We undertook an unannounced focussed inspection of Mostyn Lodge Residential Home on 13 December 2018. We last inspected Mostyn Lodge Residential Home on 01 September 2017 and we had rated the service as good. At this inspection we found the service had deteriorated and has been rated as requires improvement.

We carried out this inspection after we received concerns in relation to a lack of statutory notifications and information received from other health and social care organisations. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk. We inspected the service against three of the five questions we ask about services: is the service well led, effective and safe?

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Mostyn Lodge Residential 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. The service is registered to provide care and support for up to 16 older people, living with dementia and/or physical disability. To the ground floor there are two lounges, one with a conservatory overlooking the garden that is accessible to people and contains raised flower beds. There is a communal dining room and walk-in bath/shower room.

There were 14 people living in the service at the time of our inspection

There was not a registered manager for the service. 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. A manager was in place and had applied to the Commission for their registration.

Radiators throughout the home were not covered, this meant that people were at risk of burns from potentially hot surfaces. Work to fit radiator covers commenced during our inspection, however when we contacted the provider after the inspection we were told that not all the work to cover the radiators had been completed.

The service did not consistently submit statutory notifications to the Commission. Registered providers must notify us about certain changes, events and incidents that affect their service or the people who use it.

The service did not consistently recruit staff safely. In one staff file we identified that a person who had disclosed a criminal conviction had been employed by the service without a photograph ID or risk assessment. This meant that people were not always protected from potential abuse

Audits did not consistently identify shortfalls and when issues were identified corrective actions were not always taken. For example, the lack of radiator covers and incomplete staff induction records, care records and recruitment files.

The service maintained safe levels of staff. The manager used a staffing dependency tool and this calculated staffing levels required according to peoples’ individual needs, including the level of assistance required to use the toilet, mobilise and eat.

The environment was clean and free from malodours. Fixtures and fittings were well-maintained and in good condition.

The service worked with external agencies including opticians, GPs and district nurses. We also saw effective communication and resp

This inspection was unannounced and took place on 6 and 7 September 2017. This was a comprehensive inspection. The previous comprehensive inspection of the home was carried out in July 2016 and the home was rated as requires improvement. Three breaches of regulations 12, 19 and 17 of the Health and Social Care Act 2008 were identified. These were because the registered manager at that time had not consistently managed medicines safely, had not consistently followed safe recruitment procedures and had not identified the shortfalls we found. At this inspection, we found the required improvements had been made.

Mostyn Lodge Residential Home provides care and accommodation for up to 16 older people. There were 11 people living in the home at the time of our inspection. The provider had recently taken over and was in the process of making extensive improvements to the fabric of the building at the time of our inspection. The previous registered manager left the service in August 2017. A new manager was going through the process of becoming registered. 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.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

Staff received regular training in topics the provider considered mandatory and were knowledgeable about their roles and responsibilities. Staff received specialist training for some but not all people’s complex health needs; however there were plans in place to address this.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

People received their medicines safely. The manager completed regular checks to ensure medicines were safe. People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff told us the provider and manager were accessible and approachable. Staff felt able to speak with them and provided feedback on the service.

The manager, provider and management consultant undertook regular audits and spot checks to review the quality of the service provided and made the necessary improvements to the service.

We undertook an unannounced inspection of Mostyn Lodge on Tuesday 26 July 2016. When the service was last inspected in April 2014 no breaches of the legal requirements were identified.

Mostyn Lodge provides accommodation for people who require personal care to a maximum of 16 people. At the time of our inspection, 14 people were living at the service.

A registered manager was in post at the time of 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. On the day of our inspection the registered manager was on annual leave. The deputy manager of the service assisted us throughout the inspection.

The service had not ensured that people were fully protected against the risks associated with medicines. Medicines that had additional legal requirements in relation to the storage, retention, recording and disposal of these medicines were not recorded accurately. The physical balance of these medicines held was inaccurate. People’s individual medicine records were not always accurate and a medicine stored in the service was not fit for consumption. Recruitment was not safe as some Disclosure and Barring Service checks had not been completed as required.

The registered manager had not ensured staff had received appropriate supervision and appraisal. The service understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS), however we found that staff knowledge in DoLS was limited. DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. In addition, staff were not fully aware of how the Mental Capacity Act 2005 impacted on their work despite receiving training in the subject.

There were some governance systems to monitor the health, safety and welfare of people. However, the absence of some systems or the failure to use other systems already in place had resulted in the procedural errors and omissions we have identified not being identified by the registered manager. Records were not stored securely and could not be produced when required.

People at the service felt safe and spoke positively about their relationships with staff. People’s relatives and visitors also spoke positively. Staff understood how to respond to suspected and actual abuse. There were sufficient staff on duty to keep people safe and the registered manager and deputy manager supported staff when required. The service was clean and audits of infection control practice were completed. There were emergency plans for people in the event of a fire and the service completed checks of fire safety equipment.

People and their visitors said staff at the service provided effective care. We received positive feedback to support this. Staff received appropriate training to provide a good standard of care and when asked, spoke positively about the frequency and standard of training they received. Staff also had the opportunity to obtain national qualifications with support from the provider. People had access to healthcare professionals where required and supporting records showed that appropriate referrals had been made when needed. People were supported with eating and drinking as required to maintain their health and wellbeing.

People and the visitors we spoke with told us the staff at the service were caring. We received positive feedback about staff and the care provided. We reviewed the compliment cards in the hallway of the service that reflected the views of the people and visitors we spoke with. People’s relatives and visitors were welcomed to the service at any time and we observed good relationships between visitors and staff. S

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. Comments included, “Staff are very kind”, and, “Staff provide good care; they listen to me and do what I ask.” We also spoke with a relative of a person who used the service. The relative told us, “Staff treat people well” and said they were very happy with the care provided. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us, “I’ve been here six years and wouldn’t change anything. Staff provide the care that I need”. Staff told us they were able to provide the care that people needed.

People using the service, their relatives and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people’s records which indicated they had been consulted over the care they received. This meant that information about people’s preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We looked at two standards which were not being met at the last inspection. Action had been taken to make improvements in these areas. We found that people’s medication was being kept more securely as a result of changes in the storage facilities.

People told us that they were being asked for their views about the home and the service they received. One person said there were meetings in the home when people could “air their views”. We found that standards in the home were being checked and audits undertaken as part of a new system for quality assurance. These arrangements helped to ensure that the risk of harm to people was reduced and improvements were made when needed.

We heard positive comments from people about the staff team and the care that they received. Staff, for example were described as “friendly and helpful” and one person said that seeing the doctor was “never a problem”.

Staff told us that they felt well supported in their work. We found that the arrangements being made for supporting staff had improved and there was a more planned approach to training.

However the provider had not taken sufficient action to ensure that all the standards were being met. As we found at the last inspection, there was no effective system in place for monitoring and assessing the quality of service that people received. There were risks to the people who used the service, as relevant guidance and legislation were not always being followed.

People told us that their wishes were being respected, for example about when they would like to get up and how they wanted to spend their time. People said that there was a friendly and informal atmosphere in the home. One person we met with was pleased to have been able to bring their dog with them when they moved in.

People said that they were able to maintain some independence in the home. One person for example said they received support when having a bath, but were able to manage most areas of personal care by themselves. Other people needed more support and we were told that staff helped people with making decisions, such as about what clothes they wanted to wear and the meals they would like.

A local ‘churches together’ group held an informal service in one of the lounges on the day we visited. People told us that some entertainments and social events were also being arranged although these did not include regular activities outside the home.

People told us that staff were polite but their competence could be varied. One person commented “some are more helpful than others”.

People knew who they could talk to if they had any concerns, although their views were not being obtained as part of a system for assessing and monitoring the quality of service provided.