Mount Lodge

Updated 19 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This inspection took place on the 25 and 29 October 2018 and was unannounced. The inspection team consisted of one inspector.

Before the inspection we checked the information we held about the home and the service provider. This included information from other agencies and statutory notifications sent to us by the registered manager about events that occurred at the service. We also reviewed the information sent in by the provider and registered manager in the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service; such as what they do well and any improvements they plan to make.

We observed the interaction between people, visitors and staff and the care and support provided in communal areas of the home. We spoke with six people and a relative. We spoke with five staff including the trainee service manager, who has day to day responsibility for the service.

We looked at the care plans and associated records for three people. We reviewed other records, including medicine records, accidents and incidents and staff files.

We asked the trainee service manager to send us copies of records after the inspection including statement of purpose, staff rota and service users guide. These were sent to us as requested.

Updated 19 December 2018

This inspection took place on the 25 and 29 October 2018 and the first day was unannounced.

Mount Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home was registered to provide personal care and accommodation for up to 15 young adults with mental health and emotional needs. At the time of the inspection there were 13 people living there.

At the time of this inspection the registered manager had applied to de-register. The trainee service manager told us they would be applying to register with CQC as the registered manager and was in the process of completing their application. They were at the home for the inspection and were responsible for the day to day management of the home. A registered manager is a person who has registered with 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.

During the inspection there was considerable discussion about how the staff saw their role in supporting people to be independent and work towards moving from a care environment to living with support or independently in the community. Since the last inspection there has been more involvement of mental health professionals within the organisation. A psychotherapist was employed in the last year and the provider plans to employ a psychiatrist to work as part of the staff team, to offer people additional support. As part of the changes there have been ongoing discussions with CQC about the regulated activities that Mount Lodge is registered to provide. Staff spoke about moving away from support with personal care and some staff explained as recovery practitioners they were not trained to provide this. We found the focus was moving towards a supported living service rather than a residential care home and staff agreed they were moving away from 'care' towards independence. However, Mount Lodge is currently registered to provide the regulated activity 'accommodation for person who require nursing or personal care'. The expectation was they would offer this to people living in the home and the service has been inspected as a residential care home.

Consequently the rating of Good from the last inspection has changed to an overall rating of Requires Improvement as improvements were needed in some areas with regard to the services current registration.

The quality assurance and monitoring system was not effective. Although audits looked at all areas of the services provided they had not identified the concerns we found during this inspection. For example, the home was not well maintained, staff had not followed the fire risk assessment and there were not enough staff consistently working at the home, with the skills to offer support when people needed it. For example, agency staff.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff said people could communicate their needs and were aware that people’s changing behaviour was a form of communication.

We recommend appropriate training is provided to enable staff to have a clear understanding of AIS.

Staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been requested when needed to ensure people were safe. People were protected from the risk of abuse as staff had completed safeguarding training and knew what action to take if they had any concerns.

Robust recruitment procedures ensured only suitable staff were employed and staff completed relevant training, including medicines, health and safety and equality and diversity. Additional training, such as, conflict management, enabled staff to understand how best to support people to calm down, or distract them if their behaviour was inappropriate. Supervision and staff meetings kept staff up to date with current best practice and they had a clear understanding of their roles and responsibilities as recovery practitioners.

Support plans were written with and agreed by the person concerned and people made decisions about all aspects of the support provided; which was planned around their individual needs and preferences.

People said the food was good. They decided what meals would be on the menu and they shopped for essentials with staff. People were supported to cook meals if they wanted to and one person said they liked to cook meals.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.