Mountdale Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At this assessment, this key question has improved too requires improvement. This meant the service management and leadership continued to need to make improvements. Leaders needed to consistently make improvements to create a culture that supported the delivery of high-quality, person-centred care.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff shared the provider's vision to deliver good care to people using the service. Staff treated people with dignity and respect and supported them to be as independent as possible.

The provider held regular meetings with staff to give direction on the service. Since the last inspection training had been updated for staff to ensure they had the correct skills to provide support for people. The registered manager had developed new documents to help staff raise concerns should they need to.

Care staff told us they felt supported by the nurses they worked with. However, some staff felt they needed additional staff to be able to perform their role effectively.

The service had a registered manager and nominated individual who were visible and based at the service. For day-to-day management nurses were in charge of the general running of the service with support from care staff. Since the last inspection recruitment checks had improved and new staff had an induction including shadow shifts. Regular supervision had been put in place for staff however we found these did not include actions to be taken when challenges were identified or if staff requested further training. Staff meeting minutes also lacked direction in them with how issues would be addressed and by whom, with outcomes or learning discussed. Since the last inspection the registered manager and nominated individual had been working with the local authority quality improvements team to implement improvements and meet regulations. However, we found areas at this inspection that continued to need work and did not meet regulations. For example, notifications of serious injuries had not been raised to the CQC as required.

Not all staff felt confident to speak up about any issues or that they would be addressed by the management team.

Staff were supported with regular supervision meetings should they wish to raise any concerns confidentially in these. There were frequent staff meetings where issues could be raised however there was not a system in place to show any actions taken. Staff had renewed their training on safeguarding, and this was a regular agenda item to discuss.

The provider had developed an inclusive workforce and recognized the value of diversity amongst the team.

Recruitment processes had improved at the service and the registered manager provided opportunities for staff to discuss their development through supervision and staff meetings. However, we found these needed to be more focused on how they would be achieved.

We had varied feedback from staff on the support they received from management. However, care staff felt they worked well together as a team.

The quality assurance and governance arrangements in place were not always effective in identifying shortfalls at the service. Although the provider had worked with the local authority to develop auditing processes, we found these did not address the issues we found at this inspection. For example, there was no audit in place for medicines other than completing counts of tablets. This meant issues with medicines being destroyed in a timely way and care plans detailing risks of medicines had not been identified and addressed. Environmental and IPC audits had not addressed the issues we had found with the storage of equipment, damaged equipment and people having their own identified hoist slings. Audits in place did not always address lessons learned, themes or trends so that improvements could be made. Where people were on a timed repositioning program when these times were not met there was no action in place as to how this would be addressed or improved. There was no audit in place of the information contained in care plans to ensure this was detailed and accurate. If audits had been in place they would have identified the issues of medicines and their impact on falls and injuries. Notifications of serious injuries had not been made on 3 occasions even though this had been highlighted at the last inspection. We could not be assured at this inspection that enough improvements had been made to allow for the provider to have full oversight of the service. Effective systems to monitor and improve the quality of the service were not in place. This was a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider told us they had been working closely with the local authority to implement changes at the service.

Feedback from the local authority was that the provider had been engaging and was working on implementing improvements.

The quality improvement team has been working with the provider to implement improvements at the service. We found although improvements had been made there were still areas which needed more work. Such as with governance and oversight of the service.

Staff told us they had updated their training. The registered manager had updated their training and had been delivering training to staff on moving and handling. Identified staff had also competed their fire marshal training so that they could lead in an evacuation.

The training matrix reflected that the provider had worked to update all staff training. However, due to ineffective governance, and lessons learned not being shared with staff to review and improve outcomes for people, we could not be assured how improvements would be implemented.