This inspection was carried out on 27 and 28 April 2015. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received.
Mont Calm Residential Home provides accommodation and personal care for up to 39 older people. There were 25 people living at the service during our inspection. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Accommodation was provided in two adjacent houses. There was a passenger lift between floors in each house.
The service did not have a registered manager. The previous registered manager had ceased working at the service in December 2014. The provider told us that a new manager was due to start working in the service during the week of our inspection.
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 2014 and associated Regulations about how the service is run.
At our previous inspection on 19 and 20 January 2015 we found breaches of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We took enforcement action and required the provider to make improvements. We issued four warning notices in relation to care and welfare; safeguarding people from abuse; quality assurance and having enough staff. We found six further breaches of regulations. We asked the provider to take action in relation to nutrition, privacy and dignity, obtaining consent; handling complaints; staff training and record keeping.
The provider gave us an action plan on 6 February 2015 but did not provide timescales by which the regulations would be met. The provider did not send us the updates we requested in relation to progress they had made.
At this inspection we found that some improvements had been made but the provider had not completed all the actions they told us they would take. In particular they had not met the requirements of the warning notices we issued at out last inspection. As a result, they were breaching regulations relating to fundamental standards of care.
Some people made complimentary comments about the service they received. People told us they felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Most of the relatives who we spoke with during our visit were satisfied with the service.
Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. The provider was not aware of some incidents of abuse and had therefore not notified these to the relevant authorities to make sure people were protected from the risk of abuse.
Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. The provider had not arranged for a fire safety risk assessment to be carried out by a suitably qualified person to make sure people were protected from the risk of fire.
People were not always provided with enough to eat and drink. One person had experienced significant weight loss. Action had not been taken in a timely manner to ensure they were protected them from malnutrition. People were not offered choice at mealtimes in ways they could understand.
Some people had not received their medicines as prescribed. Suitable arrangements were in place for managing medicines, but the recording of some medicines did not follow guidance issued by the National Institute for Health and Clinical Excellence.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had not submitted Deprivation of Liberty Safeguards (DoLS) applications for most people, although they were aware of the requirement to do so. People’s mental capacity had not been assessed before decisions were made on their behalf.
The provider did not have an effective system to assess how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times. We observed that there were not enough staff deployed to care for people effectively.
Staff had not received training in managing people’s behaviours that had a negative effect on themselves or others. Staff had not been trained in privacy and dignity or how to meet some people’s specific needs.
The complaints procedure was out of date and did not provide information about external authorities people could talk to if they were unhappy about the service. People told us they would speak to staff or the provider. We have made a recommendation about this.
People were not always involved in planning their care and their spiritual needs were not taken into account. We have made a recommendation about this.
People were not always provided with personalised care. They were not provided with sufficient, meaningful activities to promote their wellbeing.
Staff were cheerful and patient in their approach and had a good rapport with people. The atmosphere in the home was generally calm and relaxed and there were lots of smiles and laughter.
People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received. People were consulted through resident’s and relative’s meetings and their views taken into account in the way the service was run.
Most staff had received the essential training and updates required, such as food hygiene and fire safety training, to meet people’s needs.
People were generally complimentary about the food and drinks were readily available throughout the day.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
Ensure that providers found to be providing inadequate care significantly improve
Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
You can see what action we told the provider to take at the back of the full version of this report.