The inspection took place on 5 March 2018 and was unannounced. We last inspected this service on 3 and 5 July 2017 and rated the service inadequate overall and in two key questions: Safe and Well led. It was requires improvement in the three other questions we inspect against. We made seven regulatory breaches; five were repeated breaches from the previous inspection in August 2016. The breaches we identified included Regulation 13: Safeguarding people from harm, Regulation 18: Staffing, Regulation 9: Person-centred care, Regulation 17: Good governance, Regulation 18 of the registration requirement: Reporting incidents. Regulation 12: Safe care and treatment, and Regulation 11 consent were new regulatory breaches identified in July 2017. We issued a warning notice for a continued breach of regulation 17.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the overall service with particular emphasis on key questions relating to Safe and Well Led and how they were going to meet the regulatory breaches and conditions on their registration. One of which was to have a registered manager in post. Their action plan was submitted to us in a timely way, and updated at regular intervals. We noted over the last three years this service has not achieved an overall good rating. Because the service was rated inadequate, we placed it in special measures. Services in special measure will be kept under review and if we have not taken immediate action to propose to cancel the provider's registration of the service, we undertake to inspect within six months of the last inspection. The expectation is that the provider should have made significant improvement within this period.

At our inspection on the 5 March 2018, we did not identify any new risks or significant concerns. We saw some improvements and were confident going forward that the service would continue to improve. The provider had taken enough action to improve the service and come out of special measures. We identified areas where continued improvements were still required in the way this service operated.

At our last inspection, there was no registered manager in post. At our most recent inspection in March 2018, there was an acting manager in post but they were not registered with CQC. They told us they had submitted an application. The service also had a deputy manager who was on leave at the time of our inspection but came in briefly during our inspection. The registered provider made themselves available during the inspection and told us they were regularly at the service, at least every week. The provider had employed a person to oversee the quality of the service and help bring about the necessary improvements.

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

The duties and responsibilities were shared between the manager, the deputy manager and the provider The service was not able to provide us with all the information we requested so we gave them five days to produce the information. This was received as requested.

The Mount Residential 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 Mount residential home provides accommodation and support to a maximum of 22 men who have mental health needs and/or dementia. At the time of our inspection there were15 people using the service.

At our latest inspection on the 5 March 2018, we found things were improving in terms of staff confidence and morale. People using the se

This inspection took place on 3 and 5 July 2017 and was unannounced.

We had previously inspected the service in August 2016 and had identified six regulatory breaches. These related to safeguarding people from harm, staffing arrangements, dignity and respect, person-centred care, the governance of the service and the requirement to report incidents to the Commission.

This July 2017 inspection identified seven regulatory breaches, five of which the provider had been in breach of from the August 2016 inspection. These repeat breaches related to safeguarding people from harm, staffing arrangements, person-centred care, the governance of the service and the requirement to report incidents to the Commission. The provider was no longer in breach of the regulation relating to dignity and respect. However, they were also now in breach of regulations regarding safe care and treatment and consent. You can see what action we told the provider to take at the back of the full version of the report.

The Mount Residential Home provides accommodation and support to a maximum of 22 men who have mental health needs and/or dementia. At the time of this July 2017 inspection, there were 19 men living in the home.

There was no registered manager in post. The manager of the home had been in post for approximately eight weeks. They told us that they had commenced the process to apply for registration. 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 main partner in the business (referred to as the provider in this report) was at the home most days during the week. They completed most of the care plans. The deputy manager oversaw the management of people’s medicines and was responsible for health and safety checks and related maintenance of the home. The manager oversaw the general day to day operation of the home.

We found that incidents taking place between people living in the home that required reporting to the local authority’s safeguarding team were not always reported. This meant that the local authority was unable to accurately determine whether people living in the home were at risk or would benefit from the input of health professionals. The service had not reported a safeguarding incident to the Commission in over two and a half years.

The provider was not clear about how many staff were required to support people during day. We had previously been told on two occasions that four staff were required. However, staffing levels fell below this, particularly at weekends. Staff training was considerably behind, but some training had been arranged. However, there was little training in place for staff in relation to people’s mental health emotional needs.

Risks to people’s health were not always identified. When they were identified the service did not always take appropriate actions to minimise the risks to people’s welfare.

There was limited understanding and application of the Mental Capacity Act other than at a basic level. Where significant decisions needed to be made assessments had not been carried out appropriately.

People’s care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a high standard of care and support to people.

The provider’s auditing system was not robust and had not identified the concerns we found during this inspection. The provider had not made significant improvements since the August 2016 inspection.

People received their medicines as prescribed. The staff were kind and considerate and people were comfortable in their company. Most people felt involved in decisions relating to their care. Staff told us that morale was improving in the home. However

This inspection took place on 22 and 26 August 2016 and was unannounced.

The Mount provides accommodation and support to a maximum of twenty two men who have a mental health needs and/or dementia. It does not provide nursing care.

There was a manager in post who had been appointed in June 2016. At the time of our inspection, the manager had not submitted an application to the CQC to become 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 this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

People were not protected from avoidable harm and abuse because staff did not always identify when safeguarding referrals were required. Effective systems were not in place to ensure people were safeguarded and referrals made. Not all risks to people were adequately identified or managed, this included risks relating to the management of the premises.

Staffing levels and deployment of staff was not always sufficient. Staffing levels did not always meet the level that the provider had identified as sufficient to meet the needs of people living in the home.

Medicines were managed safely and people received these in time. People were supported to access health services when required.

Staff did not feel supported to deliver effective care. They felt the quality of training was poor. Healthy eating was not always understood or promoted. There was mixed feedback regarding the quality of the meals provided. The menu offered did not always incorporate people’s individual preferences or needs. The service was not always acting within the requirements of the Mental Capacity Act (MCA).

People were supported by kind and caring staff who knew them well. People and their representatives were involved in decisions about their care. Information was provided to people so they knew how to raise concerns or complaints. People told us they felt comfortable to do so.

Some practices had developed that were not always respectful of people’s privacy and dignity. A closed circuit television camera monitored communal areas. However, there were no records to indicate that people living in the home and others had consented to this and privacy issues had not been considered. People’s personal preferences and needs were not always met; this included the provision of activities.

Staff morale was low in the home. Staff did not feel listened to or supported. There were no effective systems in place to gather the views of staff and people living in the home. Not all records in the home were complete. Auditing and quality monitoring had been ineffective. The provider had not identified the issues found during this inspection.

We considered our inspections findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We found the staff and manager offered a service to people living at The Mount that was caring and that the care and support was focussed on the person’s individual need. People told us they were happy, well cared for and had no complaints. We received comments such as such as, “I cannot fault the home at all. I am so well cared for,” .

We looked at records of the individual care provided. These told us the home knew the people who lived there well and gave appropriate care and support when required.

Is the service responsive?

We noted in care plan records that information on any concerns was acted upon and people were supported quickly when issues arose. For example, when a person was struggling with their blood sugar levels or when a person was unwell and required a doctor. We saw the continence advisor who had been asked to visit due to a continence concern and noted the purchase of a new boiler when people could not be kept warm during the cold weather.

Is the service safe?

The home had maintenance records that were checked regularly such as fire records to ensure the building was of a safe standard. The records were audited at random to ensure the building was suitable and safe. Throughout the inspection we noted the clean and tidy environment with no risks or hazards seen during the observations.

Staff had support with training and regular meetings to ensure they could deliver safe care and support to the people living in The Mount. Contact with professionals for further support was triggered quickly when concerns arose.

Records were kept up to date to ensure current care needs were recorded that enabled the correct care to be delivered safely.

Is the service effective?

The people who lived in the home told us that they have been happier since living in The Mount.

We noted in one care plan the use of Age Concern to deliver an advocacy service to one person who had no family support. The home had regular meetings to ensure individual needs were met. One person told us how much better they felt for getting out on their bike more often. This told us that the service was helping the individual people to lead the lives they preferred.

Where a concern was triggered by erratic blood sugar recordings for a person with diabetes the home used effective methods to record and report the findings to health professionals. This showed the action taken was effective and quickly managed.

Is the service well led?

The home had a registered manager who had been working at the home for a number of years. It was evident throughout the inspection that this manager was knowledgeable about each person living in the home. We were informed of the needs and concerns of people in the home in detail. We saw evidence of improvements that had been made since the last inspection and also noted the methods used to audit the quality of the service. We saw completed questionnaires on the service delivered and noted the positive answers given.

Complaints were acted upon thoroughly and people and staff were listened to. We spoke with a social care professional who told us the manager listened and acted on suggestions and that people living in the home were receiving correct care and were safe.

We saw evidence of how staff were supported, such as with training, meetings and one to one supervision by the manager. The senior staff member we spoke with had clear knowledge and understanding of the people living in the home and what the requirements were for each person. We were assured that the service was well led.

People we spoke with told us that staff treated them well and that they were given choices about their daily lives. They told us that they enjoyed the food provided in the home. One person said that they liked the barbecues they had during the summer months. We found that people were offered a range of meal choices during the week which they were satisfied with.

We looked at people's care records and made observations of people's experiences of care. We found that care plans were in place and contained some person centred information. However, some records did not accurately reflect people's health and care needs as they were not being reviewed and updated when needed. In addition, mental capacity assessments were not being carried out to determine whether people could or could not consent to their care.

During our visit we looked at some staff files and spoke with the provider about their recruitment processes. We found that recruitment processes ensured that staff did not work in the home unsupervised until they were deemed to be suitable. Staffing levels were low for short periods in the day but no one expressed any concern about not being able to find staff when they needed them.

People who lived in this home told us, "I am supported well and encouraged to make decisions. I have lots to do that are of my choosing. I am very happy here." We heard and observed people being supported in a dignified and respectful manner.

The care and support needs of people living in The Mount were recorded in their individual plans of care. They were centred round the different needs and had been regularly reviewed to ensure they were up to date and that the support offered met their current needs.

We found that the home was managing infection control appropriately. We found examples and observed staff carrying out tasks that were following correct procedures to reduce or eliminate the possible spread of infections.

We found that the home had enough experienced and skilled staff to support the 22 people living there. The people told us that the support from staff was good. They said, "I get the support I need when I need it. All the staff know us and help us with what we need."

Although the home had not received any complaints there were appropriate methods available for people to complain if they so wished.

During our visit, we spoke with several people who live in the home.

People told us that they were happy and well looked after, praising the staff for their understanding and kindness. We were told that food was very good and that there is a choice. One person told us that they did not like beef, but, “Staff know and they serve me sausages, which I love”. People explained that they were offered a choice of drinks throughout the date.

People were satisfied and stated that they had everything that they needed in their bedrooms and that they liked the communal areas. “We can sit together and talk, it is never boring here”, as one person commented.

There were no objections to staff keeping and administering people’s medication. People felt safe and well protected and stated that staff were kind, supportive and responsive when asked to help or called by the call bell system to individual bedrooms.

People stated that they could see a doctor or a nurse or any other health professional if they needed to.