The inspection was unannounced and took place on 3 and 4 December 2018.

We carried out a responsive inspection on 23 March 2018 in response to concerns that had been raised about standards in clinical care. The inspection found that these were being managed well and we rated the service good. Our previous comprehensive inspection on 9 February 2016 also found the service was rated good.

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

The home has accommodation for up to 33 people. Accommodation is provided over two floors. There are single bedrooms and all but four of the home’s bedrooms have ensuite facilities including wash basin and WC. Two lounges and a dining room are located on the ground floor. The home is set in its own gardens in a semi-rural location near Macclesfield. At the time of our inspection 29 people were living in the home.

At our last inspection we rated the service good. At this inspection we found that there were several areas for improvement and we found that the provider was in breach of Regulation 18 as staff did not have access to regular supervision. The service was rated requires improvement overall. This is the first time, the service has been rated requires improvement.

We found that call bells took a long time to answer, which meant people were not receiving support in a timely manner. Staff told us that they felt there were not sufficient staff to meet the needs of the people in the service. We spoke to the regional management team who were investigating this in more detail to assess whether the current staffing levels were sufficient.

Staff were not receiving regular supervision to support them in their roles. This had been identified as an area for improvement earlier in the year, but little progress had been made to improve this.

Although some of the issues we found on our inspection had been identified by the provider’s quality assurance systems, little or no improvements were seen since these had been identified in August.

People and their relatives we spoke with were all positive about the care they received and approach of the staff within the home.

There were systems and processes in place to ensure that people who lived in the home were safeguarded from abuse and staff were aware of how to report any concerns.

Risks to people were effectively recorded and subject to regular reviews and there were clear instructions for staff to try to minimise risks to people without unnecessary restrictions.

Staff were safely recruited.

Medicines were managed and administered safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were trained to give them the skills and knowledge to meet the needs of the people.

People had access to other health professionals and staff maintained good relationships with other health professionals.

We observed that staff knew people well and respected their dignity. Staff promoted independence as far as possible and everyone spoke positively about the staff and manager.

People’s care plans were person centred and contained details about the person, their history, preferences and how they wanted to be supported. These were regularly reviewed and contained any necessary advice from other professionals. There was a complaints procedure in place and people were clear who to speak to if they wanted to raise any issues.

People, their relatives and staff spoke positively about the management of the home and the approachability and responsiveness of the manager. The home had links with the local community.

You can see what action we took at the end of the report.

The focused inspection took place on 23 March, 2018 and was unannounced.

Mount Hall is a ‘care home’, registered to provide accommodation and nursing or personal care for older people. The care home is registered to provide support to 32 people. At the time of the inspection there were 29 people living at the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is set in its own gardens in a semi-rural location near Macclesfield town. Accommodation is located over two floors. There are 32 single bedrooms, all but three of the homes bedrooms have en-suite facilities. There are two communal lounges, a well presented dining room and a passenger lift and stairs providing access to the first floor.

The was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

At the previous comprehensive inspection which took place in February, 2016 the home was rated as ‘Good’ in all five key areas (safe, effective, caring, responsive and well-led)

This focused inspection was carried out due to notifications of concern which CQC received in relation to clinical support people were receiving, particularly in relation to feeding tubes and acute specialist support which was required.

This inspection was carried out to ensure people were receiving safe care and the registered provider was meeting all legal requirements. The team inspected the service against two of the five key questions we ask about services: is the service safe and well-led?

No risks or concerns were identified in the remaining ‘Key Questions’ (effective, caring and responsive) through our on-going 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.

During this inspection we looked at the clinical care of people with feeding tubes as well as other people who were receiving nursing care for more acute clinical conditions. We did this in order to assess whether relevant risks had been assessed by nursing staff. We saw people’s medical conditions were clearly recorded and staff followed specific care and treatment plans to support these conditions.

We reviewed a number of clinical monitoring charts; these were for areas such as, repositioning, people being nursed in bed and fluid/ diet charts. These charts helped to provide a good evaluation of the care provided. The charts seen were up to date showing that care was being monitored and evaluated.

We found medicines were administered safely and people received medicines on time. A medication policy was in place. Staff who administered medication had received medication training and had undergone competency assessments to ensure they had the skills and knowledge to administer medicines to people safely.

The day to day support needs of people living at Mount Hall were being met. We found staff liaised with external health and social care professionals at the appropriate time to optimise people’s health and well-being.

Accident and incidents were being recorded and staff were familiar with the reporting procedures which needed to be followed. There was an accident/incident reporting policy in place and trends were being established as a measure to mitigate and manage any potential risks.

We found the environment to be clean, well maintained and free from any odour. There was an effective cleaning rota in place and staff were co

The inspection was unannounced and took place on 23 February 2016.

This service was last inspected on 2 October 2014 where it was found to be compliant in all the areas we looked at.

Mount Hall provides accommodation and nursing or personal care for up to 32 older people. Accommodation is provided over two floors. There are 32 single bedrooms. All but three of the home’s 32 bedrooms have en-suite facilities including wash basin and WC. Two communal lounges and a dining room are located on the ground floor. Access between floors is by stairs or a passenger lift.

The home is set in its own gardens in a semi-rural location near Macclesfield town.

The home had a registered manager. 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 time of our inspection there were 30 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. The home was managed and staffed by a consistent team of nurses and care assistants who were well trained and well supported.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

The provider had their own induction training programme that was designed to ensure any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively. Staff informed us that they had access to external training in addition to the corporate providers training and also the manager held group supervision that reflected on areas of practice where staff could learn from one another.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their characters and personal preferences’. The care plans were holistic as they considered in detail people’s physical as well as mental health needs to maintain a good standard of well-being.

People living in the home told us that the standard of care they received was good. Comments included, “the home is excellent”, “I feel I can talk to all the care and nursing staff on an equal footing”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they had every confidence that their relatives were safe and protected from harm and enjoyed a very good quality of life. One person told us, “the care is wonderful, just wonderful”.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant that staff were able to help and support people who had difficulty in making decisions and ensured that plans were put in place in the persons best interests. The manager was part of a group linked to the local authority consider

We visited Mount Hall Nursing Home because at our last inspection in July 2014 we found that the provider did not have adequate arrangements in place to protect the care and welfare of people who lived in the home. We took enforcement action and issued a warning notice and referred our findings to the local authority safeguarding team.

During this inspection we spoke with the manager and three other staff members. We also spoke with five people who lived in the home and we found that action had been taken to improve the systems in place to provide care for people who lived in the home and that people were happy with the care that they received.

Prior to this inspection we had received information stating that the staff did not use hoists to support people to move safely. We did not find any evidence that staff did not follow safe practices to support people to move. We saw that staff were trained in safe moving and handling and that there was adequate equipment for people to use.

We carried out this inspection in response to information of concern from a whistle blower. The whistle blower had told us that two people in the home were not receiving good care or treatment. They also told us that staff were not moving people safely and that people were receiving inadequate pressure relief and were developing pressure sores.

During our inspection we spoke with the registered manager, two nurses, a senior care worker, the home's administrator and two people who lived in the home. We also looked at records.

We found that the two people identified were not receiving adequate care to meet their needs and we referred our findings to the local authority safeguarding team.

We could not find any evidence to substantiate the other concerns raised.

We carried out this inspection to see what progress the provider had made to improve the standards of care for the people who used the service.

We found that the people who used the service received safe and appropriate care that met their needs and protected their rights.

All the people we spoke with during our visit praised the staff, the standard of care, catering and facilities and services provided. One person told us that they were treated with respect and were always involved in making decisions about their care and support.

We observed staff carrying out their duties and responsibilities in good humour and in a relaxed and positive manner. We could see that staff enjoyed good relationships with the people who lived at the home and had ample time to meet their health and social care needs without hurrying.

We looked at the care records for four of the people who lived at the home and could see that arrangements made for their care and support were centred on their individual needs and personal preferences.

We could see that managers, nurses and senior care staff were continuously monitoring the quality of recording and care provided so that people were safe and protected from receiving inappropriate care.

In this report the name of a registered manager appears who was not in post and not managing the home at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection.

We found that the home had a relaxed, sociable and welcoming atmosphere. All the people we spoke with during our visit praised the staff, standard of care, catering and facilities and services provided. They told us that they were treated with respect and were always involved in making decisions about their care and support. One person said “the staff are lovely they are excellent, they treat me with respect and the food is very good too". Another said “the staff are brilliant and the care is good and the food cannot be faulted”.

We looked at the arrangements the home had for ensuring people were protected from abuse and found them to be robust and effectively implemented.

Six people who lived at the home told us that they were concerned about staffing levels. They gave examples of having to wait long periods of time for assistance to go to the toilet. One person said “the staff are very good but they can be brusque with you because they are rushing, everything is on the clock”. Another person said “there is not enough staff on duty-we have to wait for everything”.

We looked at the care records for four of the people who lived at the home and could see that arrangements made for their care and support were centred on their individual needs and personal preferences.

We found that there were areas where improvements were needed including staffing levels and record keeping to safeguard the health, safety and welfare of the people who live at the home.