We carried out a comprehensive unannounced inspection at Montrose Care Home on 26 October 2018. At our last inspection on 16 May 2018 we found that there were serious failings from management and staff to ensure people received care and support in a safe and effective way. We found breaches of Regulation 12, 13, 9, 14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider was in breach Regulation 18 of The Care Quality Commission (Registration) Regulations 2009 because they did not let us know about incidents that happened at the service as they are required to do by law.

Following the inspection on 16 May 2018 we imposed a condition on the provider`s registration preventing them from admitting new people into the home without the written permission from us (CQC). This was to ensure that the provider had time to make the necessary improvements. We also placed the service in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Montrose Care Home 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.

Montrose Care Home is registered to provide accommodation and personal care to 50 older people some of whom may live with dementia. At the time of the inspection there were 46 people living in the home. The home is spread across four levels, one of which is below the ground floor and accommodates the kitchen, chapel, an activity room and a dining area for people. The ground floor and two upper floors accommodate 50 bedrooms, lounges and storage facilities.

The registered manager who was in place at the time of the last inspection had left the service. There was a manager in post who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People told us they felt safe. Staffing levels had increased since our last inspection and staff were deployed effectively to ensure people`s needs could be met promptly. Call bells were answered in a prompt way to ensure people were safe and had their needs met.

Incidents and accidents had reduced significantly since the new manager was appointed. These were effectively analysed and actions were taken to reduce the risks. Risks to people`s well-being and health were assessed and risk assessments were in place to detail the measures taken to mitigate the risk. The number of falls people had reduced by more than half since our previous inspection and this was due to effective risk management and appropriate equipment use.

Care plans were developed and gave clear guidance to staff on how to effectively meet people`s health and care needs. Staff knew people well and took account of people`s likes, dislikes and preferences when supporting them.

People told us staff were kind and caring and protected their dignity and privacy when dealing with their personal care needs.

Staff had training and support to help them understand and carry out their roles and responsibilities effectively. Staff told us they felt supported by the management in the home and they had regular supervisions and staff meetings where they discussed any issues concerning them or the people they suppo

We carried out a responsive comprehensive unannounced inspection at Montrose Care Home on 16 May 2018. This inspection was in response of the concerns the Care Quality Commission (CQC) received from members of the public. At our last inspection on 14 September 2016 we found the service was meeting the required standards. At this inspection we found that there were serious failings from management and staff to ensure people received care and support in a safe and effective way.

Montrose Care Home 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.

Montrose Care Home is registered to provide accommodation and personal care to 50 older people some of whom may live with dementia. At the time of the inspection there were 48 people living in the home. The home spread across four levels, one of which is below the ground floor and accommodates the kitchen, chapel and two dining areas for people. The ground floor and two upper floors accommodate 50 bedrooms, lounges and storage facilities.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People told us that they felt safe living in the home, however they all reported that they felt there were not enough staff to meet their needs in a timely way. People told us they waited long periods of time for their call bells to be answered and they assumed this happened because the service was short staffed. We found that call bells at times rang in excess of 20-40 minutes. Staff were not present to provide support for people sitting in the communal areas for long periods of time on the morning of the inspection.

Risks to people`s well-being and health were not always identified, assessed or mitigated in a way to reduce them. There was a high number of un-witnessed accidents and incidents recorded in the home and we found that people involved in these accidents had no risk assessments or care plans in place to provide staff with sufficient guidance about how to mitigate the risk of reoccurrence.

The provider told us that from March 2017 they started to roll out the switch from paper records to electronic care planning in every home they had in a fazed way, Montrose Care Home being scheduled to start in November 2017. The registered manager told us that paper records were archived in November 2017 when the electronic care plans were set up and only the electronic care plans were available. Care plans we checked only had a care plan summary completed to detail personal information about the person and any immediate risk that had been identified at the time of completion. These had not been updated regularly to reflect any risk identified after the summary page was in place. The care plans we checked had no falls, seizure, mobility, choking risk assessments completed although some people had these risks listed on the summary page of their care plans.

We found that after people had falls and sustained injuries there was no review of their care needs and no preventative measures were considered to reduce the risk of falls. Staff and members of the management team told us that people were frail and lived with dementia and they could not stop people falling.

People who came to harm because of ineffective measures in place to mitigate risks had not been referred to local safeguarding authorities. This meant that further actions had not always been implemented to keep people safe. Staff were knowledgeable about signs and symptoms of abuse and their responsibilit

This inspection took place on the 14 September 2016 and was unannounced.

Montrose Care Home is a residential home in Watford providing care and support to up to 50 older people. At the time of our inspection there were 46 people using the service.

There was a registered manager in post, although they were not present on the day 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 2008 and associated Regulations about how the service is run.

Staff were aware of the safeguarding process and understood how to keep people safe. There were risk assessments in place which detailed control measures which would minimise the risks to people using the service. People had enough to eat and drink and their healthcare needs were met. Each person had a personalised care plan which was created with involvement from them and their relatives. People were supported to have their views heard and had individual key workers who were responsible for the management of their care. People’s medicines were administered correctly by trained staff, and medicines were managed and stored appropriately.

Staff demonstrated a kind, caring and considerate approach and treated people with dignity and respect. They received a variety of training which supported them to carry out their roles effectively, and were provided with regular supervision and appraisal by the management team. They understood the fundamentals of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS), and these were being applied correctly in practice.

People, their relatives and staff were positive about the support they received from the registered manager and the rest of the management team. Staff were supported to develop and contribute to the development of the service through team meetings. There were robust and thorough quality monitoring processes used to identify improvements that needed to be made across the service.

This inspection was carried out on 03 November 2015 and was unannounced.

Montrose Care Home is a residential home that provides accommodation and personal care for up to 50 older people, some of whom live with dementia. The accommodation was arranged over three floors and at the time of our inspection there were 48 people living at the home. There was a manager in post who was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

When we last inspected the service on 28 August 2014 we found them to be meeting the required standards. At this inspection we found that they were in breach 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 the report.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. Mental capacity assessments had not been carried out by management for the people who lived in the home and DoLS applications had been made to the local authority just for the people who had a formal diagnosis of dementia.

Staff obtained people’s consent before providing the day to day care they required however processes to establish if people had lacked capacity for certain decisions were not followed in line with the MCA 2005; as a result people were at risk of receiving care which was not in their best interest.

Staff was knowledgeable about their responsibility to safeguard people from possible abuse. They were confident in their ability to recognise abuse and report concerns following the safeguarding procedure which was displayed on notice boards around the home.

People felt safe living in the home; they told us that their needs were met when regular staff members were working; however they felt that at times the agency staff who worked in the home was not knowledgeable enough to meet their needs.

People had their medicines administered by staff who were trained. We found that the storage of medicines was not always safe and medicines which should have been stored in a locked cupboard in a locked medicines room were left out from the cupboard in the medicines room. Medicine audits were carried out monthly however they were not efficient and failed to identify medication errors.

People told us that the standard of food provided at the home was good. We saw that the meals served were hot and that people were regularly offered a choice of drinks. Staff monitored food and fluid intake for people who were at risk of losing weight however they failed to record this to ensure information was available for other staff members.

People living at the home and their relatives were positive about the home, the manager and the staff. They felt they had the opportunity to participate in activities provided by an activities coordinator until recently; however due to the absence of the activity coordinator activities were not planned and were not provided regularly.

People, relatives and staff were confident in raising any issues with management and they were confident that the management team will listen and will solve their problems. The management team carried out regular audits to check the quality of the service provided however there were no action plans developed following these audits to ensure a continuous improvement.

When we inspected Montrose Care Home on 31 October 2013, we found some of the care plans did not have sufficient detail to ensure that people who used the service received safe and effective care. We told the provider to make improvements and they wrote to us, telling us that they would be compliant by 4 April 2014.

One inspector from the Care Quality Commission (CQC) conducted this inspection. We gathered evidence against the standard we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found.

Is the service safe?

People's needs had been assessed and risk assessments described how any identified risks to people were minimised. We saw that the premises were free from any hazards that might prevent people from walking around the home freely. Following our previous inspection, we found the service had also taken adequate steps to ensure that they safely met the needs of the two people whose care had been deemed inadequate. This included the manager ensuring that the care provided to people who use the service met the requirements of the Mental Capacity Act 2005, and the related Deprivation of Liberty Safeguards.

Is the service effective?

Detailed care plans were in place to provide guidance to staff on how to deliver appropriate and effective care. We also saw evidence that the provider sought additional support from other health and social care professionals, to ensure positive care outcomes for people who use the service.

Is the service caring?

Whilst being shown around the home, we observed that people were supported by kind and attentive staff. From our observations and from speaking with the manager, we saw that the staff had a good understanding of the needs of the people they supported. The people we saw also appeared happy and well looked after.

Is the service responsive to people's needs?

We saw that the care plans had been updated when people's needs changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to engage in a variety of activities of their choice.

Is the service well-led?

The service had a registered manager in post, who had managed the service for many years, providing guidance and support to the staff and continuity of care. We found the manager took account of our previous judgement and acted on our comments to improve the quality of the service and the care experiences of people who use the service.

We visited this home to carry out an inspection to follow up the actions required to the concerns that had been identified during the previous inspection in July 2013. These concerns were in regard to the care delivered to the people living in the home and with the quality of records being kept in the home.

We spoke with seven of the people using the service, staff on duty and visitors to the home.

One person told us "The staff are lovely" and "I have no worries or concerns".

A carer told us "I really like it here" and "I have really supportive seniors".

A visiting relative told us "The staff keep me informed" and "the home is very good". Another visitor said "This is a lovely place. It is excellent".

The home was decorated to a high standard and visibly clean and free from malodours.

We saw that staff interactions with people were generally positive and respectful. People told us there were enough staff on duty to meet their needs.

We saw evidence that that the home had made improvements in updating the care plans and that while there was evidence of regular reviews, there was evidence that these reviews were not always effective as there were areas of risk as care plans did not always reflect people’s needs and therefore could not detail how staff should meet the person’s needs.

We found that people's records were kept securely and could be located promptly when needed.

People we spoke with were generally complimentary about the care and service provided. They commented that the care workers provided good care and that they had no complaints.

The relatives we spoke with told us that they were very pleased with the care and service provided and that they had been kept informed of their relative’s condition.

We spoke with two visiting community nurses who were attending to people who required wound care and dressings. They said that they had been involved in caring for people with wounds or pressure sores and that staff communicated well with them to ensure that people received appropriate care and treatment.

During our inspection, a person said that they could not remember when the staff last went through their care needs with them. A relative we spoke with said that they had been involved in the review of their relative’s care needs, and that the care staff and the visiting community nurses had kept them updated in regard to their relative’s daily progress.

However, we found that the care plans had not been consistently and accurately maintained; some people’s healthcare needs were not always reflected in the care plans. We noted that many of the care plans we reviewed had not been signed by the author, the person using the service or their relative. It was noted that the care plans had not been securely stored in line with the Data Protection Act, 1998.

We carried out a follow-up inspection on 26 October 2012 to check whether the provider had made improvements to the service to become compliant in regard to the outcomes specified in this report. This followed an earlier inspection in July 2012 where non-compliance was identified in some areas.

People we spoke with gave positive comments about the care and service provided. A person said, "The staff are very kind and helpful. They always try to please you." This was echoed by another person who commented, "The staff are very good. I am pleased with the care. I have no complaints."

We spoke with a relative of a person who had recently moved into Montrose Care Home. The relative commented, "The staff are very attentive and know the person by name; the staff interact very well and show kindness." The relative described the service as 'excellent' and added that they were 'very pleased' to have found such a care home.

The provider is now fully complaint.

People told us they like being at Montrose, but enjoy going out with Family members.