This inspection took place on 8 and 10 May 2018. The first day of our inspection visit was unannounced.

Montgomery House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Montgomery House is registered to provide nursing and personal care to a maximum of 90 people. It provides a service to older people and younger adults who may have dementia, learning disabilities or autistic spectrum disorder, mental health needs, physical disability or sensory impairment. At the time of our inspection 75 people were living at the home.

Montgomery House accommodates people across five separate units, each of which has separate adapted facilities. Two units specialise in providing care to people living with dementia, one of which is nursing. Two units support people who require nursing care and one unit provides residential care.

A registered manager was in post and present during 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 2008 and associated Regulations about how the service is run.

At the last inspection in June 2017, we rated the service as Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

The provider’s quality systems had not ensured records relating to people’s care, medicines and safety were always accurately maintained. Risks to people who used the service were assessed but these did not always give information on how the risk was to be safely managed and records were not always accurately maintained. Environmental risks were not always minimised and we found areas of the home that should have been kept secure for people's safety were not. This gave people access to areas with equipment and substances which could pose a risk to their health and safety. Food fridge temperatures were not monitored as per the provider’s procedures and this meant the provider could not be confident that foods were fit for consumption.

There were not always sufficient staff to meet people’s needs and to help keep them safe. Agency staff were used to cover shortfalls in staffing levels. However, staff were kept busy and could not always ensure people received a person centred approach to their care and support. As a result people did not always feel confident with the staff that supported them.

People did not always feel listened to when they raised concerns about their health. Not all staff understood people’s specific needs, despite receiving the training they needed.

Staff did not always demonstrate positive interactions and engagement with people and people felt they were too busy to spend quality time with them.

People's experiences of the support they received to eat and drink differed throughout the home. Staff did not always maintain accurate records of what people had to drink in line with their care plans. This placed people at risk of not having enough to drink to promote their health.

People and their relatives were able to express their views on the service and to participate in care planning and reviews. Staff worked with outside professionals to help ensure the effectiveness of care provided.

Staff asked people’s permission before they helped them with any care or support. Staff respected people's right to make their own decisions and supported them to do so. Where people were unable to make their own decisions systems were in place to ensure decisions made were in their best interests.

Staff understood their individual responsibility to protect people from potential abuse. The provider had safe recruitment systems in place to en

This unannounced inspection took place on 27 June 2017. Montgomery House provides nursing and personal care for up to 90 people. Some people were living with dementia. At the time of our inspection 72 people were living there.

The home is a new build and this was the first inspection of the service. 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. The registered manager was away from work and was not present at this inspection.

The systems for assessing the quality of the service were not consistently used or reviewed by the provider to ensure lessons were learnt and improvements made.

There were varying opinions about staffing levels from staff, people and relatives. The provider had assessed people's dependency levels and provided some agency staff when the service fell short of that needed to meet people’s needs.

We found that people may not always be protected against the risks associated with abuse. Care staff understood what abuse was and how this was to be reported. Referrals had been made to the local authority, but not consistently.

People were protected against the risks associated with the unsafe management of medicines. There had been an error and management had responded to this and medicines were available as prescribed.

People were protected against the risks associated with meeting their nutritional needs. People were assessed for nutritional risk and appetising meals were provided.

People were able to make choices and decisions and staff supported them to do this. Healthcare professionals visited when required and clear records were kept of the visits. There was evidence of communication from the mental health team and their guidance was followed.

People were supported by staff that were trained and had access to training to develop their knowledge. Most people were treated with kindness and care. We observed most staff engaged with people in a positive way and they were caring when they supported them. Relatives felt welcomed in the home and told us the staff were kind but could do more to engage with people to get to know them well.

People had some activities to choose from. The provider intended to make better links with the local community so people could socialise outside the home.

Staff meetings were starting to be held. Resident and relative meetings were yet to start. People had not been able to formally contribute to the running of the home.