Monson Retirement Home

People’s experience of using this service and what we found

People’s prescribed medicines were not consistently stored, administered, or managed safely. This put people at potential risk of harm.

A registered manager was not in place and the provider’s senior management team, had day to day responsibility of the service. A new deputy and manager had been recruited and were due to commence.

The provider had and continued to experience, staff recruitment and agency staff difficulties. The provider had taken all reasonable action to address these issues and some improvements had been made. Whilst the provider used a dependency tool to assess staffing requirements, concerns were identified with the safe staffing levels the provided had risk assessed for. The provider agreed to ensure the optimum staffing levels they had assessed as required were consistently met. Following the inspection, the provider submitted staff rotas to confirm this.

The provider had safe staff recruitment checks and staff received ongoing training and support.

Risks associated with people’s care needs had been assessed and were regularly monitored. A new electronic care record system was being introduced and people’s care plans and risk assessments were all being reviewed. A sample of the new care records were found to be more detailed and person centred. The provider had a short time scale to complete these reviews.

The provider had systems and processes that regularly monitored the health and safety of the premises, equipment, and the environment. Fire safety remedial action had been completed and some refurbishment and redecoration work had been completed since the last inspection and this was ongoing. Incidents were analysed for themes, patterns, and any lessons to reduce further risks.

Infection prevention and control measures overall followed best practice guidance. Some practice issues were identified in how soiled laundry and mop heads were managed. The provider took action to address this.

People who used the service, relatives and a visiting professional were overall complimentary about the approach of staff, who they described as being kind, caring and attentive. Concerns were raised about changes within the management team and people were looking forward to having a stable and effective management team.

The providers senior leadership team had day to day responsibility and development for the service. There was ongoing oversight with clear roles, responsibilities, and accountability. However, this needed to be improved upon within the staff team, to ensure the provider’s policies and procedures were consistently followed.

The provider had used and improved, systems and processes that monitored the safety and quality of the service. A robust improvement plan was in place that reflected the shortfalls identified during this inspection.

People, relatives and staff received opportunities to share their experience and feedback about the service. The provider took positive action in response to feedback received to make improvements.

Staff had developed positive partnerships with external health and social care professionals to support people to achieve positive outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 11 September 2020).

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Monson Retirement Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the management of people’s medicine at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found

Relatives we spoke with felt their family members were safe at the service and that the service was being managed well. Staff were provided with safeguarding training and understood their responsibilities in relation to keeping people safe from harm.

People were protected from the risks of infection as the registered provider had processes in place to minimise the risks of the spread of infection.

The registered provider had improved the arrangements in place to monitor and review the care people received and ensure care plans and risk assessments reflected people's needs.

Staff were recruited safely and people were supported by adequate numbers of staff. Staff had received training and appropriate levels of supervision for their roles. People’s medicines were managed safely.

Relatives told us they were involved in their family member’s care. Staff worked with health professionals to support the people and ensure care was delivered in a joined-up way. A range of management systems and quality audits were in place to enable the home to continue to keep improving the care people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 11 February 2020). There were multiple breaches of regulations. The registered provider 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 registered provider was no longer in breach of regulations.

Why we inspected

We carried out this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (1) (safe care and treatment) and Regulation 17 (1) (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition to the warning notice we had also previously found that the registered provider was in breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led.

This report only covers our findings in relation to the key questions safe and well-led and the breaches of regulations identified at the last comprehensive inspection. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained at requires improvement. This is based on the findings at this inspection.

As part of this inspection we also looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

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.

Monson Retirement Home is a residential care home for up to 50 older people and people living with dementia. At the time of inspection there were 31 people living at the home.

People’s experience of using this service and what we found

Monson Retirement Home had changed owners in May 2019. There had been a Registered Manager who deregistered in October 2019. The new provider had failed to provide enough oversight of the home between June and October 2019. This led to systems to assess, monitor and improve the quality and safety of the home not being implemented or embedded.

Since November 2019 the provider employed an experienced management team who had begun the process of implementing procedures to improve all areas of the home. For this reason, all the planned systems and processes were in their infancy and required completion or embedding into practice.

The provider had an action plan for all the areas they had identified and those we identified at this inspection. Their action plan required time and resources to complete. The provider continued to commit the resources required.

People’s risk assessments and care plans did not always reflect their current needs. The management team were training staff in a new care planning system and had yet to transfer people’s records to this. Staff did not always have information about people’s current needs, which put people at risk of not receiving all the care they needed. The management team put measures in place to inform staff of people’s needs at handover.

The provider was supported staff to improve their skills and knowledge in safeguarding and reported and acted upon concerns.

The provider did not have access to historical records of staff training, supervision or appraisals. This meant they could not be sure what training staff had received. They had implemented a programme of training and supervision which would take time to complete.

The provider did not have all the systems and processes in place to assess, monitor and improve all areas of the home. The management team were setting up a programme of planned audits.

Following an independent external audit in August 2019, the provider was undertaking fire safety and electrical works to comply with fire regulations. These had not been completed at the time of the inspection.

The home required changes to the environment to be suitable for people living with dementia.

There were enough staff deployed to provide people’s care, there were care staff vacancies that were being covered by agency staff. People received their medicines safely. Staff identified when people became unwell and referred them to medical professionals promptly.

Permanent staff knew people well and had formed good relationships. People were regularly engaged in activities they enjoyed and involved people from their local community.

The management team responded to complaints, they followed the provider’s complaints policy. The provider held their first meeting with people using the service and their relatives; they implemented suggested changes and improvements to the home.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to risk assessments, safety of the environment, staff training, supervision of staff and management oversight. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received excellent care that was individualised and person centred. Their choices and wishes were promoted and respected. People had formed excellent relationships with staff and were encouraged to maintain relationships with their family and friends.

People were actively supported by staff who promoted their independence, and managed their privacy and dignity in a sensitive manner.

Staff understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Risks to people’s health and safety were regularly assessed and action taken to reduce the risks.

There were sufficient numbers of staff employed and people’s needs were met in a timely manner because staff were organised and well deployed. People received their medicines when they needed them and medicines were stored and recorded appropriately.

Staff received regular and appropriate training for their roles and understood their responsibilities in obtaining consent when providing care for people.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition as staff had a good knowledge of people’s dietary requirements. Mealtimes were a sociable and supported time with staff working together to ensure it was an enjoyable experience.

People health needs were managed well with staff working with health professionals to ensure all concerns were managed in a co-ordinated and timely way.

People received care from a group of staff who were caring and kind. They promoted people’s independence and worked with people to ensure they achieved the best level of independence they could.

People were supported by staff who treated them in a respectful and inclusive manner and their opinions and views on their care were recognised and acted upon.

People were encouraged to remain socially active and the service provided a wide range of supported activities for people and their families.

People felt they could report any concerns to the management team and they would be taken seriously. The management team were approachable and proactive in developing the quality of the service for the benefit of the people who lived there.

As part of our inspection visit we spoke with six people who lived at the home and the relative of one person. We also spoke with the manager and four staff members.

People told us staff were caring and responded to their changing needs. One person said, 'I have to say the care is excellent and staff keep coming when I call them.'

We found people were supported to undertake a range of activities. One person said they liked playing games and enjoyed listening to music. The person said. 'There always seems to be a lot happening and I don't have to join in if I don't want to.'

People told us they enjoyed all the meals they had and there was always plenty to drink when they wanted it. A relative we spoke with said, 'A good range of food is provided. XXX needs a special diet and they sort that out.'

Staff we spoke with told us they felt they had the right levels of management support, supervision and training to meet people's needs.

There were systems in place for the provider to regularly monitor and assess the quality of care people received. The home owners and manager demonstrated they took action to address any issues or concerns raised and learned lessons from them.