Mont Calm Residential Home

We undertook this targeted inspection to check infection control and prevention measures in place at this service. The overall rating for the service has not changed following this targeted inspection and remains Good.

We found the following examples of good practice.

¿ Due to the outbreak of COVID-19 the service was closed to visitors in accordance with Government guidelines. Prior to this there were procedures in place to support safe visiting. This included the use of a heated outbuilding, risk assessments and provision of personal protective equipment to help protect people from infection.

¿ Isolation had been implemented effectively and people living in the service were monitored for symptoms of COVID-19. There was an up to date infection, prevention and control policy in place supported by COVID specific protocols. When we visited Mont Calm was clean and cleaning schedules had been completed.

¿ The service had an adequate supply of personal protective equipment to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe.

¿ Support had been provided by the GP and district nurses. Care plans had been updated and medication reviewed to ensure people were receiving the most appropriate care and treatment.

Further information is in the detailed findings below.

Mont Calm is a residential care home providing accommodation and personal care for up to 39 older people, some of whom are living with dementia. There were 33 people living at the service at the time of the inspection.

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

People told us they enjoyed living at Mont Calm Residential Home and felt safe with the staff. Comments from people included, “I am very happy here, staff are all very considerate” and “Staff very friendly, always checking to see if I am comfortable.”

People spoke highly of the staff, we observed kind natured interactions between people and staff. Comments included, “Carers are wonderful, couldn’t wish for a better lot, they are all good” and “Loving, caring, well qualified, really good, they have become my family.” Staff knew people well and responded to people’s emotional needs as well as their support needs.

People’s safety had been promoted and potential risks posed to people had been reduced. Staff understood their responsibilities about safeguarding and had been appropriately trained. People’s safety in the event of an emergency had been considered. Equipment was serviced and maintained. People received their medicines safely as prescribed by their doctor.

There were enough trained staff with the right skills to meet people’s needs. Staffing levels had increased when there had been changes in a person’s needs. Staff were observed spending time speaking with people and their relatives. Staff were recruited safely to ensure they were suitable to work with people.

Staff felt there was an open culture where their views were listened to and respected. Staff felt supported in their role by the management team and received guidance when needed. The management team worked alongside the care staff to support them and observe practice. Staff were encouraged to complete further education courses to widen their skills and knowledge.

People were supported to seek medical support when this was required to maintain their health. People had access to food and drink they enjoyed; as well as snacks throughout the day. People’s nutrition and hydration needs had been assessed; records were up to date and accurate.

People were at the centre of their care and support, making choices about their lives. Care records were kept under review to ensure they continued to meet people’s needs. 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 service supported this practice.

People and relatives were encouraged to give their feedback about the service and make suggestions for improvements or to raise any complaints.

People were supported to participate in activities and events within the service and in the local community. A coffee shop had been made in the back garden enabling people to spend time with their loved ones outside of the service. People were enabled and encouraged to maintain as much independence as possible.

Systems were in place to monitor and audit the quality of care people received. Action was taken when any shortfalls were identified. Lessons were learnt and improvements were made when things went wrong.

The registered manager and management team were committed to ensuring people received a high-quality service. Attendance at regular events and forums enabled the sharing of best practice.

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 June 2018) 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

We carried out an unannounced comprehensive inspection of this service on 2 March 2017, where the service was rated as Good overall. After that inspection we received concerns in relation to an incident where a person died in hospital following a period of respite. The concerns related to meeting the nutrition and hydration needs and meeting people’s health care needs. As a result we undertook a focused inspection to look into those potential concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mont Calm Residential Home on our website at www.cqc.org.uk”

We undertook an unannounced focused inspection of Mont Calm Residential Home on 11 April 2018. The team inspected the service against three of the five questions we ask about services: is the service well led, is the service effective and is the service responsive to people’s needs. This was due to the concerns that had been raised, and the potential risk to others living at Mont Calm Residential Home. At this inspection the service was rated as requires improvement in effective, responsive and well-led. Therefore the overall rating for the service is now requires improvement.

Mont Calm Residential 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.

Mont Calm is a privately owned care home providing accommodation and personal care for up to 39 older people, some of whom are living with dementia. The service consists of two properties next door to each other with a pathway connecting the two. There is a lift to enable people to move between different floors. There were 32 people living in the service when we inspected.

The service had a registered manager in post who managed the service during the full comprehensive inspection in March 2017. 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 this inspection, the registered manager was not aware of all of their responsibilities to ensure compliance with fundamental standards and regulations. They had failed to notify CQC of a notifiable event in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Some people’s care plans were detailed and gave staff guidance regarding how to meet people’s needs. However, some people’s care records had not been reviewed and updated for over a period of ten months.

People’s nutrition and hydration needs had been assessed; however, best practice guidance had not been followed to ensure accurate records.

There were standard set amounts of fluid targets for people to drink throughout the day. People received food they enjoyed and specific dietary requirements were catered for. Staff worked with health care professionals to ensure people remained as healthy as possible.

Information was not made accessible to enable people to make an informed choice. People did not always have access to the equipment they required such as, height adjustable tables.

People were encouraged to make their own choices about their lives. 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 service supported this practice. Staff offered people choices and gained people’s consent prior to any care or support tasks. However, some staff lacked understanding regarding the principles of the Mental Capacity Act 2005 (MCA). We have made a recommendation about this.

People were supported to take part in a range of activities to meet their needs and interests.

Staff were not always given the support, skills and knowledge to meet people’s needs. Staff understood their role and responsibility to provide quality care and support to people. Policies and procedures were in place to guide and inform staff to fulfil their role.

Systems were in place to monitor the quality of the service being provided to people. They were a range of checks and audits carried out to ensure the safety and quality of the service that was provided to people. However, these had not always identified the concerns regarding people’s care records, access to information, appropriate equipment and the shortfalls in staff’s knowledge regarding MCA which we found during this inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

At our previous inspection on 12 January 2016 we found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A breach of Regulation 19 (2) (a), the provider had failed to ensure recruitment information was available for each person employed. A breach of Regulation 11 (1) (2) (3), the provider had failed to adhere to the Mental Capacity Act (2005), in relation to assessing people’s capacity and a breach of Regulation 9 (1) (a) (b) (c), the provider had failed to provide activities to meet people’s individual needs. The provider sent us an action plan which stated they would meet the regulations by December 2016. At this inspection we found that improvements had been made to meet the relevant requirements.

We required the provider to make improvements in relation to assessing people’s capacity to consent, providing activities to meet people’s needs and the safe recruitment of staff. We found that significant improvements had been made and the provider was now meeting the regulations.

Mont Calm is a privately owned care home providing accommodation and personal care for up to 39 older people, some of whom are living with dementia. The service consists of two properties next door to each other with a pathway connecting the two. There is a lift to enable people to move between different floors. There were 19 people living in the service when we inspected.

At the time of our inspection, there had been a registered manager in place since July 2016. They were an experienced member of staff who had worked for the provider for a number of years. 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the previous registered manager had applied for DoLS authorisations for some people living at the service, with the support and advice of the local authority DoLS team. The registered manager and the management team understood their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments and decisions made in people’s best interest were recorded. People were actively encouraged and supported to make decisions relating to their lives.

People experienced a service that was safe. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put into place to manage any hazards identified. The premises were maintained and checked to help ensure the safety of people, staff and visitors. People’s safety in the event of an emergency had been considered, assessed and recorded.

People participated in activities of their choice within the service and the local community. There were enough staff to support people to participate in the activities they chose.

There were enough staff on duty with the right skills to meet people’s needs. Staff had been trained to meet people’s needs. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. Staff had received the training they required to meet people’s needs. Staff were supported in their role by the management team.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and senior staff had been trained to administer medicines safely. People were supported to remain as healthy as possible with the support of healthcare professionals.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required. People’s nutrition and hydration needs had been assessed and recorded. Staff met people’s specific dietary needs and received guidance from health care professionals where required.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. Care and support was planned with people and their loved ones and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to meet people’s needs including any specialist support needs.

Systems were in place for monitoring the quality and safety of the service and assessing people’s experiences. Annual questionnaires were sent to relatives, and a monthly newsletter was given to people and their relatives. People were encouraged to raise any concerns or complaints they had which were acted on.

The registered manager had a clear vision of how they wanted the service to run, which was shared with the staff team.

Mont Calm provides accommodation and personal care for up to 39 older people, some of whom are living with dementia. There were 17 people living in the service when we inspected.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures.

At our previous inspection on 27 and 28 April 2015 we found breaches of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action and placed the service into special measures. The provider was required to make improvements. We placed a condition on their registration which related to the carrying out of the regulated activity:

The Registered Provider must limit the number of service users living at Mont Calm Residential Home to 22 and not admit any service users into the home should any of the 22 service users leave the home. The Registered Provider must not admit any new service users into Mont Calm Residential Home, without the prior written agreement of the Commission. This condition also applies to service users requiring respite care.

We required the provider to make improvements in relation to meeting nutritional and hydration needs, good governance, having sufficient qualified, competent, skilled staff to meet peoples’ needs, safe care and treatment, need for consent, person centred care, safeguarding service users from abuse and improper treatment and dignity and respect. We found that improvements had been made; however, the provider remained in breach of three regulations.

There was a manager employed at the service who had applied to the Care Quality Commission to become the registered manager. Their application was in progress at the time of the inspection. 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the previous registered manager had applied for DoLS authorisations for some people living at the service. However, the principles of the Mental Capacity Act 2005 had not been applied prior to the applications being made. Mental capacity assessments had not been completed and decisions had not been made in people’s best interests. The current manager and staff were aware of their responsibilities under the MCA 2005 and DoLS. The manager planned to complete the MCA assessments with people’s representatives.

There were enough staff on duty with the right skills to meet people’s needs. Staff had been trained to meet people’s needs. Recruitment files did not always contain the required information under schedule 3 of the Health and Social Care Act 2008 (Regulated Activities). Full employment histories had not been requested nor gaps in employment checked or explored at interview. Other checks had been carried out to ensure staff were safe to work with people.

People told us they felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. However, some staff required refresher training in this subject. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified.

People were not encouraged to participate in activities that took place and activities were not specific to meet people’s needs.

The premises were maintained and checked to help ensure people’s safety. Health and safety risk assessment relating to staff had not been completed. For example, manual handling loads.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required. People’s nutrition and hydration needs had been assessed and recorded.

Staff had received the training they required to meet people’s needs including their specialist needs. However, staff had not always completed refresher training as per the providers training requirements.

Staff told us they felt supported by the manager and staff team. Staff told us the manager was approachable and they were confident to raise any concerns they had with her. Staff received supervision and support to fulfil their role.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to provide all areas of the care and support people needed.

People’s health was monitored and when it was necessary, health care professionals were involved to make sure people remained as healthy as possible.

Accurate records were kept about the care and support people received and about the day to day running of the service. These provided staff with the information they needed to provide safe and consistent care and support to people.

Systems were in place to monitor the quality of the service being provided to people. People and their representatives were asked for their feedback to develop the service.

We found 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 this report.

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

Is the service safe?

The registered manager ensured that staff underwent checks before starting work at the home. For example they checked a person's character by carrying out Disclosure and Barring Service checks. (DBS). This was formally known as a criminal records check.

During our inspection we saw that staff delivered the care outlined in people's care plans. For example we observed that staff ensured people were safe when they were lifted because staff used specialist equipment. Also to ensure people's safety, where two staff were required to carry out a task, we observed that two staff were available.

Procedures for dealing with foreseeable emergencies were in place and staff were able to describe these to us. The manager understood how care would be continued in the event of a foreseeable emergency occurring. Staff had access to support and advice at all times from a senior member of staff.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that people's rights were protected because the manager understood how to support people to make decisions in their best interest.

The service was kept clean and free from infection because the manager ensured that there was a cleaning schedule and that this was followed.

There were systems in place for making regular checks on the risks of providing the service and safety of the premises. Incidents and accidents were monitored. The manager had made changes as a result of learning from incidents and these had been put into practice.

The manager ensured that there were enough staff to meet people's needs. We found that that they had ensured that staff had the required skills and knowledge to care for people in a safe way.

Is the service effective?

People had an individual care plan which set out their care needs. We found that the manager used an assessment system that was appropriate for people living with dementia. People's relatives had been fully involved in the assessment of people's health and care needs when appropriate. Relatives and other key people had been involved in supporting decisions that had been made in people's best interest. For example, when people lacked capacity to make the decisions for themselves. People's care plans were reviewed regularly to check they were still effective. During our inspection we saw staff delivering the care outlined in people's plans. When people fed back about the service they talked positively about the care provided at the service.

Is the service caring?

We found that people were treated with respect and their dignity was maintained. People appeared relaxed and comfortable with the staff that supported them. We observed that people had a positive relationship with staff. Staff took time to chat with people about day to day matters. People told us that the staff were caring. One person said 'X is well cared for, I cannot fault staff'. Other people said 'People are very well cared for, the staff are very kind to X'. Other people had commented 'Staff are very caring, understanding and supportive' and 'The staff are kind, they do a good job'. Staff we talked with told us that people were well cared for. We observed that staff were attentive to people's needs and responded positively when people required their support.

Is the service responsive?

The service reviewed people's care plans regularly. There was a nominated person in charge of the service with the required training and authority to manage how the service was delivered. The manager or their deputies were available via telephone for further advice when needed.

We found that the manager asked people about what they experienced from the care and treatment they had received. People told us that registered manager had consulted them about the quality of the service.

Is the service well-led?

The provider continually monitored areas of risk in the service and made regular checks on quality. There was evidence that the provider learnt from incidents. Changes had been made to minimise the risks of incidents occurring again.

People's care was assessed, planned and managed. Staff were aware of people's care needs. The manager had ensured that the resources required to deliver the regulated activities were available.

Staff were trained and inducted. Team meetings enabled staff to express their views about service quality and they were able to raise issues that concerned them.

The manager ensured that daily checks of the quality and safety of the service were carried out. Regular reviews of people's care plans took place which ensured their needs were being met.

We found that a new management team was in place in the home and improvements had been made.

We saw that a system was in place to make sure people's consent to care was obtained and that they or their representatives were consulted and involved in planning how their care would be delivered.

Medication was given at the right time, in the right way and recorded accurately to make sure people received the medication they needed, when they needed it.

Where people made complaints about the service, these were recorded and followed up to make sure any concerns were addressed.

We saw that people were treated with respect and kindness. People told us they could choose what they wanted to do. They said, 'I can get up when I want to.' 'Everyone is very friendly.'

During our visit we found that people's care and welfare needs were met.

There was no system in place to make sure people's consent to care was obtained or that they or their representatives were always consulted or involved in planning how their care would be delivered.

Medication was not always given at the right time, in the right way or recorded accurately to make sure people received the medication they needed, when they needed it.

Staff received the training they needed to enable them to provide appropriate care and support to people who lived in the home.

Where people made complaints about the service these were not recorded or followed up to make sure any concerns were addressed.

During this visit we found that improvements had been made. We spoke with people who lived in the home. People told us the home was always nice and clean. They said they enjoyed their meals and there was plenty of choice. People felt comfortable to express their views about the service to the provider. We spoke with people who used the service. They told us, 'Its always nice and clean.' 'I like it here, the manager is very good.' 'The food is very good, there's always a choice.'