About the service:

Mornington Hall Care Home is a large care home for people living with dementia some of whom also have nursing care needs. It is divided into four communities for 30 people each. Two of the communities are for people with nursing needs, and two are for people living with dementia. At the time of our inspection 108 people were living in the home.

People’s experience of using this service:

People living in the home had varied experiences of care. While some people told us they felt safe and well cared for, others told us they were bored and staff were slow to respond to their requests for support. During the inspection we saw people were not always treated with kindness and compassion.

Risks to people living in the home had not always been mitigated and care plans lacked details about people’s needs and preferences. Information within files was sometimes contradictory and this put people at risk of harm.

Information about people’s ability to made decisions and choices was not clear. It was not clear that staff were following the principles of the Mental Capacity Act 2005.

Staff were deployed according to people’s level of need, and had been recruited in a way that ensured they were suitable to work in a care setting.

The service had identified many of the issues we found with the quality and safety of the service. However, the actions in place to address these issues had not yet been effective.

There were lots of different ways for people to provide feedback about their experiences.

Some areas of the home had been redecorated to make them more suitable for people living with dementia. However, it seemed these resources were being under-used.

Rating at last inspection:

The service was rated Good overall and in each of the key questions when it was last inspected in July 2017.

Why we inspected:

This inspection was brought forward as we received information from local authorities and members of the public that indicated the quality and safety of care at Mornington Hall Care Home may have deteriorated.

Enforcement:

We identified breaches of six regulations. These related to person centred care, dignity and respect, need for consent, safe care and treatment, staffing and good governance.

Please see the end of the report for details of our regulatory response.

Follow up:

We will continue to monitor the service closely and liaise with commissioners to monitor progress. We will return to inspect the service in line with our public commitments.

The service provides accommodation and support with nursing and personal care for up to 120 adults. At the time of our inspection 118 people were living at the service. The home was divided into four units each capable of accommodating up to 30 people. One unit specialised in residential care, one in nursing care, one in nursing and dementia care and one in residential and dementia care. At the previous inspection of this service in April 2016 we found that they were in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because not all staff had up to date training about supporting people living with dementia. During this inspection we found this issue had been addressed. In addition, at our last inspection we found that care plans did not always include details of people’s past life history. During this inspection we found this issue had been addressed.

The service had a registered manager in place. 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 and had practices in place to protect people from harm. Staff had training in safeguarding and knew what to do if they had any concerns and how to report them. People who used the service told us they felt safe and protected from harm.

Risk assessments were personalised and detailed. Staff had the information they needed to mitigate risks.

Staffing levels were meeting the needs of people who used the service.

Recruitment practices were safe and records confirmed this.

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Newly recruited care staff received an induction and shadowed other members of staff on various shifts. Training for care staff was provided on a regular basis and updated regularly. Staff spoke positively about the training they received.

Care workers demonstrated a good understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was being recorded in people’s care plans.

The service was supporting people who were subject to Deprivation of Liberty Safeguards (DoLS) in an effective way.

People were supported with maintaining a balanced diet and the people who used the service had access to the kitchen without restriction.

There was mixed feedback about the food and some people told us they were unhappy with it. The service was actively engaging with people to obtain their feedback and act on their suggestions for improvement.

People were supported to have access to healthcare services and receive on-going support and records confirmed this. The service made referrals to healthcare professionals when necessary and advice from healthcare professionals was followed.

Staff demonstrated a caring and supportive approach towards people who used the service and we observed positive interactions and rapport between them.

The service promoted the independence of the people who used the service and people felt respected and treated with dignity.

Care plans were reviewed every month and any changes were documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service told us they knew how to make a complaint.

The registered manager had a good relationship with staff and the people who used the service. Staff spoke positively about the registered manager and their management style.

The service had robust quality assurance methods in place and carried out regular audits.

Feedback from people was mixed about how quickly staff attended to their needs. Some people who used the service told us it took a prolonged amount of time for staff to attend to them when they used their call bells. We have made a recommendation about this.