The inspection took place on 27 September 2018 and was unannounced.

Mortimer 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. Mortimer house accommodates up to 28 people in one adapted building. At the time of our inspection 22 people were living at the home. Accommodation is spread across two floors. The home provides care to people with learning difficulties, dementia and those in need of palliative care.

There was 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.

People received support from staff who were kind and caring and clearly wanted to do their best for the people they supported. However, there were areas of the service where improvements were required. There was evidence of good practice in relation to the MCA and DoLS and it was clear that the service understood the principles of this legislation. However, there were lapses where it wasn’t evidenced that people’s rights had been fully protected. For two people who had conditions on their DoLS authorisations, it wasn’t clear whether these had been met in full.

Staff told us that there had been some challenges at the service with high use of agency and bank staff. Where possible, bank and agency staff familiar with the service were used to minimise the impact on people using the service. Some staff reported morale being low due to all the changes that had occurred. The registered manager told us new staff had been recruited and were in the process of having checks completed. They hoped that this would lead to a period of stability for people using the service and the staff team.

Record keeping was inconsistent. There were areas of good practice but also evidence that records were not always completed fully.

Our observations throughout the day showed that people were treated with dignity and respect. People received comfort and reassurance when needed. Staff used humour to engage people and help build positive relationships. Staff understood people’s individual needs and preferences for care and talked to us about the ways in which they provided this.

People’s nursing needs were met and staff worked effectively with other healthcare professionals to ensure this was the case. We saw evidence of people receiving support from the speech and language therapist, dietician and GP. During our visit, there was a review taking place of one person’s complex health condition. Staff were knowledgeable about this person’s condition. Staff also demonstrated good knowledge about people’s dietary requirements and whether they needed a modified diet to reduce the risk of choking.

The inspection took place over two days on 7 and 14 February 2017 and was unannounced. The service was last inspected in December 2015 and was given a rating of ‘requires improvement’. No breaches of legislation were found.

The service provided nursing care and accommodation for up to 28 people with a diagnosis of dementia and/or learning disability.

There was 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.

We found that improvements to the service had been made since the last inspection. The process for administering medicines had improved. Pharmacist and GP support had been sought to review people’s medicine regimes and this had reduced the need for crushing medicines.

We also found that improvement in supervision of staff had taken place so that staff were meeting regularly with a senior member of staff to discuss their performance and development needs. Staff reported feeling well supported and told us that managers were approachable so they felt able to raise issues and concerns.

People were safe. There were sufficient numbers of staff to ensure their needs were met. Staff spoke positively about how they had time to spend with people between care tasks and that staff worked together as a team to ensure people’s care needs were met.

People were supported to ensure their health needs were met. Staff worked with healthcare professionals such as speech and language therapists, dieticians and district nurses.

People received good care and were treated with dignity and respect. . We observed that people experienced positive relationships with staff and other visitors to the home. People were able to maintain relationships with their families.

Staff understood people’s individual needs and people were able to follow their own daily routines. We observed that people were able to get up and ready for the day at a time of their choosing. There was a programme of activities for people to take part in if they wished to. People had opportunity to go out in their local community.

The home was well led, with a registered manager in place supported by a deputy manager. There was an open and transparent culture in the home. Staff were well informed about the issues arising from the last inspection and there was also information on display in the home so visitors were aware of the improvements required.

We inspected the service on 17 December 2015. This was an unannounced inspection.

Inspection. The service was last inspected in January 2014 when it was compliant with the regulations at that time.

The service is registered to provide accommodation and nursing care for up to 28 people. People who use the service live with a learning disability and/or a diagnosis of dementia. At the time of our inspection there were 27 people living at the home.

There was a registered manager for the service. 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.

We found that the procedures for giving people their medicines were not fully safe. Nurses were not always following the providers own procedure in relation to ensuring that staff had safely given people their medicines. There was a lack of readily available guidance for staff. Specifically there was no information easily available to ensure that medicines which people needed crushed were given to them safely.

Staff supervision was not up to date. This could impact on the quality of the service people received if staff were not properly supported and guided in their work.

The system for checking the quality of the care and service people received was not fully effective. Shortfalls in the way the service was run had not been picked up by recent audits of the service. This meant there was a risk that the quality of care people received was not safe and suitable for them.

People were given the support they needed at mealtimes and there was a plentiful supply of food and drinks provided for each person based on their preferences.

Staff demonstrated that they were knowledgeable about their responsibility to protect people from possible abuse. They were able to explain how to recognise abuse and report concerns following the providers safeguarding procedure.

Staff were kind and caring, and they supported people to live a varied and fulfilling life in the home and in the community. Staff had a good understanding of the needs of the people they supported and knew how to provide them with effective care.

People had good access to health professionals and were supported to attend appointments. Care plans clearly explained how to meet people’s range of care needs, and included detailed life histories of each person. This helped staff to know each person and to provide them with personalised care.

People were supported by staff to make decisions in their daily lives. Staff understood about the requirements of the Mental Capacity Act (MCA 2005). The service worked with people, relatives and social care professionals when needed to assess people’s capacity to make specific decisions. Staff also understood the importance of seeking consent before providing people with all aspects of care.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was part of a themed inspection programme specifically looking at the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. The programme looked at how providers worked together to provide care and at people’s experiences of moving between care homes and hospital.

At the time of this inspection there were 24 people living at Mortimer House. The deputy manager told us that six people had a diagnosis of dementia and that some others were undergoing assessment of their condition to determine whether they too were living with dementia.

All of the areas of Mortimer House we saw appeared clean and fresh. People who lived in the home looked clean, tidy and appropriately dressed. Staff were open and friendly towards us and the interaction between staff, and between staff and people who used the service was friendly and respectful.

People's needs were assessed and care was planned accordingly. Care plans were reviewed at least six monthly and more frequently when people's needs changed. There was good communication between staff and records had been kept of the support and health care needs of people.

People's health was monitored and they had access to community health resources as required. There was regular access to a GP and other healthcare professionals. When people needed emergency care they were treated as far as possible at the home. If they needed to go into hospital, information about their needs was sent with them and they were supported by staff from the home for continuity.

There were arrangements in place to monitor the quality of care people received and manage any risks.

We left comments cards at the home for people to complete in order to gain their views. One person completed a comment card. They wrote "Having been a regular visitor with 48 visits throughout the year and having visited a number of care homes in the Bath/Bristol area over the last five years. I acknowledge that the care and attention I have witnessed on each of my visits to this home has always been courteous attention provided by the staff to all residents. In particular the professional Food and hygiene good. Edible and well presented".