The inspection visit took place on 05 July 2017 and was unannounced.Mountford is a care home providing nursing care for up to 38 people some of whom are living with dementia. The service is set in a residential area of Truro. It is a single storey purpose built service. There were a range of aids and adaptations which were suitable to support people. The service is close to local amenities and a transport network. The garden area has been developed as a sensory area which is suitable for people with mobility needs. At the time of the inspection visit there were 34 people living at the service.
At the last inspection in July 2015 the service was rated overall ‘Good’.
Staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at the service. People told us staff were very respectful and spent quality time with them or their relative. There were numerous examples of how caring attitudes of staff had a very positive impact on people’s lives. For example, staff were supporting people who were entering the end stages of their life. Staff made sure they knew what people wanted, including experiencing events of their choice, having personal items around them and listening to specific pieces of music. Comments we received included, “Nothing is too much trouble, its 24/7. We were supported as well as (Person),” “Absolutely excellent. Just couldn’t have asked for more. The support from staff was exceptional” and “We were encouraged to visit anytime. It was very important especially for the grandchildren.”
Systems were in place to help ensure staff had up to date information on how best to support people at this stage of their lives. People received individualised person centred care that was designed to meet both their health needs and their social needs and individual preferences. The management team lead by example when delivering care and support and displayed a commitment and passion for the service they provided. The service had achieved a national award for providing end of life care. Staff told us they were very proud of the support and care they give to people and their families as they are coming to the end of their lives.
Health professionals we spoke with told us how they felt the service provided outstanding care. They were impressed with the knowledge of staff with their attention to end of life care.
There were enough staff to help ensure people’s health and social needs were met. Staff were effectively deployed across the service to ensure people’s needs were being met. In general call bells were responded to quickly. However we observed one occasion when a call bell was not answered promptly. When informed the management team responded immediately to address the issue.
Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe.
Staff were aware of their responsibilities to protect people from avoidable harm. Staff had received adult safeguarding training and had information available of the action required to respond to any concerns that may be raised. The management team had taken appropriate action when safeguarding incidents had occurred to reduce further risks.
Recruitment procedures were safe to help ensure staff were of suitable character to work with people who may be vulnerable.
We observed people receiving their medicines as prescribed. The system for storing medicines was safe. There were suitable storage systems for keeping medicines safe and secure. Only staff with responsibility for medicine administration had access to medicines. It was clear from the medicine records that people received them as prescribed. Regular medicines audits were taking place to identify if any errors occurred.
Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. Any accidents and incidents were recorded and audited to help ensure the risk of re-occurrence was reduced.
The organisation Cornwall Care had a robust training programme in place to ensure staff were appropriately trained to meet the needs of the people using the service. More specialised training specific to the needs of people using the service was being provided, for example, end of life care training. Staff were supervised in their roles to aide their personal development.
People were provided with a healthy and varied menu to meet their nutritional 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 support this practice. This meant the service was effective in meeting people’s needs.
People were supported by kind and attentive staff. Staff responded to people’s needs in a respectful dignified manner. Staff discussed interventions with people before providing support. Staff understood people’s abilities and preferences, and were knowledgeable about how to communicate with people.
People's rights were mostly protected because staff acted in accordance with the Mental Capacity Act 2005. Some consent forms were signed by the person themselves. Where a person was unable to do this, the consent was not always signed by a person with the legal power to sign on behalf of another, such as a lasting power of attorney for care and welfare. The registered manager was aware of the need for this and was taking action to ensure families would inform them who held such legal powers. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. 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 were provided with choices and their wishes were respected.
People and relatives said they were highly satisfied with the service and felt able to talk to the registered manager about any concerns or complaints.
There was a broad range of activities available to suit people’s needs. An activity co-ordinator arranged regular events for people and had the knowledge and skills to support people living with dementia. These included singing, crafts and visits to the local area. The service had developed a programme to support people to experience activities that they hope to accomplish in their lifetimes. For example, the service had supported a person to watch surfers in the sea and for a person to attend a gliding club.
The registered provider had a robust quality assurance process in place to drive improvement.at Mountford. These included regular audits of the service, annual surveys, resident meetings and staff meetings to seek the views of people about the quality of care at the service. There was also evidence of the service engaging with external quality assurance organisations which showed the service was open and transparent.