Mountdale Nursing Home

Mountdale Nursing Home is a residential care home providing the regulated activities of personal and nursing care to up to 24 people. The service provides support to older people, older people who require nursing care and people who are living with dementia. At the time of our inspection there were 23 people using the service.

People’s experience of the service and what we found:

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

Staff did not routinely support people to take part in social activities. People did not benefit from an environment that met their needs. Not all staff could communicate effectively with people using the service and this impacted on the quality of care some people received. Staff supported people with their medicines in a way that promoted their health outcomes.

Right Care

Staff did not understand how to protect people from abuse and harm. The provider and staff had training on how to recognise and report abuse but did not know how to apply it to keep people safe. The service did not have enough appropriately skilled and competent staff to meet people’s needs. Information about risks were not comprehensive or up to date. People were not protected by the service’s infection, prevention, and control of infection arrangements.

Right Culture

There was a lack of clear leadership and oversight. Responsibilities and accountability arrangements were not clear. The arrangements for identifying, capturing, and managing risk were not effective. Although staff reported incidents, managers failed to act on known issues. Feedback and complaints were not dealt with in an open, transparent and timely way. Staff were not aware of the service’s vision and values.

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

Rating at last inspection

The last rating for this service was Good [Published November 2017].

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of Safe and Well-Led. During the inspection we found concerns with protecting people from harm, staffing, including the provider’s recruitment practices and procedures. Therefore, we widened the scope of inspection to include the additional key question of Effective. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Mountdale Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding people from abuse, risk management, staff recruitment practices, including staff training, induction and supervision and governance arrangements. We have also made a recommendation about the premises.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ The registered manager was following the government’s guidance on whole home testing for people and staff. This included using rapid testing and weekly testing for staff.

¿ People were supported to isolate when required and the environment was spacious to allow for social distancing in communal areas.

¿ Staff completed regular health screening on people to help identify any symptoms early.

¿ The registered manager had processes in place to admit people safely to the service.

¿ Visiting areas had been adapted to allow for social distancing, the use of screens and personal protective equipment (PPE) was provided for visitors.

¿ People were able to connect to the internet and there were facilities for people to video call and keep in touch with their friends and relatives when unable to visit.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, district nurse, tissue viability nurse and palliative care nurse. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The registered manager had a number of ways of gathering people’s views, they held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered manager carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

Many of the people we met during our inspection could not, because of their complex needs, tell us verbally about their experiences and so we used observation to help us understand their experience of the service. We also looked at care records and gained feedback from staff about people's care and support needs. We talked with some people who used service and with visiting family members. Below is a summary of what we found.

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

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had detailed policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

Staff we spoke with said they had been properly recruited and trained. Staff told us that they received good support in their roles.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People's health and care needs were assessed and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative said, 'We are very pleased that our relative is living in this home, the staff are kind and good at keeping us informed about our relative'. Other comments we received from relatives were, 'The staff are approachable and listen to our views, they are also caring and thoughtful'.

The responses and views of people who used the service, their relatives and professionals involved with the service provision, were recorded at the annual quality monitoring review. Any shortfalls or concerns raised were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people's wishes.

Is the service responsive?

People had the opportunity to enjoy a range of activities and, with staff support, were able to get out and about in the local community.

A person who used the service we spoke with told us, 'There are things for us to do each day, staff talk to me about what I want to do and if I decide not to get involved in the activities, that's fine'. 'The staff are good to me, I tell them if I'm not happy about something and they try to sort it out for me'.

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the aims of the home and of the standards of care and support that was expected of them.

Regular service monitoring processes were in place. This helped to ensure that people received a good quality service at all times.

A relative we spoke with told us, 'I am glad that my relative is in this home, the staff are attentive to my relative's needs and the managers and staff are good at keeping me updated about my relatives wellbeing'.