Montrose Care Home

Updated 1 December 2018

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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2012, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

The inspection was carried out on 26 October 2018 by two inspectors 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 service. The inspection was unannounced.

Before the inspection we reviewed information we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us. We also reviewed the provider information return (PIR) submitted to us. This is information that the provider is required to send to us, which gives us some key information about the service and tells us what the service does well and any improvements they plan to make.

During the inspection we spoke with nine people who used the service, two relatives, six care staff members, the chef, the deputy manager and the manager.

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 communicate with us. We also looked at other care records relating to the management of the home including medicine administration records and audits.

Updated 1 December 2018

We carried out a comprehensive unannounced inspection at Montrose Care Home on 26 October 2018. At our last inspection on 16 May 2018 we found that there were serious failings from management and staff to ensure people received care and support in a safe and effective way. We found breaches of Regulation 12, 13, 9, 14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider was in breach Regulation 18 of The Care Quality Commission (Registration) Regulations 2009 because they did not let us know about incidents that happened at the service as they are required to do by law.

Following the inspection on 16 May 2018 we imposed a condition on the provider`s registration preventing them from admitting new people into the home without the written permission from us (CQC). This was to ensure that the provider had time to make the necessary improvements. We also placed the service in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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

Montrose Care Home is registered to provide accommodation and personal care to 50 older people some of whom may live with dementia. At the time of the inspection there were 46 people living in the home. The home is spread across four levels, one of which is below the ground floor and accommodates the kitchen, chapel, an activity room and a dining area for people. The ground floor and two upper floors accommodate 50 bedrooms, lounges and storage facilities.

The registered manager who was in place at the time of the last inspection had left the service. There was a manager in post who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People told us they felt safe. Staffing levels had increased since our last inspection and staff were deployed effectively to ensure people`s needs could be met promptly. Call bells were answered in a prompt way to ensure people were safe and had their needs met.

Incidents and accidents had reduced significantly since the new manager was appointed. These were effectively analysed and actions were taken to reduce the risks. Risks to people`s well-being and health were assessed and risk assessments were in place to detail the measures taken to mitigate the risk. The number of falls people had reduced by more than half since our previous inspection and this was due to effective risk management and appropriate equipment use.

Care plans were developed and gave clear guidance to staff on how to effectively meet people`s health and care needs. Staff knew people well and took account of people`s likes, dislikes and preferences when supporting them.

People told us staff were kind and caring and protected their dignity and privacy when dealing with their personal care needs.

Staff had training and support to help them understand and carry out their roles and responsibilities effectively. Staff told us they felt supported by the management in the home and they had regular supervisions and staff meetings where they discussed any issues concerning them or the people they supported.

People told us their meal time experience and choices in regard to the food they received improved and they were happy with the menu. People who were found to be at risk of malnutrition or dehydration had their food and fluid intake monitored effectively and actions were taken by involving the GP and dietician in people`s care.

Appropriate safeguarding referrals were made to local safeguarding authorities by the manager and CQC had been notified as required. Lessons were learnt when things went wrong and ways to improve the service were discussed with staff and people.

People received their medicines safely from appropriately trained staff who had their competencies checked. Where required people had their capacity assessed to take certain decisions and restrictions to people`s freedom were taken following a best interest process.

After the previous inspection the provider reviewed their governance systems and implemented new processes and quality assurance audits to ensure that they could effectively monitor and assess the quality of the care provided to people.

People, relatives and staff were complimentary about the manager and the support received from the provider to improve the overall service. This included extra resources to improve the environment and increase staffing.

The manager carried out daily, weekly and monthly audits looking at all aspects of the care delivery and where actions were needed to improve any areas these were recorded with clear time frames and signed off when completed.