Archived: Mount Hermon Dementia Care Home

Updated 2 July 2019

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 6 and 7 September 2018 and was unannounced. The inspection team consisted of one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had particular experience in caring for people living with dementia.

Before the inspection we reviewed information we held about the home. This included notifications the provider had sent to us. A notification is information about an important event the provider is required to tell us by law. We also reviewed the information the provider sent to us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

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 spent time observing the interactions between staff and people within the communal areas and observed tow meal times and a medication round. We spoke with six people, three relatives and a visiting health care professional. We also spoke with the manager, the director of the company, the service development lead, the deputy and five care staff, the activity lead and chef. We spent time looking at records, including four staff recruitment files, care plans and assessments relating to four people, the accidents and incidents book, the maintenance records and the audit and quality assurance processes.

Updated 2 July 2019

Mount Hermon Dementia Care Home 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. Mount Hermon Dementia Care home can accommodate up to 30 people and on the day of the inspection there were 25 people living there. It is on the seafront of Lancing and care is provided over two floors. The communal areas include a dining area, two lounges and an enclosed garden. There is also an activity room, in the garden.

We inspected Mount Herman Dementia Care Home on 6 and 7 September 2018. This was an unannounced inspection.

When we completed our last inspection on 27 June 2017 we found concerns relating to the safe management of medicines. Following this, the provider sent us an action plan, detailing how they would improve the key question of ‘safe’ to at least ‘good’. At this inspection we identified further concerns, relating to the prescribing and management of medicines. There was a medicine audit in place but the actions plans were not detailed and had not led to improved practice. You can see what actions we told the provider to take at the back of the full version of this report.

The management had not ensured that standards had been improved since the last inspection. There was also a lack of oversight of the running routine management of the home. Weekly environmental checks had not been completed since July 2018, when the maintenance person left. These checks had not been passed on to another person. Similarly, when the member of staff responsible for returning the medicines to the pharmacy had left, it had not been identified that this role should be passed onto another member of staff. You can see what actions we told the provider to take at the back of the full version of this report.

There was a system of audit and quality control measures, but these had not always led to improvements in the standard of care delivered. One example, was with the management of medicines. The management team had identified that some of the action plans, relating to audits, needed to be improved and were in the process of reviewing the audit and quality assurance processes.

Staff and people told us that on occasions there were not enough staff available. There were insufficient permanent members of staff and the service were using a lot of agency staff. The management had identified this and were actively recruiting additional staff. The aim was to increase staff numbers sufficiently, to the allow for an overall increase in the number of permanent staff on each shift. The recruitment process had been reviewed and tightened up, to ensure that new staff were appropriate to work in a care setting. Before the introduction of these new standards there had been gaps in the pre-employment checks.

Staff training was not always up to date. Staff were aware of the principles of keeping people safe from abuse. However, not all staff had received their yearly update regarding safe-guarding. Staff did not always have regular supervision. There were staff meetings but on occasions information was not passed onto staff, in a timely fashion. Some staff required additional training and support to improve the standard of care within the home.

There was an activity programme in place but this had not been tailored to individual’s preferences and abilities and some people did not receive sufficient stimulation. People and their relatives had limited opportunities to provide feedback, about the care they were receiving. There was a complaints procedure, however, relatives told us they did not feel their concerns were always dealt with in a satisfactory way.

Food was prepared on site and people’s hydration and nutritional needs were met. However, some people would have benefitted from additional support at meal times. People had access to health-care professionals, as necessary. There were personal risk assessments and care plans. These were person-centred and contained details about people’s personal history. Methods to ensure information was accessible were considered. The staff cared for people who were nearing the end of their lives, working closely with specialist health-care professionals to ensure appropriate care was delivered. Staff used technology to help them access the care plans and record activities promptly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. Consent was gained from people and they were offered choices in their daily lives. People’s privacy and dignity was maintained. Staff aimed to promote independence and we saw examples of compassionate care. However, people and relatives told us there was a difference between different members of the care team, with some being more supportive than others.

The home was clean and tidy. Staff took appropriate steps to reduce the risk of infection. The home had some adaptations to help people with reduced memory or poor eyesight. These included clear signage on doors and painted hand rails in the hallways.

The registered manager had recently resigned and a new manager had just started at the home. It was their third week in post at the time of the inspection. It was their intention to register with CQC as 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 felt able to approach the management team with any concerns and told us they worked well as a team.

This is the third consecutive time the home has been rated Requires improvement.