The inspection visit took place on 05 July 2017 and was unannounced.

Mountford is a care home providing nursing care for up to 38 people some of whom are living with dementia. The service is set in a residential area of Truro. It is a single storey purpose built service. There were a range of aids and adaptations which were suitable to support people. The service is close to local amenities and a transport network. The garden area has been developed as a sensory area which is suitable for people with mobility needs. At the time of the inspection visit there were 34 people living at the service.

At the last inspection in July 2015 the service was rated overall ‘Good’.

Staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at the service. People told us staff were very respectful and spent quality time with them or their relative. There were numerous examples of how caring attitudes of staff had a very positive impact on people’s lives. For example, staff were supporting people who were entering the end stages of their life. Staff made sure they knew what people wanted, including experiencing events of their choice, having personal items around them and listening to specific pieces of music. Comments we received included, “Nothing is too much trouble, its 24/7. We were supported as well as (Person),” “Absolutely excellent. Just couldn’t have asked for more. The support from staff was exceptional” and “We were encouraged to visit anytime. It was very important especially for the grandchildren.”

Systems were in place to help ensure staff had up to date information on how best to support people at this stage of their lives. People received individualised person centred care that was designed to meet both their health needs and their social needs and individual preferences. The management team lead by example when delivering care and support and displayed a commitment and passion for the service they provided. The service had achieved a national award for providing end of life care. Staff told us they were very proud of the support and care they give to people and their families as they are coming to the end of their lives.

Health professionals we spoke with told us how they felt the service provided outstanding care. They were impressed with the knowledge of staff with their attention to end of life care.

There were enough staff to help ensure people’s health and social needs were met. Staff were effectively deployed across the service to ensure people’s needs were being met. In general call bells were responded to quickly. However we observed one occasion when a call bell was not answered promptly. When informed the management team responded immediately to address the issue.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe.

Staff were aware of their responsibilities to protect people from avoidable harm. Staff had received adult safeguarding training and had information available of the action required to respond to any concerns that may be raised. The management team had taken appropriate action when safeguarding incidents had occurred to reduce further risks.

Recruitment procedures were safe to help ensure staff were of suitable character to work with people who may be vulnerable.

We observed people receiving their medicines as prescribed. The system for storing medicines was safe. There were suitable storage systems for keeping medicines safe and secure. Only staff with responsibility for medicine administration had access to medicines. It was clear from the medicine records that people received them as prescribed. Regular medicines audits were taking place to identify if any errors occurred.

Risks in re

We carried out this unannounced inspection of Mountford on 18 June 2015. Mountford is a care home that provides residential and nursing care for up to 38 people. On the day of the inspection there were 35 people using the service. Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia. The service received a comprehensive inspection in October 2013. At that time we found records were not being completed accurately. There was not an accurate record in respect of each service user, which included appropriate information and documents in relation to the care and treatment provided to each service user. The service provided us with an action plan showing how it would improve record keeping. We inspected the service again in February 2014 and found the service had taken action to improve the information about peoples care and treatment.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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.

Work was taking place to replace and renew external windows and paintwork. The front of the building had been completed but work was continuing so that all windows and paintwork would be replaced and renewed. Internally there were areas where paintwork and woodwork was chipped or damaged and needed decoration due to the constant use of wheelchairs and mobility equipment. A business plan had identified where environmental improvements were necessary and had been planned for.

A garden project was well underway after the service was awarded lottery money to create a sensory garden. People using the service, visitors and staff were excited by the project. Some of the comments included, “It’s going to be a great place to sit in and enjoy, we can’t wait”. A staff member said, “A few people have enjoyed their own gardens so it will be nice for them to be able to go out and sit amongst the flowers”.

The atmosphere at the service was welcoming, calm and friendly. The service had a central hub of lounge and dining space, as well as two separate lounges. People were able to spend their time in various areas of the service as they chose. Some people were sitting and reading daily newspapers in the lounge, others chose to sit in the other lounge areas. For people with mobility aids there was suitable storage for equipment so that it did no impose upon the living areas of the service. People’s bedrooms were personalised as were the furnishings in lounge areas. Signage supported people with dementia who had issues to help them move around.

There was a stable staff team who had a good knowledge of each person’s needs. People using the service and visitors spoke well of the staff team. Visiting families told us, staff had the right knowledge and skills to meet their relative’s needs. People told us they felt safe living at the service. “I like living here, I feel safe” and “They treat me well here”. A family member told us, “We came unannounced to look around, we were shown around and are very impressed”. There were enough staff on duty to meet the needs of people living at the service.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. Tables were laid with decorative coverings and the dining experience we observed during the inspection visit was positive. People were seen to enjoy their meals on the day of our visit and were supported by respectful staff.

Staff were recruited using suitable checks to ensure staff were safe to work in a care environment and had the appropriate skills and knowledge to support people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had the appropriate level of knowledge and skills.

People were well cared for. Staff were kind and respectful when supporting people. Visitors commented, “Staff care for my (relative) with respect”. “Staff are always kind to my (relative), they are treated with dignity”. Visitors were welcomed at any time and encouraged to be involved in their relatives review’s.

Health professionals told us staff had good knowledge of the people they cared for and made appropriate referrals to them when people needed it. People and visitors told us they were confident that a doctor or other health professional would be called if necessary. People were well cared for and were involved in planning and reviewing their care. There were regular reviews of people’s health and staff responded promptly to changes in need. Staff had good knowledge of people including their needs and preferences.

Staff were positive about their work and confirmed they were supported by the management team. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs.

People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Families and staff felt they could raise any concerns or issues they may have with the manager, who they said was approachable. People felt their views and experiences were listened to.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, meetings and comment cards. Response from this monitoring showed that overall satisfaction with the service was very positive.

We did not speak with people who lived at Mountford as this was a follow-up inspection to check compliance with record keeping only. Records were accurate, up to date and showed that they were monitored with appropriate action taken where necessary.

We spoke with people and staff at Mountford and a visiting relative. People told us they were happy with the care they had received and comments received included “nothing is too much trouble – that goes for all staff”. Another person told us “I can’t fault it in any way”.

People were protected by a clean environment and medicines were well managed. The care home adhered to a robust recruitment procedure in order to protect people.

We saw that staff were supported, both by their colleagues and seniors, and also by Cornwall Care Limited.

Records were not always accurate or up to date.

One person told us they liked it at Mountford and that the staff had been kind and helpful. We were told “it is excellent here, the food is good and the whole place is spotless”. Two visitors to the home told us they thought their relative was very happy there. They were satisfied with the care provided by the staff. We observed the staff talking with people who used the service and saw they were respectful, friendly and supportive to them. The atmosphere in the home was warm and welcoming. We saw people were comfortable with each other and with staff at Mountford.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw people’s wishes were respected. We observed people moving around the home without restriction.

Care plans and associated documentation provided sufficient detail to direct and guide staff of the action they needed to take in order to meet people’s assessed care needs. People's records were personalised and provided clear information about the person’s wishes and abilities.

People were protected from abuse and staff were trained to carry out their roles. Staff were not fully supported with supervision.

We observed the home was clean, tidy and free from odours. People were protected from the risk of infection. People lived in a warm and comfortable home and appeared well looked after with clean and pressed clothes.

We reviewed all the information we hold about this provider, carried out a visit on 3 March 2012, talked with people who use services, talked with staff, checked the provider’s records, and looked at records of people who use services.

We were able to observe people who used the service and staff throughout the inspection. We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people who used the service or staff. People who used the service were moving freely around the home. We did see people speaking with staff, and approaching staff without hesitation. We saw and heard staff talking with people in an adult to adult, respectful way. The atmosphere at the home was relaxed and pleasant throughout the inspection. People told us they were happy at Mountford, and happy with the staff and the care provided. We saw and heard people being offered meaningful choices; for example, people were asked what they would like for breakfast. We saw some people opted for a cooked breakfast, whilst other went for cereal or poached egg on toast.

Staff told us that training was provided, that they enjoyed working at Mountford, and that they felt they could approach the manager and senior staff if they needed to. Staff told us they would not hesitate to report any perceived abuse. They also told us that supervision had lapsed over recent months.