We carried out an unannounced inspection on 12 and 14 October 2016.

The service provides care and support to older people with a range of support needs, including chronic health conditions, physical disabilities, and those living with dementia. At the time of the inspection, 58 people were being supported by the service.

There was no registered manager in post as the manager had recently left the service and deregistered with the Care Quality Commission. A manager from the provider’s other service was temporarily managing the service until a recently recruited manager started in November 2016. 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.

Potential risks to people’s health, safety and welfare had been reduced because there were risk assessments in place that gave guidance to staff on how to support people safely. There were systems in place to safeguard people from avoidable harm and staff had been trained in safeguarding procedures. The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People’s medicines were managed safely.

Staff had regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care and support being provided. The requirements of the Mental Capacity Act 2005 (MCA) and the related Deprivation of Liberty Safeguards (DoLS) had been met.

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives and how they wanted to be supported. People had enough to eat and drink to maintain their health and wellbeing. They were supported to access other health services when required.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Where possible, people and their relatives had been involved in reviewing people’s care plans. The provider’s ‘Rhythm of Life’ programme promoted person centred care. People had been provided with a variety of activities within the home. The provider had appointed another activities coordinator so that more activities could be provided to help people to socialise more and to keep active.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives other professionals and staff, and they acted on the comments received to continually improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements. The interim manager had provided stable leadership and effective support to the staff until a new manager started in November 2016. They worked effectively with care team managers to promote a caring and inclusive culture within the service. Staff were motivated to do their best to provide good care to people who used the service and support people’s relatives.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. At our previous inspection on 12 September 2013 we found that the provider was meeting the legal requirements of the Health and Social Care Act 2008.

Mountbatten Lodge is a residential home for up to 60 people who may be elderly, have a physical disability or be living with dementia. It does not provide nursing care. At the time of our inspection there were 60 people who lived at the home. The home has four units. Two units accommodate people who require personal care but who are not living with dementia. The remaining two units accommodate people who are living with dementia of various degrees. People who are living with dementia in the more advanced stages live in one unit whilst people living with dementia in a less advance stage live in the second unit.

The home is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection an application by the manager to become the registered manager of the home was being processed by the CQC.  

People who lived at the home told us that they felt safe.  People who lived at the home were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff members had received training on the Mental Capacity Act 2005 (MCA) and were aware of the Deprivation of Liberty Safeguards (DoLS). They demonstrated an understanding of the requirements of MCA. A number of applications for DoLS had been made to the local authority.

Personalised risks were identified and strategies were in place to reduce the risk as much as possible. People were involved in deciding the level of risk to which they were exposed.

There were enough qualified, skilled and experienced staff to meet people’s needs. Use of agency workers was limited as the permanent staff had a better understanding of people’s needs.  People were cared for by staff who were supported to deliver care safely and to an appropriate standard.

The home was clean, well lit and there was an up to date infection control policy in place to protect people from the risk of acquiring a healthcare associated infection. However, this policy was not always followed, which put people at a greater risk of acquiring an infection.  The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. Two units of the home had been adapted for the needs of people who were living with dementia.

People, or relatives on their behalf, had been involved in determining their care needs.  People were supported to be able to eat and drink sufficient amounts to meet their needs and told us the choice of food was good. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

People were supported to maintain their health and well-being. People's needs were assessed and care was planned and delivered in line with their individual needs.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Information about complaints and how to make them was included on noticeboards in each of the four units. People who lived at the home and their representatives were asked for their views about their care and they were acted on.

The manager was supported by a deputy manager and also a team leader on each of the four units at the home. Staff members were encouraged to discuss improvements that could be made to the service and raise any concerns that they had at the regular staff meetings. Staff members felt supported, empowered and had a good understanding of their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The manager was supported by a number of specialists in the provider’s organisation to ensure that best practice was identified and implemented.

People we spoke with during our visit told us things had improved in the home, the activities were more frequent and one person said that "care and staff at the home had always been good" but now things seem even better. Staff told us that they felt well supported and really enjoyed working at Mountbatten lodge.

We found that the provider had made all the required improvements and was now meeting all the standards that had previously been assessed as being non-compliant. People who lived at Mountbatten Lodge looked well groomed and told us they had been assisted with personal care. People were taking part in various activities that were taking place. We observed that people had been supported to eat and drink regularly. Snacks and a choice of drinks were offered to people at frequent intervals. A new menu was being introduced and people were involved in the planning. We found the home was clean and odour free, many rooms had been redecorated and people had new beds, mattresses and flooring as well as other soft furnishings. We noted that people had received their medication appropriately and records were properly documented. There was adequate number of staff on duty with the right skills, qualifications and experience to care for the people in the home. Quality monitoring had been completed with clear actions and timescales where issues were identified. Records had been updated and new care plans were in the process of being introduced. The care plans we reviewed contained good person centred information and this informed staff how to provide appropriate care for people.

We found that people who lived in the home had not always received the standards of care that should be provided as part of their assessed needs. People who were more independent and were able to make decisions said that they felt the standard of care was good. However, during our inspection, we found that some people had not been assisted with personal care and hygiene, and some were wearing soiled clothing and had not been helped with grooming or oral hygiene. We found that people were not being encouraged to drink at regular intervals. People had not been given their medication at the prescribed times, and there were gaps in the recording of medication. There was an inadequate number of staff on duty with the right skills, qualifications and experience to care for the people in the home. Quality monitoring was inadequate and issues that were identified had not been followed through. Records had not been kept up to date and some of the care plans did not reflect people’s current care needs. This meant that staff, relatives, visiting professionals and the people who live in the home had relied heavily on verbal communication, which was insufficient to ensure that relevant factual information was communicated in a timely way. People therefore had been exposed to inappropriate care and treatment.

During the second day of our inspection, we saw some of the people attended activities which they enjoyed, and one had their family joining in. The people we spoke with told us that they liked the activities but said that it was sad that, when there was an evening event, some people attended in their night clothes, which they felt detracted from the ambience of the event.

People that we spoke with told us that staff had always treated them with respect and that they received the personal care they needed. They were satisfied with the social activities available to them.

We spoke with two relatives that were visiting the home on the day of our visits, overall both were happy with the care their relative had received. Comments from relatives included “In general the treatment of my mother is very good. She has put on weight since being here”.

People confirmed that staff were helpful, friendly, attentive caring, and approachable. People were happy with the activities available to them and felt that staff supported them to participate when required. Most people felt that they have enough to eat, however seven of the eight people we spoke with said that the quality of the food was poor.