About the service: St Mary’s Mount is a residential care home that was providing personal care to 30 people older people, some of whom were living with dementia, at the time of the inspection. Accommodation was provided on two floors with a lift to the upper floor. The home was set in large grounds with a range of outdoor facilities including a large lawn area.

People’s experience of using this service:

People told us they were happy living at St Mary’s Mount and were happy with the service they received. People visiting the service said the home had a family atmosphere and told us people were engaged in activities they enjoyed on an ongoing basis.

Processes were in place to protect people from avoidable harm and abuse. Staff were aware of their responsibilities in relation to this and were clear about the way to escalate any concerns they identified. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again. Sufficient staff were available to provide a timely response to people and provide safe care. People received their medicines as prescribed and medicines were managed safely.

People continued to receive effective care. Staff were well trained and were given regular opportunities to review their work and identify their learning and development needs. Staff supported people to access healthcare services when needed and liaised well with other professionals to provide coordinated care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. Consent to care was obtained in line with legislation.

People were treated with kindness and sensitivity. Staff knew people well and used this knowledge to provide reassurance when people were anxious or distressed. They were responsive to people’s individual needs and wishes and the service was provided flexibly. People were involved as much as possible in decisions about their care. People were supported to access services outside the home and links with the local community were well developed.

The service continued to be well led. Roles and responsibilities were clear and staff were proud of the service they provided. Systems were in place to monitor and improve the quality of care. People were encouraged to be involved and given opportunities to provide feedback and put forward their ideas for the service.

Rating at last inspection: Good (Inspection report published in July 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected St Marys Mount on 22 June 2016 and our visit was unannounced. St Marys Mount provides accommodation and personal care for up to 30 older people some of whom may be living with dementia. There were 30 people living at the service when we visited. The service was meeting the regulations that we checked at the last inspection on 3 January 2014. The service 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.

People were not always protected from harm because some staff did not recognise all forms of abuse or report incidents in line with the safeguarding policy. There was not a consistent approach to support people whose behaviour could cause harm to themselves or to others. When incidents relating to people’s behaviour were recorded they were not fully reviewed to ensure that the risk of repetition could be minimised.

Other risks were assessed and reduced and people were supported safely. Their healthcare needs were met promptly and plans were reviewed and amended to reflect any changes in people’s needs. People and their relatives were involved in planning and regularly reviewing their care. People consented to their care and if they did not have the capacity to do this for themselves a best interest decision was made on their behalf. Applications were made to restrict people’s liberty when it was identified that this was in their best interest to keep them safe.

People received the medicines they were prescribed safely and there were systems in place to reduce the risks associated with them. Mealtimes were not rushed and people said that the food was good. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk.

Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. There were enough staff to meet people’s needs promptly and they had developed caring, patient relationships with the people they supported. People were encouraged to pursue interests and regular activities were planned for them. Visitors were welcomed at any time. People and relatives knew the manager and felt confident that any concerns they raised would be resolved promptly.

Quality improvement systems were implemented and regularly reviewed to ensure that they were effective. Staff said they were well supported by the registered manager and plans were in place to continue to develop their skills. There was an inclusive culture which welcomed feedback in order to support the development of the service.

During the inspection we spoke with four people who used the service, four staff who provided support and the registered manager. We did this to understand the experiences of people who lived at the home.

We found that the provider had systems in place to gain consent for care and treatment from people who used the service. We spoke with staff who told us that they respected people’s decisions and understood their responsibilities with regards to the Mental Capacity Act 2005.

We observed people who used the service being treated in a caring and respectful way. One person told us, “I like the staff here they are very good”. Another person told us, “I feel happy here. The staff are very good; they (the staff) always come when I need them”.

We saw records that showed care was planned and delivered in line with people’s preferences. Staff we spoke with knew the needs of people who used the service and how they preferred care to be carried out.

We saw that the provider had systems in place that prevented the risk of cross infection. We saw staff used protective equipment during our inspection and staff we spoke with understood the importance of infection control.

Staff we spoke with told us they had completed an induction before they provided support to people who used the service. Staff received formal supervisions and told us that they felt supported by the registered manager.

The provider had effective systems in place to assess and monitor the quality of the service provided. We saw that the service was well led by the registered manager.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. During our inspection we spoke with seven people using the service, three visitors, two members of staff and the registered manager.

Due to the nature of the needs of people living at the service it was not always possible to speak directly with them to get their opinions. We used other methods such as observations to obtain information. We observed interactions and saw that people were relaxed with staff.

We checked to ensure medication was stored and administered in a safe way and found medication was managed appropriately. One person confirmed they were involved in their medication reviews and knew what medications they were taking and why.

We spoke with three members of staff who told us they felt supported by their manager and received regular training to enable them to provide good care. Staff told us they enjoyed working at the home.

The provider had systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.

The majority of people living at St Mary’s Mount had complex communication needs and were not able to verbally communicate their views and experiences to us. We spent time observing people and spoke to relatives and staff in order to gain their views on the service provided to people who live at the home.

People we spoke with who lived at St Mary’s Mount told us their dignity and privacy were considered and respected. They felt they were supported to make decisions about their care and how the service was run. People confirmed the staff asked permission before carrying out any care with them. They told us the attitude of staff was good and they felt safe and well cared for at the home. Comments about food and drink were favourable and everyone we spoke with felt they had enough to eat. Cleanliness and tidiness were reported, and seen to be good. People said that staff were,” very kind” and, “certainly seemed to know what they were doing.” People had confidence the staff would do the right thing for them and considered what was in their best interests.

One person reflected the comments made by others, by saying, “They are all lovely, hard working, thoughtful and considerate.”

People told us that staff were attentive and respond immediately to requests for support. One person living at the home said, “as soon as I ring the bell someone comes.”

A relative said that staff were extremely good and commented, “They're always very caring.” Another relative told us they were always kept informed and consulted in relation to health and personal care issues.

Staff told us they enjoyed working at St Mary’s Mount. Staff felt they worked well as a team and supported each other in order to do a good job, they confirmed the management team offer leadership and support.