This inspection took place on 13 June 2018 and was unannounced.

Montague House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Montague House is a privately-owned care home providing long and short term residential care for up to 19 older people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the day of the inspection there were 17 people living at the service, some of whom were living with dementia.

At the last inspection in April 2017 the service was rated ‘Requires Improvement’. There was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. We asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-Led to at least ‘Good’. At this inspection we found that improvements had been made and the breach in Regulation had been met. Risks to people were assessed and staff had guidance to follow to reduce risks to people in the least restrictive way.

The registered manager worked at the service each day and was supported by a stable and established staff team who had been recruited safely. A registered manager is a person who has registered with 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 service is run.

People told us they felt safe living at Montague House. They were protected from the risks of abuse, discrimination and avoidable harm. Staff completed training about how to keep people safe and had guidance to support people to stay as safe as possible. Risks to people were assessed, identified, monitored and managed. People had their medicines when they needed them and these were administered by staff who were competent to do so. The registered manager monitored accidents and incidents to make sure people were referred to health care professionals when needed.

People were supported by staff who knew them well. Staff kept their skills and knowledge up to date and met with the registered manager on a one to one basis to discuss their performance and personal development.

People were protected from the risks of infection. The service was clean and tidy and regular checks were made to make sure the environment and any equipment was safe and well maintained.

People and their relatives were involved in planning their care and support. People’s needs were assessed before they moved into the service to make sure staff could meet their needs. They were offered the support of an advocate if they required additional support to help them make decisions about their care. Each person had a care plan which had been written with them and their relatives. These gave staff the guidance they needed to make sure they provided the support in the way people preferred.

People were encouraged to eat healthily and were offered a choice of home-cooked meals. Staff worked with health care professionals to make sure people stayed as healthy as possible.

People had access to private space, communal areas and the garden and visitors were welcomed at all times. 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 supported this practice.

People were supported by a caring, kind and compassionate staff team. Staff spoke with people and each other in a respectful way. People’s privacy, dignity and independence were respected and promoted. Records were securely stored to protect people’s confidentiality.

People were encouraged to ke

This unannounced inspection took place on 27 April 2017.

Montague House is a privately owned care home providing long and short term residential care for up to 19 older people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the day of the inspection there were 10 people living at the service, some of whom were living with dementia.

The service was run by a registered manager with the support of a deputy manager. 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 service is run. The registered manager was present on the day of the inspection.

We carried out an unannounced comprehensive inspection of Montague House in September 2016, the service was rated ‘requires improvement’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and we asked the provider to take action to make improvements. We issued requirement notices relating to the cleanliness of the service, mitigating risks, deployment of staff, consent, deprivation of liberty, a lack of activities and a lack of effective auditing systems. The provider sent us an action plan. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the breaches met. However there were still areas for improvement.

People told us that they felt safe living at Montague House. Staff knew how to recognise and respond to abuse and understood the processes and procedures in place to keep people safe. People received their medicines safely and on time. Medicines were stored safely. The service was clean.

Risks to people had been identified, however the registered manager had not consistently provided staff with clear guidance on how to provide the right support to keep people safe and minimise risks. Staff had been given guidance from a health professional and were changing the risk assessments.

The provider had recruitment and selection processes in place, which were followed, to make sure that staff employed were of good character. There were sufficient staff on duty during the day. However, we recommend the provider review their staffing levels along with people’s levels of dependency to make sure people are safe, particularly at night, in an emergency.

Staff completed training and had one to one supervision meetings with the registered manager or deputy manager. There were some gaps in staff training and refresher courses had been booked to cover these.

There were assessments in place to establish whether people had capacity or not to make decisions. When required meetings were planned with the relevant people to make sure decisions were made in their best interest. People were offered choices about what they wanted to do and how they wanted to spend their time.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

People’s health was monitored and staff worked with health and social care professionals to make sure people’s health care needs were met. People had enough to eat and drink and had a choice of home cooked food. People told us they were happy living at Montague House and staff respected their privacy.

Staff interactions were positive. Staff spoke with people in a kind and caring way. Staff knew people well inclu

This unannounced inspection took place on 6 September.

Montague House is a privately owned care home providing long and short term residential care for up to 19 people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the day of the inspection there were 13 people living at the service, some of whom were living with dementia.

The service was run by a registered manager with the support of a deputy manager. 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 service is run. The registered manager was present on the day of the inspection.

At the last inspection in December 2015, the service was rated ‘requires improvement’, there were breaches of regulations and we asked the provider to take action to make improvements. The breaches of regulations related to the need to gain people’s consent, staff supervision, involving people in their care, the lack of activities, involvement in the community and a lack of effective audit systems. The provider had taken action to involve people in the planning of their care. The registered manager had begun to meet with staff to hold one to one supervision meetings. However, action had not been taken to make sure that care was provided with people’s consent. The provider had not supported people to be involved in the community and take part in meaningful activities. Audits had not been completed regularly and had not identified the shortfalls found at this inspection. These were continued breaches.

Some areas of the service were unclean and unhygienic. Risks to people were not consistently identified and assessed and guidance for staff was not always provided on how to minimise risks to people.

There were not enough staff to give people the care and support they needed. Staff were often too busy to spend time with people. There were long periods of time when people had no interaction from staff.

The registered manager and staff had not assessed people’s capacity for either day to day or more complex decisions. Staff did not always act in accordance with the Mental Capacity Act 2005.

People were being deprived of their liberty without consulting with or referring to the relevant authority. No assessments had been completed to check if any restrictions in place were the least restrictive possible and in the person’s best interest.

We observed some positive interactions between staff and people. However, staff did not consistently promote people’s dignity and treat them with respect. When staff told people they would be back to support them, they did not always return to assist them.

Staff did not engage with people. Staff did not support people to be involved in the community as much or as little as they wished and to take part in meaningful activities. People told us they had nothing to do except sleep or watch the television.

There was a lack of regular and effective auditing and monitoring. Audits were not completed regularly or effectively. People, relatives, staff and health professionals were not asked their views about the quality of the service. Shortfalls identified during the inspection had not been identified by the registered manager or provider.

People told us that they felt safe living at Montague House. Staff knew how to recognise and respond to abuse and understood the processes and procedures in place to keep people safe. People received their medicines safely and on time. Medicines were stored safely.

The provider had recruitment and selection processes in place to make sure that staff employed were of good character. Staff completed training and had one to one supervision meetings.

People’s health was monito

We spoke with people and observed the interactions between people and staff. There were 18 people using the service at the time of our inspection. We observed how people reacted and responded to see if people were happy, bored, discontented, angry or sad. Everyone we spoke with expressed that they were happy living at Montague House. One person commented, “I am spoilt here. I have everything I want. It’s lovely here”.

People told us that they were asked to give consent and were involved in the decisions about the care and support they received.

People told us that they received the care and support they needed to remain well and healthy. Records showed how people’s needs were supported. We saw records that showed that the service worked closely with health and social care professionals to improve people’s health and well-being. One person commented, “I’m as safe here as I will ever be. I am well looked after here”.

We observed that the provider had provided an environment that was suitably designed and adequately maintained. The home was generally clean and free from unpleasant odours.

We found that there were enough skilled and experienced staff to meet people’s needs.

The provider generally informed and reported significant events that occurred to the Care Quality Commission (CQC).

We spoke with people who use the service, staff members and the Registered Manager. There were 14 people using the service at the time of our visit.

We met and spoke with some of the people who use the service and everyone we spoke with expressed that they were very happy living at Montague House. We observed interactions between the people and the staff and also people’s reactions to the staff. We observed how people responded and reacted with the staff and we observed to see if people indicated they were happy, bored, discontented, angry or sad.

People told us that they had the care and support they needed to remain well and healthy. They said were involved in decisions about their care and support. We were told, “I’ve got everything I want here. They wouldn’t let me have my cabinet at the old place but I can here. I’ve had a lot of support from staff.”

People said they liked living at the service and felt safe. One person told us, “I feel safe here because the staff are good.”

Staff engaged with people in a warm and positive way and supported people where needed.

We did not on this occasion speak to people so cannot report what the people using the service said.

People said that they were treated with kindness and respect. They said that they received the care they needed and that they felt safe. They told us that they would like to have more opportunity to go out into the community. They said that they received their medicines on time. However, improvements were required in the storage of medicines to make sure they are secure. People thought that some parts of the home needed redecoration. They said they liked their meals and spoke highly about the staff. They said that there was always enough staff on duty and they were treated with respect. They knew how to complain and would not hesitate to raise any concerns with the Manager or staff.

Montague House is a privately owned care home providing long and short term residential care for up to 19 people. The service is in a residential area of Ramsgate and is a short distance from local amenities. On the days of the inspection there were 17 people living at the service.

The service was run by a registered manager with the support of a deputy manager and they were both present on the days of our inspection. 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 service is run.

People told us that they felt safe living at the service. People looked comfortable with each other and with staff. Staff understood the importance of keeping people safe and knew how to protect people from the risk of abuse. People received their medicines safely and were protected against the risks associated with the unsafe use and management of medicines. Recruitment processes were in place to check that staff were of good character.

The provider employed suitable numbers of staff to care for people safely. They assessed people’s needs and made sure that there were enough staff with the right mix of skills, knowledge and experience on each shift. People told us that their call bells were answered promptly. However, the registered manager did not coach and mentor staff through regular one to one supervision meetings or appraisal. Staff had not had the opportunity to talk about their role and there were no personal development plans in place to support staff to develop their skills, knowledge and experience.

The service was generally clean and tidy; however, some areas of the service were not very clean and had an unpleasant odour. There was no cleaning schedule in place to identify what should be done each day / week / month.

People were provided with a choice of healthy food and drinks which ensured that their nutritional needs were met. Meals looked appetising and were well presented. People’s physical health was monitored and people were supported to see healthcare professionals, such as doctors and chiropodists.

Some people were able to make decisions for themselves about all areas of their life. They were supported to do this by staff who knew them well. Other people were unable to give valid consent to their care and support; staff did not always act in people’s best interest and in accordance with the requirements of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

People told us they were happy living at the service and their comments about the staff were positive. Staff supporting people had a friendly approach and showed consideration towards people. People and their loved ones were not involved with the assessment, planning and reviewing of their care. Each person had a care plan but these were not person centred and did not always give staff the guidance and information they needed to look after the person in the way that suited them best.

There was a complaints system and people knew how to complain. Views from people and their relatives were taken into account and acted on. The provider used concerns and complaints as a learning opportunity and discussed them openly with staff.

The design and layout of the building met people’s needs and was safe. The atmosphere was calm, happy and relaxed. Many people did not have the opportunity to go out unless they had friends or family to support them. There was a risk of social isolation because staff did not support people to keep occupied with a range of activities.

There were no robust systems in place to monitor the quality of the service. There were no reports following the audits to detail any actions needed, prioritised timelines for any work to be completed and who was responsible for taking action.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.