This inspection was unannounced and took place on the 25, 26 and 28 October 2016. At the last inspection on 23, 24 and 26 June 2015 we found that the provider had breached three regulations associated with the Health and Social Care Act (Regulated Activities) Regulations 2014 (HSCA 2014). These related to: the provider not managing risks in relation to people’s food allergies appropriately; not ensuring that complete, accurate and contemporaneous records were maintained relating to people’s care; and staff not receiving appropriate training to enable them to carry out the duties they were employed to perform. We told the provider they needed to take action and we received a report setting out the actions they would take to meet the regulations. At this inspection we reviewed whether or not these actions had been taken and the provider was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding two of the breaches identified concerning staff training and food allergies. However we found one continuing breach regarding the complete, accurate and contemporaneous completion of documentation and a new breach with regards to meeting the requirements of the Mental Capacity Act 2015 (MCA). We have also made two recommendations regarding the design of the environment and activities provided for those people living with dementia.
Mountwood is a home which provides nursing and residential care for up to 39 people who have a range of needs, including those living with dementia, epilepsy and the detrimental effects on people’s physical health following a stroke. At the time of our inspection 33 people were living in the home.
Mountwood is a two storey building with its own secure garden situated on the outskirts of the town of Andover. The home comprises of 40 single rooms, 36 of which have en-suite facilities. Access to the first floor is by a passenger lift and main staircases are accessible via user operated keypads. On the ground floor is a communal lounge with a separate activities room/lounge area, the home’s kitchen and a dining room as well as laundry facilities and a nurse’s station. On the first floor there is a joint lounge and dining area with tea making facilities available in a small kitchenette and a further nurses station. To the front of the property is a newly secured garden area with raised flower beds, seating and bird tables to provide interest for people living in and visiting the home.
The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.
People were assisted to receive their medicines as prescribed. However people’s records in relation to these medicines were not accurately and fully completed which meant it could not be identified if people were receiving the care they required in order to keep them safe and manage their pain.
People were not always supported by sufficient numbers of staff. The provider was regularly using agency staff to support staff working at the home and had taken action to increase the number of staff employed. People were receiving the care they required however would sometimes have to wait to receive care. Records regarding the care people received were also not completed fully as a result of these staffing shortfalls.
People were supported by staff to make their own decisions regarding the day to day care they received. However documentation did not always show that people’s decisions regarding their care had been appropriately assessed and documented prior to care being delivered in accordance with the requirements of the MCA We could not always see that assessments and appropriate decision specific best interests meetings had been held before a course of care was delivered.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted. However these had not always been accompanied with the required appropriate MCA assessment and best interest decision documentation.
People’s care plans and documentation were not always subject to regular monthly review. Whilst appropriate risk assessments were in place for most people we could not always see that staff had been provided with the most up to date information regarding people’s care. Agency staff responsible for administering medicines did not always have the most accurate information available allowing them to support them in their role. People were at risk of not receiving the care they required to meet their needs and wants.
The registered manager was supported by a clinical lead who was responsible for overseeing the completion of documents and records specifically relating to peoples care. We could not always see the registered manager had been supported by the provider and the clinical lead to ensure that records were effectively and accurately completed for people living in the home. Quality assurance processes were also not always completed effectively. Processes did not always identify where information relating to people’s care was inaccurate or missing allowing appropriate action to be taken to ensure people received the care they required to meet their specific needs.
Staff provided care to those living with dementia, however, the environment did not always support people to move around the home safely and to remain independent. Corridors were well lit however flooring was not always appropriate to support those with limited eyesight. Continual changes in type and colour of flooring would not assist those with limited vision as a result of their condition to be able to move effectively around the home. Appropriate signage in communal areas was not always in place allowing people to orientate themselves independently around the home.
We have made a recommendation about having an appropriate environmental design to support those living with dementia to mobilise independently.
The provider sought to engage people in activities however we could not see that all the activities provided supported those living with dementia to fully participate in familiar and recognisable tasks.
We have made a recommendation about having additional activities to enable people living with dementia to participate fully.
Relatives of people living at the home told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.
People were supported by staff who had been through a thorough recruitment procedure to ensure they were suitable to deliver care. Staff had received an effective induction into care delivery. All new care staff were required to complete initial induction training and accompany experienced members of staff whilst they completed their role to see what was required of them. Regular supervisions were not always being completed in line with the provider’s guidance. However staff told us they were able to express concerns at any time with the registered manager and their colleagues and felt supported as a result.
Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding.
People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed or diabetic diet, received these and the food was pleasantly presented.
The staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.
Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.
People told us they knew how to complain and all said they would speak with the registered manager and senior staff if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during participations in the completion of annual survey questionnaires and providing feedback to an independent survey company.
The provider’s mission statement regarding the quality of the care people were to receive whilst living at Mountwood were openly displayed within the home but were not immediately known by staff. However staff were able to describe how the registered manager wanted them to treat residents and they demonstrated they knew these standards of providing care which was respectful of people’s dignity. We could see these standards were evidenced in the way care was delivered.
The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to receive care themselves. The registered manager had fulfilled the requirements of their role as they had informed the CQC of notifiable incidents which occurred at the home allowing the CQC to monitor that appropriate action was taken to keep people safe.
We found a continuing breach and a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told th