Mont Calm Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified two breaches of the legal regulation. People did not receive effective care. Although people were supported to access healthcare when required, staff failed to follow healthcare professional’s guidance which had a detrimental impact on people's wellbeing. People and their relatives were not always involved in assessments around their care, meaning their contributions could be missed. People’s rights were not always protected due to staff not understanding the principles of The Mental Capacity Act (2005). Records around mental capacity and best interest decisions were also lacking important information to ensure the least restrictive practices were used to deliver care. People were not at the centre of their care. Staff and leaders did not embrace effective communication with partners and did not implement robust continuous monitoring tools to ensure people's needs were met.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were relatives that felt care and support was well coordinated and planned. One told us, “They ring me quite regularly just to keep me appraised of anything going on.” There were other relatives that did not feel involved with one telling us, “I didn’t have a call to go through what was important. We didn’t have a chance.”

Staff told us they were allocated as key workers to people. They told us this involved checking people had enough toiletries, checking people’s clothes, any mobility equipment and speaking with their relatives. However, there was a no focus on discussing the skills, strengths and goals of people which would enable them to continue living fulfilled lives. The registered manager and a senior staff member reviewed people’s care needs. However, they did not consider that key workers could be involved in these reviews given they spent more time with people and their families, so potentially missing out on key information that could improve the support delivered and build relationships.

Staff regularly reviewed people’s care plans and sent these to people and relatives to ask them if they wanted to include any further information. Although reviews included people’s health needs, there was a lack of review of people’s overall wellbeing and communication needs to enable them to receive person-centred care bringing best possible outcomes.

There were some relatives that said they were able to contact the home to get information and advice around their loved one’s care needs. However, people we spoke with said they were not always asked what was important to them. One told us, “I have to fall in with a community and they don’t fall in with me.”

Staff did not always have a good understanding of good practice and guidance. Staff lacked knowledge of how to support people living with a dementia. Most staff we spoke with fed back that having dementia was about not having the capacity to make decisions and losing one’s memory. Given the majority of people were living with dementia, this meant they were being supported by staff who did not fully understand their specific needs. Staff failed to understand the importance of robust recording around risks. For example, for people who were at risk of constipation, staff failure to record bowel movements and respond accordingly put people at risk of avoidable harm. The registered manager told us staff were recording people’s bowel movements, but we found this was not always the case.

There were evidence-based good practice tools being used to assess people’s level of needs, however these were not always used effectively. For example, we saw an Abbey Pain Scale (an instrument designed to assist in the assessment of pain) was used to determine the level of pain for 1 person with arthritis. This pain recorded the person’s pain as low however further on in the care plan it states the persons pain, ‘Can be chronic.’ This meant the person may not receive pain relief when needed as there was contradictory information and guidance. Staff were not always recording when people who were people at high risk of constipation had opened their bowels. When they had recorded this, they were not always recording the type of bowel movement. Having this information would assist staff to know whether the person is constipated, and staff may then offer additional medicine for this. Malnutrition Universal Screening Tool (MUST) was used to identify people who were at risk of malnutrition. When people were losing weight, plans were put in place to support with this.

Relatives said they were kept updated about their loved ones changing health needs. However, we found that appropriate professionals were not always consulted as required in relation to people’s changing health.

The registered manager and senior staff told us they would contact the GP when a person was unwell. However, the registered manager said they did not contact the GP to review medicines when they had observed people were having ‘as and when’ medicines more frequently than was intended.

External professionals told us in the main they had a good working relationship with staff and leaders at the home. However, they said they had not always received information in good time in relation to people’s needs.

Where people required a review of their health, this was not always taking place. For example, according to their notes 1 person had a seizure in May 2024 and then a further 2 in August 2024. No action had been taken to speak with health care professionals to determine whether the reasons for the latest seizures were as a result of an underlying health condition or if a change in their support or risk assessment was required. Another person was unable to sit in safely in the chairs in the lounges and had been moved to bed. The registered manager contacted the GP and asked for an occupational therapist referral to determine whether there was a more appropriate chair the person could sit in safely. However, staff did not follow up on this referral which was completed in July 2024. This meant there was a risk the person health’s deteriorated further without the prompt health care support. We saw records of staff contacting the GP and speaking with visiting community nurses in relation to other people’s health needs.

People and relatives told us health care professionals were involved in the care of people including the GP, dentist and opticians. One relative said staff were good at monitoring the risk of infections for their loved one. However, people were not always supported to lead healthy lives to help promote and maintain people’s overall mobility and wellbeing. There were relatives that told their loved ones were not always supported in relation to physical activities. Comments included, “[Person’s] main interest was walking. I often see staff just sitting there with them”, “[Person] hasn’t been outside since they have been there” and “I don’t think they take [person] out.”

Staff said when people were unwell, they would either speak to the senior care staff or contact a health care professional. However, staff we spoke with lacked an understanding of how to monitor and prevent other health concerns including constipation and how to support people’s emotional wellbeing, it was not clear that deterioration in people’s health was being identified and appropriately escalated.

Most people living at the service were living with dementia or had a mental health diagnosis. The care plans lacked details of how people can be supported with their wellbeing in relation to their dementia diagnosis. For example, staff recorded in one person’s daily care notes their mood was low, ‘2 out of 5’. This person could become anxious due to their dementia which was included in their individual care plan. Their care plan did not provide guidance for staff on how to support them on those occasions and what to do if their mood was low. There was no information on how staff supported this person on the days when it was noticed the person was anxious People were supported with other health care including dental, opticians and hearing appointments.

We didn’t receive direct feedback from people or relatives in relation to this. However, we found people’s care and support was not always coordinated and planned in relation to their needs.

The registered manager told us they monitored people’s fluid intake, nutritional intake, oral health care and falls. They were unable to tell or show us how they monitored people’s high levels of anxiety and changes in their mental health needs. This meant people may not be supported appropriately.

The provider failed to ensure people’s high levels of anxiety were monitored, so they could look at ways of reducing these for better outcomes for people. We noted 1 person was being given regular ‘as and when’ anti-psychotic medicine. No action had been taken to monitor this to determine why the person’s anxiety may be increasing, and if medication was the best method of reducing it. Staff carried out audits to review people’s other health needs. For example, staff monitored support people received with hydration and levels of urinary tract infections were low in the service. People’s weight was being monitored and where a person was losing weight, action was taken to address this.

People told us they were not always consulted in relation to their care or whether they wanted to live at the service. One person told us they felt they could not always make their own decisions and said, “I feel it’s a bit restrictive, more than it needs to be.” Relatives did tell us, where appropriate to do so if people lacked capacity, they were contacted to seek consent in relation to any decisions that needed to be made relating to their loved one’s care.

Staff did not have a good understanding of the principles of the Mental Capacity Act 2005. This meant there was a risk the appropriate consent was not sought before decisions were made in relation to people’s care.

The service did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. For example, people’s mental capacity assessment documented multiple different decisions at once rather than assessing each specific decision. There was a lack of evidence in some care plans around how people were involved in the assessment, how information was provided or what adjustments were made, and what the person views were. Where it had been deemed the person lacked capacity, there was not always evidence of a best interest meeting to determine the least restrictive support and care options. There were restrictions being placed on people without evidence their capacity had been assessed. For example, 1 person was on a modified texture diet. However, the person would seek food that was not modified. The registered manager told us they reminded staff to ensure these foods were not left around for the person to have. They had not considered whether the person was able to consent to the modification of their diet and whether they understood the risks.