Mundy House 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.

Mundy House provides care and support for up to 58 people, some of whom may be living with dementia. At the time of our inspection, 51 people were using the service. The service is set over two floors in the local community.

At the last inspection, the service was Good. At this inspection, the service remained Good.

A registered manager had been in post for a number of years. 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.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. There were systems in place to minimise the risk of infection. People’s medicines were dispensed by staff who had received training and were competent to do so.

The service was effective. People were cared for and supported by staff who were well trained and understood how to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice. People had access to a balanced diet and were supported to eat and drink in a safe way. Referrals to other health professionals were made when required. The environment was appropriately designed and adapted to meet people’s needs.

The service was caring. People were cared for by staff who were kind and compassionate towards them. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. Care plans were reviewed on a regular basis, and people and their relatives were involved in the planning and review of their care. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner. People were provided with the appropriate care and support at the end of their life.

The service was well-led. The service had systems in place to monitor and provide good care. These were reviewed on a regular basis. Staff, people and their relatives spoke very highly of the registered manager. The registered manager had good links with the local community and looked at ways they could participate in activities that promoted good practice.

The inspection was completed on 17 and 18 May 2016 and there were 51 people living at the service when we inspected.

Mundy House provides accommodation and personal care for up to 58 older people. Some people also have dementia related needs.

A registered manager was in post. 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.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff felt supported and received appropriate formal supervision. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Care plans accurately reflected people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

We spoke with five of the 55 people who were using the service at the time of our inspection. We also spoke with two people's relatives and seven staff members. We looked at five people's care records. We also looked at staff records, health and safety checks, staff and resident meeting minutes and records of the checks the provider’s representative completed to monitor the quality of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Staff we spoke with were aware of individual people’s needs and how to meet them safely in line with the person’s plan of care and risk assessments.

People were cared for in in a clean, hygienic environment. Staff were provided with the knowledge and equipment to protect both themselves and people who used the service from the risk of infection.

Quality checking systems were in place to manage risks and assure the health, welfare and safety of people who received care at the service and the staff who supported them. We saw records which showed that the health and safety in the service was regularly checked.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, “The care is very good. I feel very safe with the very familiar and regular staff.” A visiting relative added, “It’s a really lovely feeling that staff know the family, and that they know [person who used the service] so well, there is great consistency in the care.”

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Our observations and discussions with the acting manager demonstrated that people who used the service received regular support from a variety of health and social care services and professionals as their conditions and circumstances required.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, “They do respect you. They keep the door closed. They are thoughtful and cover you up where they can.”

One person said, "The care is very good. They are very gentle. My key worker showers me. I think it's quite nice having the same person. I've just been to the hairdressers, I go every week." Another person said, “The care is very good. I feel very safe with the very familiar and regular staff.”

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. Information was provided in a way that made it easier to see and understand. People's choices were taken in to account and listened to.

People had opportunities to express their views and these were listened to and acted upon. We saw that where people had asked for changes to the menu and the timings of certain foods, these had been actioned. They had also been included in the planning of activities, such as going to the garden centre to choose plants for their garden.

Is the service well-led?

Staff had clearly defined roles and responsibilities. They were allocated specific tasks on a daily basis to ensure all tasks were completed properly and this was checked by their senior or head of department. Staff said that they felt well supported and were able do their jobs safely.

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

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were addressed. As a result the quality of the service had improved.

As part of this inspection we spoke with five people who used the service, six members of staff (including the care manager) and reviewed five people's care records.

Throughout our inspection the atmosphere at Mundy House was observed to be calm and relaxed. Staff interactions with people who used the service were noted to be positive and it was evident that staff had a good knowledge and understanding of people's care and support needs.

Each person was noted to have a care plan in place detailing their care needs and how they were to be supported by staff. Records also showed that people who used the service were supported with their healthcare needs.

Whilst we acknowledge that there were a lot of positives as detailed above and that improvements had been made to ensure that appropriate numbers of staff were now available for people living at Mundy House and cleanliness and infection control procedures had improved; further work is required in relation to staff training, supervision and appraisal.

We found that a number of improvements had been made by the provider since our last visit in November 2012. We found that the information in people's care files was accurate and up to date and there were effective systems in place to monitor continued compliance.

As a result of concerns raised prior to our inspection we found that staffing levels were not always maintained. Our findings demonstrated that the provider was non-compliant with the prevention and control of infection and measures were not part of everyday practice at Mundy House.

We found that a number of improvements had been made by the provider since our last visit in September 2012.

We found that suitable arrangements had been made to ensure that any formal decisions made on behalf of people who use the service were recorded in their best interest. At this visit we found that people experienced care, treatment and support that met their needs. Staff interactions were much improved and support provided to individual's was seen to be less task and routine orientated. We also found that assistance provided by staff was undertaken in a timely manner. People told us that they were happy with the care and support provided. People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines. As a result of concerns raised prior to our visit we found that there was an effective recruitment procedure in place to protect people and sufficient staff were on duty to meet people's needs.

Areas for improvement included ensuring that people's care records were up to date and accurate; and that an effective quality assurance system was in place to identify non-compliance and/or risk of non-compliance.

Where people were unable to provide a verbal response to tell us verbally their experiences, for example as a result of their limited verbal communication or poor thought processes, we noted their non verbal cues and these indicated that people living at the home were relaxed and comfortable and found their experience to be positive.

We spoke with three people who use the service. They told us that they liked living at Mundy House and found the staff to be kind and supportive.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that the majority of people in the home were relaxed and comfortable and found their experience at the home to be positive.

Four people spoken with told us that they received good care and support. People described the care staff as “nice” and “friendly.” People spoken with told us that they were happy living at Mundy House. Two relatives spoken with told us that they were very happy with the care and support provided for their member of family.

Where people were unable to provide verbal responses or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues. These suggested that most people were generally relaxed and comfortable and found their experience at the home to be positive. Other people spent much of their day isolated and disengaged. Some people experienced poor supervision to support good falls prevention. We also saw that one person was physically moved in an unsafe way that potentially put them at risk.

People using the service who were able to comment verbally told us they were satisfied with the care and support they received. They felt able to make choices and that their privacy and dignity was respected.

Comments included, “I get very good care. There are good activities like bingo and quizzes and the hairdresser.” Another person said, “I forget things now but it is nice here, the staff are nice, they do look after me well.” A relative told us, “My relative loves it here, there are plenty of staff and they are all very nice. There is good care. This manager has made improvements. Staff communicate well and tell me things I need to know.”

People with whom we spoke told us that they felt safe and respected and would be able to voice any concerns or worries they had with staff or the manager. One person said, "I do feel safe and could say if I was not happy." Another person told us, "Some of the staff are really nice and I do feel safe with them." People spoken with also told us that they found the manager approachable and that they would feel able to raise any complaints or issues with them.

Mundy House provides accommodation and personal care for up to 58 people, some of whom are living with dementia.

The unannounced inspection was completed on 5 and 6 February 2015 and there were 57 people living at the service when we inspected.

A registered manager was in post. 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.

People did not always feel safe or feel that the care and support provided to them was appropriate to meet their needs. The deployment of staff did not meet people’s needs, particularly people living with dementia and people who were immobile and spent a lot of time in their bedroom.

Suitable arrangements were in place to safeguard people against the risk of abuse. Safeguarding concerns and complaints had been managed effectively.

Suitable arrangements were not in place for people to receive their prescribed medications safely.

The dining experience for people was variable and not all people experienced a positive dining experience. Nutritional advice by healthcare professionals was not always followed and the accuracy of some records could not be relied upon.

Staff did not demonstrate a good understanding of dementia and how this affected people in their day-to-day living. Some staff were observed to not communicate effectively with individual people or to provide positive interactions.

Staff were not always able to tell us about the care needs of the people they supported. We found an over reliance by staff on routine and tasks, rather than focussing on people’s individual needs.

People’s dignity and respect was not always maintained and people’s independence was not promoted.

Staff told us that the culture of the service was not always open and staff felt that they could not raise some matters with the manager. Although the provider had a range of systems in place to inform the provider of what was going on in the service, an effective and proactive quality monitoring and assurance system was not in place detailing the actions taken where issues were highlighted. There was a lack of managerial oversight of the service. The manager was unable to demonstrate how they identified where improvements to the quality of the service was needed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.