Archived: Mount Hermon Dementia Care Home

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.

Mount Hermon Dementia Care Home provides care and accommodation for up to 30 people who were living with dementia and there were 24 people living at the home at the time of our inspection. All were aged over 65 years. The home is situated on the seafront at Lancing, West Sussex.

All bedrooms were single and each had an en suite toilet with a wash basin. There is a passenger lift so people can access the bedrooms on the first floor. Communal living rooms and a dining area were also provided as well as a garden and an activities room.

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.

At the last inspection on 16 August 2016 we recommended that the activities for people should be improved. At this inspection we found action had been taken to extend the range of activities for people.

At this inspection we found the provider had not ensured the proper and safe management of medicines. Records of medicines administered to people were not always accurately maintained. We also found some medicines had not been administered and there were no recorded reasons for this.

A range of audits and checks were made on the service including regular visits by the provider’s regional management team. Audits of incident s such as falls and accidents were completed and action plans devised to prevent any reoccurrence. Medicines audits were carried out but these had not identified the errors we found and we have made a recommendation about this.

People and their relatives said the staff provided safe care to people and people said they felt safe at the home.

Risks to people were assessed and recorded along with care plans with guidance for staff to follow to mitigate those risks.

Sufficient numbers of staff were provided to meet people’s needs. Checks were made on newly appointed staff to ensure they were suitable to work in a care setting.

The premises were found to be clean and well maintained. There was an absence of any unpleasant odours.

Staff were trained and supervised so they had the skills to provide effective care to people.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the MCA and DoLS. People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

People’s nutritional needs were assessed and people were supported to eat and drink. There was a choice of meals.

People’s health care needs were assessed. The staff had good links and worked well with local health care services.

Staff were kind and compassionate and were observed to treat people well and with dignity. Care was personalised to reflect each person’s preferences and lifestyle. People’s privacy was promoted. Staff were trained in end of life care and a health care professional reported that this was an area of practice the staff were particularly good at.

The service had introduced a system whereby care records were held on a specifically designed IT

system which staff accessed via smart phones provided by their employer. This had numerous advantages such as alerting staff to risks and staff having ready access to information on people.

People’s relatives said they were able to raise any concerns which were usually resolved. The provider maintained a record of any complaints and any action they took as a result of complaints, although we identified a lack of full records regarding one complaint. This was later rectified.

Relatives and a health care professional described the management team as approachable and responsive. There was a management team which included team leaders who coordinated care when on shift.

You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was 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, their relatives and staff all spoke highly of the management of the home.

Care provided was not always responsive to the needs of people living at the home. Some people who were living with dementia did not have meaningful activities to occupy and stimulate them. We have made a recommendation that the provider seek information about providing meaningful occupation, based upon current best practice in relation to the specialist needs of people living with dementia.

Some monitoring systems were not consistently effective in identifying gaps in recording. This meant that the registered manager could not always be assured that high quality care was being delivered. This was identified as an area of practice that needs to improve.

People and their relatives spoke highly of the caring nature of the staff. Their comments included, “The staff are all kind, without exception,” and “I am yet to find one that I don’t like, they are all lovely, caring people.” Staff knew the people they were caring for well and had developed positive relationships with them. Staff contacted health care services when people needed medical support. A visiting health care professional told us that staff were quick to make referrals when they had concerns about people and that they acted upon instructions and recommendations that were given.

Staff received the training and support they needed to care for the people living at the home. People told us they had confidence in the skills and knowledge of the staff, their comments included, “You can’t fault them, they are well trained and nothing is too much trouble for them.” Staff had received training in MCA and demonstrated a firm understanding of their responsibilities to comply with the legislation and guidance.

People were supported to have enough to eat and drink and they told us they enjoyed the food at Mount Hermon. One person said, “The food is very nice, there is lots of choice. They are always bringing snacks and drinks round too, it’s lovely.” People told us they felt listened to and that their views were respected by staff. One person told us, “I didn’t want to come into a care home, I thought they would tell me what to do all the time but it’s not like that here. They asked me exactly what I want and how I would like things to be. It’s really lovely here actually.” People and their relatives knew how to make complaints and there was an effective system in place to record and respond to complaints received.

Incidents and accidents were recorded and monitored by the registered manager. Actions were taken to address any emerging patterns. The provider used a number of external and internal resources to audit care quality including a questionnaire for people and relatives. The registered manager used this information to identify areas for service improvement in a development plan.

Staff protected people’s privacy and spoke to them respectfully. People and their relatives were happy with the care their received and spoke highly of the staff. One relative said, “The care is very, very good. They try very hard to maintain peoples’ dignity,” and a person said, “It is very well run, they are a good team.”

There were 24 people living in the home on the day of our inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Care was planned to meet people's needs. Where a need had been identified a plan had been put in place to inform staff how to support the person concerned. Care plans were up to date and reflected the needs of people we case tracked through this inspection.

People were supported by staff who felt well-supported and trained. We found that staff had either completed training about safeguarding vulnerable adults or were scheduled to attend training. Staff understood what safeguarding was and what they would do if they suspected someone was being abused.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. One application had been submitted and authorised by the relevant Supervisory Body and other cases had been discussed with the local authority.

Is the service caring?

People were treated with consideration and respect. People we spoke with, who were able to give an account of their life at the home, told us that they were well cared for and had no concerns. These views were also expressed by a visiting relative we spoke with. One person told us, 'They always discuss everything with you'. One relative told us, 'It has been wonderful here; they always ring us if there are any issues.'

We observed that staff communicated with people in a sensitive and considerate manner and supported people appropriately.

Is the service responsive?

People were referred appropriately to other health care services and professionals when required. Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians, chiropodists and GPs were documented.

Is the service effective?

Peoples' needs had been assessed and care was planned and delivered to meet their needs.

Is the service well led?

The provider undertook a variety of audits to check the quality of the service and also employed an outside consultancy to identify compliance with essentials standards we inspect against. For example, we saw audit reports relating to care planning, complaints and falls sustained in the home.

Since taking over the home in June 2013, the new management had increased administration support to the registered manager and also appointed a deputy manager.

People were able to comment on the service provided, although we were able to view the results of the last survey as results had not ben collated at that time.