Mount Lodge

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.

The home is a detached older building in its own grounds, just off a main road through Eastbourne, with accommodation on three floors. There are large communal seating areas on the ground floor, a garden to the rear and car parking spaces to the front of the building.

A registered manager was responsible for the day to day management of the home. 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.

The inspection took place on the 9 February 2016 and was an unannounced, which meant staff did not know we were coming.

People were involved in decisions about the support and assistance provided, they felt safe and comfortable. Risk had been assessed to ensure people were able to take risks and, if staff support was required this was agreed with each person. Such as, the time and day when staff were going with a person to withdraw money from their bank.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (Dols) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were up to date with current guidance to ensure people were protected.

There was an open and relaxed atmosphere in the home and people were encouraged to be involved in decision about the support they received. People told us they made decisions about what they did and how they spent their time. One person said, “It is up to us what we do and staff support us.”

People had access to health care professionals, which included the psychiatrist, community mental health team, the GP, optician and dentist. Staff supported people to maintain a healthy diet and if they lost weight, or their appetite, there were systems in place to support them. The menus were based on people’s preferences; they chose what they wanted to eat and said the food was very good.

A complaints procedure was in place. This was displayed on the notice board, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them.

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Processes were in place that ensured that people were supported to make informed choices and to give valid consent to the care and support they received.

The home's staff worked with a variety of healthcare professionals such as mental health teams and local doctors. Risks to people's safety were identified and managed.

Procedures were in place to ensure that people were protected from risk of abuse or harm and staff had received relevant training.

A robust recruitment and selection process was undertaken and relevant personal records gained prior to staff taking up employment.

Staff said they were happy working in the home, comments included. 'I really enjoy my job, it's different every day. We have a very good team committed to the people we support and a very supportive manager.'

Policies and procedures were in place to identify and deal with complaints and concerns and people told us that they were listened to.

A family member told us. 'It's a good place for my son, he has people around all the time to help him and the staff are very nice. I am always invited to meetings and made welcome at any time.'

A professional that visited the home said. 'I have seen fabulous positive changes for one of my clients, they are starting to engage with their key worker and access the community.'