that this person needed assistance to drink and they had not been provided with a drink for several hours.

We found that care and support was not always provided in a safe and consistent way. This related to pressure care, catheter care and for people who were at extreme risk of falling. There was insufficient guidance available for staff to support people with these complex needs. Staff had also not been given guidance about how to support people who became agitated or distressed.

We had concerns that staffing levels were inconsistent and this had an effect upon the ability of staff to support people that they were caring for. Since our visit we have seen an action plan which addresses this issue and states clearly what minimum staffing levels will be in the future when the service supports people with this level of collective need. We have not yet assessed whether these actions have been implemented.

People were generally satisfied with the service they were receiving. We saw that laundry arrangements had improved and staff had a good understanding of infection control procedures. There was evidence that some staff training had taken place and more had been planned. There were systems in place to assess and monitor the quality of service and we saw evidence that some changes had been made when the need to improve had been identified. We judged therefore that the provider was now meeting the three outcome areas that we reviewed at this inspection