This inspection took place on 9 and 15 June 2017.

At the last inspection on 12 and 13 April 2016 the service was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9, Person-centred care; Regulation 16, Receiving and acting on complaints; and Regulation 17, Good governance.

At this inspection we found the provider was no longer in breach of the previously identified regulations and they had made significant improvements to the service and the care people received.

Mount Vale is registered to provide nursing and personal care for up to 65 people, including people living with dementia and old age. At the time of our inspection 54 people lived at the service.

There was a registered manager in post. 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 risks associated with people’s physical health were well managed and appropriate action taken to minimise identified risks. Risks associated with people’s mental health needs were not consistently managed. We have made a recommendation that the provider review their approach and knowledge with regards to positive behaviour management.

People told us they felt safe and were well cared for. Staff had received safeguarding training and understood the safeguarding processes in place that they need to follow in the event of any concerns.

The provider followed safe recruitment practice to make sure only suitable people were employed and that nurses had active registrations to practice with the Nursing and Midwifery Council (NMC). We asked the manager to obtain staff profiles for care workers supplied from an agency so they can be confident they know who is working in the service.

There were sufficient staff employed to provide timely assistance to people. Staff received appropriate training and support for their roles.

Good medicines management systems were in place and people could be confident medicines were given safely and as prescribed.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People spoke positively about the quality of the food provided and we observed that they had access to adequate food and drinks. Nutritional risk assessments were completed and referrals to the speech and language therapy (SALT) team or a dietitian made when appropriate. People received care and treatment from external health care professionals such as speech and language therapists and community mental health nurses when needed.

People commented on staff kindness and said they were treated with respect and dignity. We observed good professional and personal relationships between people who used the service, relatives and staff.

Staff knew people well and offered people the opportunity to take part in a range of different activities.

People expressed confidence in the management and leadership and they told us that the service was well managed and organised. People were confident that the manager would listen to their views and that action would be taken to continuously improve the service.

Management process including audits and checks were well managed and the service’s premises and equipment were maintained and were in safe working order.

This inspection took place on 12 and 13 April 2016 and was unannounced. The service was last inspected in March 2015, when the service was found to be in breach of one regulation, because staff had not received the required level of training and supervision.

Mount Vale is registered to provide nursing and personal care for up to 65 people, including people living with dementia and old age. At the time of our inspection 48 people lived at the service.

The registered provider is Barchester Healthcare Homes Limited. The service did not have a registered manager at the time of this inspection visit, but there was a permanent manager in post and they completed their registration shortly after our visit. 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.

Staff were aware of the different types of abuse and how to report concerns within the home. However, not all staff were sufficiently familiar with the provider's internal whistleblowing processes or the wider safeguarding processes that could be accessed if needed.

Staff were recruited safely, with the required checks completed before staff started work. There had been difficulties maintaining staffing, with times when staffing levels and consistency of staff deployment had not been maintained at optimum levels. New staff had now been recruited and agency staff were used to cover when necessary.

Medicines were administered safely and as prescribed. The service’s premises and equipment were maintained and in safe working order.

Although people were not clinically dehydrated, some people had dry mouths and there was confusion around the effective assessment and monitoring of fluid intake levels. Arrangements were in place to monitor people’s nutritional wellbeing. A variety of meals and snacks were provided and special diets were catered for.

Staff were provided with a range of training to provide the knowledge and skills they needed. Staff felt supported and arrangements for the formal supervision and support of staff had improved with the employment of a permanent registered manager to oversee and monitor these arrangements.

People had access to healthcare professionals when needed. Staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards authorisations had been sought where appropriate to do so.

We received positive feedback from two health care professionals, who told us the service had worked well with them and involved them appropriately in people’s care.

We found that there was a lack of consistency in the quality of care provided. This was particularly the case on the unit for people living with dementia, where people sometimes did not receive person centred care that met their individual needs. Some care plans we viewed would benefit from including more person centred information, to help staff provide better person centred care.

A complaints procedure was in place. However we found that complaints had not always been investigated or responded to promptly and in accordance with the provider's complaints procedures.

Activities and social events regularly took place, with a programme of activities available to people. However, we found that the activities provided could be developed further, in response to people’s individual needs and preferences.

There had been a history of management changes and temporary management arrangements at the home, which had impacted on its leadership. However, the service now had a permanent registered manager and people we spoke with were positive about their impact so far.

Audits and checks were completed, to help the service continually improve. However, we found that these systems had not

We saw that people looked cared for they were clean and comfortable and they told us that they felt supported and "Very well looked after". They said staff were very kind and helpful. One person said "The staff are really good , I am very pleased that I live here." Another person said "I like everything; no grumbles". A visitor said "It is always a pleasure to come and visit, the staff are very kind to everyone. My mum is really well cared for".

We saw that people had a choice of well cooked and nutritious food. Staff monitored people's weight and charted food and fluid intake of people who they had identified at being at risk of dehydration or malnutrition and took appropriate action promptly. People told us the food was "lovely". One person said " We get a really good choice, we are asked what we want when we get to the table. I am going to have fish and chips today, they are usually really nice".

We looked at staff files and found that they had been recruited properly,received regular training and were on duty in sufficient numbers to meet the current needs of the people who lived at Mount Vale. The manager told us that she and the area manager undertake quality audits and work to an action plan to resolve any outstanding matters.

We spoke with people who live at the home. Everyone we spoke to made positive comments about what it was like living at Mount Vale Care Home. One person said "my every need is catered for here, I am very happy." Another person said "the care and attention is great. I am very well cared for."

We carried out this unannounced inspection on the 17 and 19 March 2015. We last inspected this service in July 2013.

Mount Vale provides nursing and personal care for up to 65 people. It also provides care for some people who have a diagnosis of a dementia type illness. Mount Vale is owned by Barchester Health Care Homes Ltd and is a new, purpose built care home in close proximity to the town of Northallerton.

The home had a registered manager in place and they have been in post as manager since January 2015. 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 observed that the carers were kind, supportive, and respectful to the people that used the service. Key pad doors on the dementia unit prevented people living with a dementia from accessing the staircases but they could walk freely within the unit. People living downstairs were free to leave the premises if they wished and escorts were provided if available.

Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were in place to reduce the risks identified.

Out of 72 staff members, 24 had not received up to date safeguarding training and nine staff member’s training were about to expire. Staff we spoke with did understand how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents recorded did not identify any trends.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and we saw evidence that a Disclosure and Barring Service (DBS) check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruiting decisions and also to minimise the risk of unsuitable people working with children and vulnerable adults. We saw that nursing staff were currently registered with the Nursing and Midwifery Council (NMC) at the time of the inspection. This should help ensure people received care and treatment from nursing staff who are required to meet national standards and to abide by a code of conduct.

Staffing levels were appropriate but could benefit from an extra nurse on duty. We saw that due to only having one nurse on each floor, they were under a lot of pressure as they had three people who required palliative care.

Staff we spoke with said they had attended a “one to one” one day induction, where fire training and manual handling were covered. We could see no record of attending an induction programme in their staff file.

We found that medicines were stored and administered appropriately.

We observed a lunchtime meal. The food was well presented, tasty and the correct temperature and the atmosphere was relaxed. The service had a dining room on each floor as well as a formal dining room for people who want to enjoy meals with their family and friends to celebrate a special occasion. The main dining room downstairs, people who chose to eat here would choose off the menu once seated. The menu provided two choices of main meal or numerous choices of a lighter meal such as jacket potato and filling or beans on toast. One the day of our inspection they were celebrating St Patricks day and the menu was themed around this.

We saw that the service was clean and tidy and there was plenty of personal protection equipment (PPE) available.

The registered manager had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made, and how to submit one. Staff did have a limited understanding but were booked in for MCA and DoLS training on the 31 March 2015.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. The care plans were found to be detailed outlining the ‘problem’, the ‘personal outcome’, the plan of care’ and the ‘review date’, however it was difficult to gain a clear overview of people’s needs and the support they required, which meant that people’s needs may be missed or overlooked. It was found to be a complex care file system and difficult to navigate; with poor quality care file binders, which meant that documentation was insecure in the binder and may result in information being misfiled or indeed lost. Care plans provided evidence of access to healthcare professionals and services.

Staff had not received all the training needed to enable them to perform their roles, for example 17 staff members moving and handling training was out of date, 30 staff members fire training was out of date and 23 staff members food hygiene training was out of date.

Staff did not receive regular supervisions and appraisals to monitor their performance. Where people had received a supervision in the last year there was no evidence of what was discussed other than a tick to say which topics had been discussed.

Staff said they were supported by their manager and were able to raise any concerns with them. Although staff, people who used the service and relatives were feeling unsettled due to management changes in the last year and the fact that the registered manager was due to leave.

The service looked at incidents that occurred and to see if lessons could be learnt and improvements would be made if and when required. No incidents had shown any trends so far. The service had a system in place for the management of complaints although complaints we looked at did not provide an outcome to say whether the complainant was happy.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks.

We found the provider was breaching one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.