- Care home
Mountfield House Care Home
All Inspections
10 August 2022
During an inspection looking at part of the service
Mountfield House Care Home is a care home providing accommodation and personal care to a maximum of 14 people over the age of 65 years in one adapted building. At the time of our inspection there were 13 people using the service.
People’s experience of using this service and what we found
People were not always protected from environmental risks because there were no effective systems in place to identify, monitor or mitigate risks. We were mostly assured the provider was meeting key principles for infection prevention and control at the service, including for COVID-19. However, some areas required attention to ensure cleaning could be carried out effectively. The provider's quality assurance procedures had not been effective in identifying the shortfalls we identified at the inspection.
People received their medicines when they needed them. People felt safe living at the home and with the staff who supported them. Staff had been trained to recognise and report any signs of abuse. The provider’s staff recruitment procedures helped to protect people from harm. Risks associated with people’s care were assessed and there were plans in place to mitigate risks.
The provider regularly sought the views of people, relatives and staff. Staff morale was good, and staff told us they felt well supported. Staff received the supervision and support needed to carry out their role effectively. The provider worked in partnership with other professionals to ensure good outcomes for people. The provider was aware of their legal requirement and of their responsibility to be open an honest when things go wrong.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was good (published 10 March 2020).
Why we inspected
We received concerns in relation to the management of risks relating to the care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safety and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mountfield House Care Home on our website at www.cqc.org.uk.
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.
4 February 2020
During a routine inspection
Mountfield House is a residential care home providing personal care to up to 14 people aged 65 and over. There were 13 people receiving support at the time of the inspection. The home accommodates 14 people in one adapted building.
People’s experience of using this service and what we found
Improvements had been made since the last inspection. People’s preferences about when to get up were respected and improvements had been made to the governance and oversight systems to ensure care was safe and effective.
People told us they felt safe. Staff knew how to identify and report concerns for people’s safety. Risks were assessed and managed to reduce the risk of avoidable harm. Staff had been recruited safely. Where things went wrong, learning took place and changes were made to reduce the likelihood of reoccurrence.
People’s needs and preferences were assessed prior to them moving in to the home. Staff received training relevant to their role which helped them provide effective support. People received enough food and drink, according to their individual preferences and support to manage their health needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People described staff as kind and felt they knew them well. People were supported to make their own decisions and felt staff listened to them and respected their choices. People were encouraged to remain as independent as possible and staff respected their privacy.
People’s needs had been assessed and were reviewed regularly. Staff supported people to take part in activities or follow their own individual interests. People knew how to raise a concern about their care. People’s choices for end of life care had been discussed with them and recorded, so their wishes would be respected.
This had driven improvement in care planning, risk assessment and the monitoring of medicines administration. People, relatives and staff spoke positively about the management of the home. People, relatives and staff were given opportunities to share their feedback about the home and suggestions were welcomed and used as a way of improving the care provided. The provider was open and honest throughout the inspection and had used the findings from the last inspection to make improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 19 February 2019) and there were two breaches of regulations. We imposed conditions on to the provider’s registration which required them to submit monthly reports about how they were assuring the governance of the service. They complied with these conditions and demonstrated to us people were no longer at risk from poor governance.
The provider also completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
12 November 2018
During a routine inspection
There was a registered manager in post who was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.’
At our last inspection on 18 October 2016 we rated the provider as ‘good’. At this inspection we found that improvements were required and the service is now rated as ‘requires improvement’.
Staff had not recognised an incident between two service users as meeting the criteria for reporting and therefore the correct process had not been followed. Lessons were not always learnt when things went wrong.
People’s preferences were not met in relation to what time they got up. People were not encouraged to follow their individual interests and people told us that they would like more to engage in. Staff had not always been responsive in relation to people’s foot care needs.
The provider’s audits in place did not identify the shortfalls we did during our inspection. There was no oversight of delegated roles and responsibilities. People’s care plans were not reflective of their current needs and had not been reviewed following incidents.
There were enough staff to meet people’s needs. People told us they felt safe. The home was clean and tidy and staff wore personal protective equipment (PPE) as required.
People were supported by staff who had the skills to meet their needs. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and sought consent people supporting people. People’s nutritional needs were met. People had access to professionals when required.
People were supported by kind and caring staff who knew them well. People’s privacy and dignity was maintained. People were encouraged to remain as independent as possible.
People and relatives knew how to raise concerns with the registered manager and felt comfortable doing so. We saw that complaints were dealt with appropriately.
People, relatives and staff spoke positively about the registered manager. People’s feedback was sought and acted on. Staff told us they felt supported.
We found the provider was not meeting the regulations around person centred care and the overall governance of the service. You can see what action we told the provider to take at the back of the full version of the report.
18 October 2016
During a routine inspection
At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.
People told us they felt safe living at the home. Staff knew what action to take if they had any concerns about people’s safety. People’s individual risks were assessed and staff knew how to manage these risks when providing care. The registered manager responded appropriately to issues regarding medicines. People told us there were enough staff available with the appropriate skills to support their needs. Staff received training and felt they had the skills to meet people’s needs. The provider had safe processes in place to recruit new staff and carried out pre-employment checks.
Staff obtained consent from people before they provided care. Staff understood people’s rights and choices when supporting them .People told us they enjoyed their meals and had sufficient to eat and drink. People told us they had access to healthcare professionals when needed. People said staff discussed their care needs with them. They said staff were kind and friendly. Staff supported people’s independence. People were involved in group and individual activities. People felt listened to and able to raise concerns they may have.
Staff understood their roles and responsibilities and felt supported by the registered manager. Systems were in place to monitor and improve the quality of the service people received.
17 and 18 December 2014
During a routine inspection
The inspection took place on the 17 and 18 December 2014 and was unannounced. At our last inspection on the 6 November 2013 the regulations inspected were met
Mountfield House Care Home is registered to provide accommodation and support for 14 older adults with dementia, mental health, physical disability and sensory impairment. On the day of our inspection there were 14 people living in the home and there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.
People we spoke with told us they felt safe. The relatives we spoke with told us that people were safe within the home. Our observations were that people were happy and staff interacted with people in a loving and caring manner. Staff we spoke with were able to explain the actions they would take to ensure people were kept safe from harm. Records showed that staff had received the appropriate safeguarding training to know how to keep people safe.
We found that where people were administered medicines ‘as required’, there was not an individual protocol in place to guide staff as to when these medicines should be given where they are not prescribed. This would reduce any potential risks to people’s safety.
We found that staff were not always available to support people when needed. Our observations were that during meal times people in the dining room who needed help to get their food cut up by staff had to wait. This was due to staff having to support people in the lounge area to eat and there being no staff available in the dining room area. This meant people would not get the support they needed when they needed it.
We found that the provider had the appropriate medicine procedures in place so staff had the skills and knowledge to administer medicines safely. We found that where people needed medicines on an ‘as required basis’ rather than a regular daily regime there was a protocol in place to advise staff. However the process was a general process and did not give specific guidance to staff as to people’s medicine needs on an individual basis. So where people may have specific risks these may not be identified.
The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. CQC is required by law to monitor the operation on the DoLS and to report on what we find. We found that people’s rights were not being protected in line with the legislation. Staff we spoke with had not had any training and where people who lacked capacity were unable to give consent or their liberty was being restricted the appropriate actions had not been taken.
People we spoke with told us how lovely the meals were and that they were able to decide on what meals they had. Our observations did not identify how easy it was for people to get hot and cold drinks. However, people and relatives we spoke with told us they could get a drink whenever they wanted one.
People and relatives we spoke with told us that staff were respecting the dignity, privacy and independence of people. Staff were able to explain how people’s dignity was being respected in how they supported people.
We found from our observations that people were not being interacted with on a regular basis either through staff communicating with them or through activities that were identified within the care records as part of the preferences or interest. People were left for over an hour at time throughout the day with no stimulation or just left to sit and sleep. On arrival to the home this was very apparent as staff were busy supporting people to get up and the member of staff in the lounge was busy administering medicines. It was unclear as to how much importance was given to people being mentally stimulated on a regular basis as part of their identified preferences in their care records.
People and relatives we spoke with told us that although they had not been given a copy of the complaints process they knew how to complain. They told us that they had not had cause to complain. Records identified there was a process in place and where complaints had been received they were being investigated and the appropriate record kept of the outcomes/action taken. We found that monitoring of trends to improve the service to people was ongoing.
People and relatives we spoke with told us the service was well led. The staff we spoke with confirmed they were able to get support from the registered manager when needed. We found that systems were in place to communicate with people, relatives and staff, however improvements were still needed in how the service was audited in terms of delivering a good quality service. You can see what action we told the provider to take at the back of the full version of the report.
6 November 2013
During a routine inspection
People made positive comments about the service. One relative told us: "All the staff are spot-on and take action if they need to. I can't fault the care. I am satisfied that X is safe and that they love her". We saw that people were consulted about their care and their views reflected in the way that care was delivered.
People experienced care, treatment and support that met their needs and were encouraged to remain as independent as possible. One relative told us: "There has been a transformation since X was admitted.They previously had low motivation".
We saw that people had a positive dining experience and that food and drinks were available to them at all times with staff assistance if needed.
There was a system in place to ensure that people were protected against the risks associated with medicines. We found that people received medicines safely and as prescribed.
People were cared for by staff who were qualified, skilled and experienced to meet their needs. The majority of staff held a care qualification.There were enough staff on duty to meet people's care and welfare needs.
Care records contained accurate information about people's individual care needs. Risk assessments were in place and had been regularly reviewed. People were protected against the risks of unsafe or inappropriate care and treatment.
15 January 2013
During an inspection looking at part of the service
We found that improvements had been made in the way that people's care was planned and delivered. One person said, 'They look after me so well here, I am really happy.'
Arrangements were in place to safeguard people from harm.
Staff had received their mandatory training in a timely manner. One staff said, 'I am up to date with all the training now.'
Systems to monitor the quality of the service provided to people had improved.
12 July 2012
During a routine inspection
We saw that people wore clothing that reflected individual choices and preferences. We saw that staff engaged with people in a positive manner and promoted people's independence throughout the day. Records showed that people were involved in reviewing their care and support plan on a regular basis. This meant that people were involved in the planning of their own care.
We found that people's care needs were not always delivered in-line with their individual care plan. We also found that staff did not always follow care instructions from other healthcare professionals. This meant that people did not always receive care that met their needs.
We found that arrangements were not in place to ensure that allegations of abuse were identified, managed, and reported appropriately. We found that improved arrangements were required to ensure that people's money was safeguarded.
We found that not all staff had received updated mandatory training. However, records showed that staff were supported through induction, supervision and meetings.
We found that there were effective systems to assess the quality of services. However, improvements were needed to ensure that all risks in the home were identified and managed.
20 July 2011
During an inspection looking at part of the service
The people who were able to speak with us told us that the staff were very good to them; they had comfortable bedrooms, were warm and felt secure. They told us that they enjoyed the food that was provided and that they could request alternatives if the menu was not to their liking. One person stated that they particularly liked the breakfasts and looked forward to it each morning.
One person told us of the weekly outing they enjoyed to a fellowship group but as they were not feeling too good they were going to 'give it a miss'. Staff arranged contact with the group explaining the person's decision not to attend.
Another person stated that they would prefer to be at home with their family but acknowledged that this would be difficult and went on to say that they were 'quite comfortable'.
We spoke with the people who found it difficult to verbally communicate they said that they were 'alright' and confirmed this by nodding and smiling. We observed people looking cosy and comfortable, staff were in constant attendance acknowledging and speaking with people in a caring and compassionate way.
One person became very uncomfortable with sitting in the lounge, they did not communicate verbally with staff about this. Staff were quick to recognise the way the person was feeling, they asked the person if they would like to have a lie down and helped them to do so.
A visiting health care professional told us that in their opinion they felt the people were well cared for and that they had no concerns or complaints with the service.
23 March 2011 and 4 March 2012
During a routine inspection
People who did speak with us told us that they were satisfied with being at Mountfield House, the staff were very good to them and that they had enough to eat.