About the service:

Mountside Residential Care Home is registered to provide support to a maximum of 52 people and 47 people were living at the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

People’s experience of using this service:

People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, “I feel safe, don’t think there is anywhere better,” and, “A nice clean and comfortable place to be.”

• The service had made improvements since our last inspection. However, whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included ensuring that medicine errors and discrepancies were acted on and appropriate action taken. There were policies and procedures in place but these had not always been followed by staff. Care plan audits had not identified that one person did not have a care plan for the management of their diabetes despite the GP identifying their blood sugars were high.

• People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe.

• People's risks were assessed and strategies put in place to mitigate the risks.

• Environmental risks were satisfactorily assessed and managed.

• Staff received improved supervision and training since our last inspection, which provided them with the knowledge and skills to perform the roles they were employed to do.

• People received their care and support from a staff team, that had a full understanding of people's care needs and the skills and knowledge to meet them.

• Staff were given an induction when they started and had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently.

• People and relatives provided consistently positive feedback about the care, staff and management. They said the service was safe, caring and well-led.

•Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.

•People were encouraged to live a fulfilled life with activities of their

choosing and were supported to keep in contact with their families.

• People's care was now more person-centred. The care was designed to ensure people's independence was encouraged and maintained.

• People were involved in their care planning. End of life care planning and documentation required further development but this had been identified and work was on-going.

• There were positive changes to the management team. Improved audits and checks were put in place to ensure the service was well-governed.

• There was a happy workplace culture and staff we spoke with provided positive feedback.

The service met the characteristics for a rating of ‘Good’ in four key questions we inspected with the well-led question remaining ‘Requires Improvement.’ Therefore, our overall rating for the service after this inspection has improved to "Good".

More information is in our full report.

Rating at last inspection:

• The service was rated "requires improvement".

• Our previous inspection report was published on 14 August 2018.

Why we inspected:

• All services rated as ‘Requires improvement’ are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received and the improvements made.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on the 11and 13 July 2018 and was unannounced.

We previously carried out comprehensive inspections at Mountside Residential Care Home in October 2016 and November 2017. At these inspections we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service received an overall rating of ‘requires improvement’. This was because systems to improve the service were not effective, Care had not been assessed, to ensure it was person centred, appropriate, met people’s needs and reflected their preferences. People’s capacity to make everyday decisions had not always been assessed and therefore the care provided was not always in accordance with the code and conduct of the Mental Capacity Act 2005. Care and treatment had not always been provided in a safe way and staff had not received appropriate training and supervision; to ensure they were competent to carry out their role and adequately supported. At the inspection in November 2017 we took enforcement action because there were no effective systems and processes in place to ensure the service met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found seven breaches of regulation. Following the inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that improvements had been made. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mountside Residential Care Home on our website at www.cqc.org.uk.”

We found significant improvements had been made in relation to meeting the breaches of regulation but there were still areas of improvement to make to ensure that safe, effective person centred care was delivered and that the quality assurance systems were fully embedded in to practice. The overall rating for Mountside Residential Care Home has remained as ‘requires improvement’ as this was a focussed inspection. We will review the overall rating at the next comprehensive inspection, where we will look at all aspects of the service to ensure sufficient improvements have been made.

Mountside 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. It is registered to provide support to a maximum of 52 people and 49 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

Mountside Residential Care 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.

Improvements had been made to the provider’s quality assurance framework; however, these improvements were not yet embedded or sustained. The registered manager and provider were also not proactive in identifying how ongoing improvements could be sustained. Shortfalls in the provision and delivery of care had not always been identified by the provider’s quality assurance framework. We have identified this as an area of practice that needs improvement.

Whilst the provider had arrangements in place for the management of risk to people’s health and well-being, we found some areas of practice that placed people at risk at of not receiving safe care. This was because care plans

We inspected Mountside Residential Care Home on 14 November 2017, this inspection was unannounced. The inspection was carried out by two inspectors and two experts by experience. An expert by experience is a person who has personal experience of using, working with or caring for someone who uses this type of care service.

Mountside Residential is a care home, providing both permanent residential and respite care for up to 52 older people. At the time of the inspection there were 48 people living at the home. Mountside Residential Care Home is an adapted Victorian property with an extension added in 2014. There are a number of communal areas and access to a large terrace and gardens.

We previously carried out a comprehensive inspection at Mountside Residential Care Home in October 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns regarding medicines management and systems and processes to monitor and improve the service were not effective. We also found areas of practice that required improvement. This was because risks to people’s safety had not consistently been assessed, training needed to improve, mental capacity decisions were not robust and care plans did not include sufficient guidance. The service received an overall rating of ‘requires improvement’. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and that the service was now meeting legal requirements. We found improvements had been made in relation to medicines, however further breaches of regulation were identified. The overall rating for Mountside Residential Care Home has remained as ‘requires improvement’. Details of the breaches identified can be found at the end of the report. We will review the overall rating at the next comprehensive inspection, where we will look at all aspects of the service and to ensure sufficient improvements have been made.

Mountside Residential Care 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.

Risks to people had not been assessed and reviewed to ensure their safety was maintained at all times. Care plans did not fully reflect people’s physical, mental, emotional and social needs. Records relating to the care and treatment of each person were not accurate, complete or updated without delay when changes occurred, or included relevant information recorded to ensure people received care that was person centred. People’s weights had not been consistently documented or actions recorded to show how the registered manager had responded when people’s weights had changed.

Staff had a limited understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Mental Capacity assessments had not been completed regularly or updated. Decisions around people’s capacity and who was legally entitled to be involved in decisions was not recorded in line with legislation.

Staff training had not been maintained to ensure all staff were suitably trained to meet people’s health needs effectively. Although identified within the PIR completed by the registered manager, at the time of the inspection, training records showed that many areas of staff training were out of date or had not been completed. Therefore it was unclear how the provider had assured themselves that staff were appropriately trained and competent to carry out their roles.

Quality assuranc

Mountside Residential Care Home is registered to provide accommodation and care, without nursing, for up to 52 adults. Mountside Residential Care Home is a large Victorian property in a residential area of Hastings, within walking distance of the town centre. The house has been extended a number of times and in 2014 a new wing, Valley View, was added. Valley View provides single bedrooms with ensuite facilities and a large lounge/dining room with a small kitchen attached. Valley View lounge opens on to an extensive terrace that overlooks the gardens and the valley beyond.

This comprehensive inspection took place on 6 and 7 October 2016 and was unannounced. There were 49 people living at the home when we visited.

This home requires a registered manager as a condition of its registration. 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 home is run. At the time of this inspection there was a registered manager who had been in post for a number of years.

People were happy to be living at Mountside Residential Care Home and they had positive, warm and friendly relationships with the staff. Staff enjoyed working at the home and were supported by the registered manager and deputy manager.

Staff had undergone training and knew how to recognise and report any incidents of harm. However, incidents were not always reported in line with local protocols. Potential risks to people had been assessed. Medicines were not always managed well, which meant there was a risk that people might not receive their prescribed medicines safely.

There were sufficient staff on duty to make sure that people’s needs were met in a timely manner. Staff had received a thorough induction and had undertaken training in some topics relevant to their role. Staff recognised that they needed further training, which had not yet been provided, so that they were equipped to do their job as well as possible. Staff had been recruited in a way that made sure that only staff suitable to work in this care home were employed.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had not always been fully assessed and some staff had a limited understanding of the principles of the MCA and DoLS. For those people who had been fully assessed, appropriate applications had been made to the relevant authorities. This ensured that these people’s rights were protected where they lacked mental capacity to make decisions for themselves.

People’s healthcare needs were monitored and staff involved a range of healthcare professionals to make sure that people were supported to maintain good health and well-being. People were given sufficient amounts of food and drink and people’s dietary needs were met.

Staff showed that they cared about the people they were supporting. Staff treated people with kindness, respect and compassion and made sure that people’s privacy and dignity were upheld at all times. People were encouraged and supported to be as independent as possible. People’s personal information was kept securely so that their confidentiality and privacy were maintained.

Pre-admission assessments had been carried out. People and their relatives had been involved in planning the person’s care and support. People’s care plans gave staff some information about the ways in which each person wanted their care and support delivered. However, this was not always in sufficient detail to ensure that each person received personalised, consistent care.

A range of activities and entertainment was planned and delivered and some people had been encouraged and supported to

A single adult social care inspector carried out this inspection. The focus of the inspection was to follow up on a warning notice issued following our last inspection in August 2014 and to follow up on compliance actions issued at that time. We looked 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 describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

A new care plan format has been introduced since our last inspection. We found that care was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that were sufficiently detailed to allow staff to deliver safe and responsive care. People told us they were happy with the care and support they received. A person who used the service said, "The carers do their work brilliantly, they are kind and patient.”

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

We looked at the staffing levels and staff skills and experience and found that there were sufficient suitably trained staff to meet the people’s needs at Mountside at this time.

Systems were in place for staff to learn from incidents, accidents and near misses

Is it effective?

People had their needs assessed and individual care plans were devised. Before anyone joined the service, a pre-admission assessment took place.

Care plans were more detailed and provided personalised information which enabled care staff to provide care and treatment which was individual to that person.

People maintained good health. The service worked closely with GPs, care coordinators and the local authority.

Systems were in place to monitor, assess and improve the quality of the service.

There was a clear complaint policy and procedure in place that ensured complaints were handled and resolved appropriately.

Care plans were personalised and included information on the person’s life history and identity. This allowed for staff to provide care that was personalised and appropriate to that person.

Is it caring?

Staff spoke with compassion and kindness for the people they supported.

People were supported by attentive staff. Observations of care found that people were treated with dignity and respect. We were told, “[My relative] receives very good care here. Everyone is so friendly and approachable.”

Staff demonstrated a good understanding of the care needs of people who used the service.

People were encouraged to treat the service as their own home.

People were treated with dignity and respect.

It is responsive?

People told us that they felt happy and confident approaching staff with any concerns.

The staff we spoke with understood and respected people's choices and decisions.

People had their needs assessed and support from external health professionals' was sought where necessary.

Where's people's health had rapidly deteriorated we saw that the service took appropriate action.

People had access to activities which we saw they enjoyed and responded to.

Is it well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Quality and compliance audits were regularly conducted. Where it was required, responses to the audits findings were developed and these were recorded.

Staff we spoke with had a clear understanding of why they were there and what their roles and responsibilities were.

The service had a business continuity policy in place. This made sure that each service had a plan in place to deal with foreseeable emergencies. This would reduce the risk of people's care being affected in the event of an emergency such as flooding or a fire.

You can see our judgements on the front page of this report.

During our inspection we spoke with seven people who used the service and one relative. They told us that the care workers and the managers in the home responded to their needs in a respectful manner. One person told us, “Staff are lovely here.” Another said, “It’s a very good home. I am warm and comfortable.”

We looked at five care plans. There was detailed information about people’s needs in the care records. One person told us they reviewed their care plan with their care worker every month. They told us they found the process reassuring. People told us they felt safe living in the home. We found that incidents were reported, investigated and acted upon appropriately.

We looked at medication records and the policies and procedures that were in place in the home. We observed the medication round and saw that the process was managed systematically and safely.

We talked with three care workers, the home manager and the deputy manager. They told us that training and supervision was in place. Staff told us they felt supported and able to carry out their role competently. People who used the service and the staff told us that the managers in the home were always accessible and responded promptly to any concerns or changes that were needed.

We reviewed a range of information during our visit and found that there were good standards of recording in place. There were systems in place to check the accuracy and encourage improvements in record keeping practice.

People using the services said that they liked living in the home. They told us that the staff were friendly and caring. We were able to speak to thirteen of the current residents.

One person said, ‘it is a lovely home. I am very comfortable here.’

Another told us that, ‘it’s all ok; I have no complaints’.

Another said, ‘I like it here. It’s very comfortable. They know what I like.’

One person told us ‘the residents here are very friendly; everyone looks out for you.’

Our inspection team was made up of one adult social care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we have found. The summary is based on our observations during the inspection. 32 people were resident in the service at the time of our inspection. We observed the care provided, looked at supporting care documentation, staff records and records relating to the management of the service.

We spoke individually with the manager, deputy manager, a senior care staff member, four care staff members and three visiting district nurses. The registered manager had been in post for seven years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We also spoke with eight people who used the service and two visitors.

Is the service safe?

People told us they were safe in the service. Comments received included, “They help me when I need anything,” and “I have just been happy here. I have been safe and they have looked after me.” One visitor said, “I have confidence in the home, they care.” Another visitor said, “I am not impressed at all, I have had to ask them to do basic care, not good enough.”

People were not always treated with respect and dignity by staff. A compliance action has been set in relation to the lack of dignity afforded to people and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people’s best interests. People had been asked for their consent for any care or treatment.

There were no clear systems in place to make sure that the provider, management and care staff learnt from events such as incidents and accidents and concerns.

Staff training was available to access to undertake their roles in the service. We saw that systems to track training and refresher courses had been developed and monitoring systems put in place. However the training matrix provided identified some gaps in individual staff training. This did not fully ensure that people were protected from unnecessary risk.

There were not enough qualified, skilled and experienced staff to meet people's needs. We saw that were not able to meet some people’s needs in a timely manner. A compliance action has been set in relation to the staffing levels and the provider must tell us how they plan to improve.

Is the service effective?

The lack of care plans and guidance for staff to follow had not ensured that people received appropriate care delivery. People’s health and care needs had not been consistently reviewed and people and their representatives had not been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and support needs had not been clearly identified and followed through with a plan of action for staff to follow. This had not ensured safe and consistent care had been provided, and up-to-date guidance for staff to meet some people’s needs were not in place for staff to follow. This had meant this person was not receiving the care delivery required and placed them at risk from uninformed staff. We also found incomplete records for fluid and food intake for people who had lost weight. A compliance action has been set in relation to inadequate care delivery and records and the provider must tell us how they plan to improve.

Is the service caring?

People were seen at times to be supported by kind and attentive staff and we saw that staff had some good relationships with people. We saw that care staff showed patience and offered encouragement when supporting people. Comments received included, “They help me when I need anything. They are very good and kind,” They are pretty good,” “They are very kind,” and “Yes they are very good.” We saw that staff were kind and treated people with respect and courtesy. However some isolated incidents during the inspection impacted negatively on some people’s dignity.

People had been not been asked to complete quality assurance satisfaction surveys.

People’s preferences and diverse needs had not been identified within individual documentation. This meant new staff would not be able to provide person centred care. People told us care and support had been provided in accordance with their wishes.

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us that staff discussed any changes to do with their care with them regularly, and that staff were approachable if there were any issues of concern. However records did not confirm that people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. One visitor told us, “They regularly consult with me in respect of my X care as my X cannot tell them anything due to their dementia.” Another visitor said, “They haven’t listened to us at all, I have had to keep on asking them to do things to ensure my X is comfortable.”

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. People told us they had not had to raise any concerns, and they were aware who to speak with if they had any concerns. They said they felt they would be listened to. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

We were told that there was a strong management team in place that were working together to improve the service. However it was acknowledged that things had slipped recently as the building works for 20 further beds was in progress.

The service had quality assurance systems to develop and improve the service provided. However we identified shortfalls in care plans, risk assessments and maintenance of the premises that demonstrated the audits were not effective at this time. A compliance action has been set in relation to the quality assurance systems and management of risks and the provider must tell us how they plan to improve.

Staff told us they were clear about their roles and responsibilities. The management team had a good understanding of the service and quality assurance processes that were in place. This had helped to ensure that the home was continually trying to improve.