This inspection took place on 19 and 23 July 2018 and was unannounced.

The Mount & Severn View is registered to provide accommodation with nursing and personal care to a maximum of 58 people, some of whom are living with dementia. There were 49 people living at the home on the day of our inspection. People’s bedrooms are over two floors and the first floor is accessed by stairs or a passenger lift. People have access to communal areas within the home and access to the home’s gardens.

A registered manager was not in post at the home. 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.

At our last inspection on 24 August 2017 we rated the service as requires improvement and we found one breach of regulation of the Health and Social Care Act 2008. We asked the provider to take action to make improvements to ensure there were sufficient numbers of staff, people received the care and support they needed and were treated with respect and consideration at all times. We also asked the provider to make improvements to their arrangements to ensure people were protected from abuse and not restrained unlawfully. We asked the provider to send us an action plan. At this inspection we found that some improvements had been made, however further improvements were required.

The systems the provider had in place to identify areas that required improvement and to drive those improvements were ineffective in ensuring the experiences of people had improved since the last inspection.

Staffing numbers had been increased, however people still did not receive care in a timely manner.

Risks to people were assessed and minimised however environmental risks had not been considered.

People were not always treated with dignity and respect and their needs were not always responded to in a timey manner.

Complaints were investigated however there was no system in place to address informal grumbles.

Infection control measures were in place however they had not prevented malodours in some areas.

People were safeguarded from the risk of abuse and their medicines were stored and administered safely.

The principles of the Mental Capacity Act 2005 were followed to ensure people who lacked capacity consented to their care and support at the service.

People were cared for by staff who were trained and supported to fulfil their roles.

People’s needs were assessed and they had access to health care agencies when they became unwell or their needs changed.

This inspection took place on 24 August 2017 and was unannounced. At our previous inspection, in February 2015, no improvements were identified and we had rated the home as Good. At this inspection we have changed the rating to Requires Improvement.

The Mount & Severn View is a nursing home. It provides accommodation with nursing and personal care for a maximum of 58 people. On the day of our inspection 55 people were living at the home. People’s bedrooms are over two floors and these are accessed by stairs or a passenger lift. There is a six bedded wing dedicated to the care of people living with dementia within the home called the Memory Lane unit. People have access to communal areas within the home and access to the home’s gardens.

The registered manager had retired the day before our inspection. The provider had already moved a registered manager from another one of their homes and they had applied to become registered manager at The Mount & Severn View. They are referred to as the new manager in this report. 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, relatives and staff all expressed concern to us about there not being enough staff at the home. People’s call bells were not always answered in a timely manner because staff were helping other people. This had impacted on people’s dignity, safety and the way in which staff were able to meet their needs when they needed help. Improvement was needed to make sure staff were always available to support people when they needed it.

Managers were not aware of staffing concerns or the effect this had had on people and their dignity. People's needs were assessed to establish how many staff were needed, but this had not been effective in ensuring people received support when they needed it.

People could be at risk of not having their right to make their own decisions upheld. Staffs' knowledge about how to support people who did not have capacity to make their own decisions was good. But the records of the processes they had to follow did not reflect this level of knowledge.

People and relatives had opportunities to give feedback about the service provided. Relatives who raised concerns informally did not always feel these had been resolved. The provider had a complaints policy in place, which people and relatives were aware of. Complaints were investigated and responded to, in a formal manner, as per this policy.

People and relatives thought staff were well trained and understood how to support them. Staff had received training to give them the skills and knowledge needed to support people's individual needs. Some staff felt they needed more specialised training to help them understand people’s health conditions better. Training had already been identified for this to happen.

Staffs’ experience of the support they received in their roles was varied. Some staff felt involved in what happened at the home whilst others did not.

Staff had received training in and understood how to protect people from any avoidable harm and abuse. Staff knew how to and were confident in reporting any concerns they may have about a person’s safety. However, managers told us they had not been made aware of staff concerns about staffing levels.

People continued to have their health needs met. People had access to a range of healthcare services, when required.

Risk to people had been identified and assessments reflected how care should be provided to the person to minimise any risks to them. Staff knew what they needed to do to help reduce risk to people and keep them safe.

People were supported to take their medicines when they needed them. Medicines were stored safely and the processes in pl

Not all the people we met were able to speak with us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people. This helped us to make a judgement on how their needs were being met.

We carried out this visit as a result of concerns we received with regard to staffing levels on Salway unit. Salway unit is a unit for six people living with dementia.

We reviewed people’s care needs on the unit, talked with staff and made observations during our visit. We did not identify any concerns and found people experienced care, treatment or support that met their needs and protected their rights. People were cared for by enough qualified, skilled and experienced staff.

We found that people who used the service were protected from the risk of abuse. This was because the provider had taken reasonable steps to identify potential abuse and acted appropriately.

There were systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. The registered manager undertook audits including care plan audits. We saw that the manager used a needs analysis tool to calculate staffing levels. They told us that if a person’s dependency level increased staffing levels were adjusted to reflect this. We saw evidence of these audits/tools in records we sampled.

People told us that they were happy with the service they received. They said that the staff were, "Very kind" and, "Very sweet". One person told us, "I couldn't be better looked after".

Staff told us that they enjoyed working at the home and that they were well supported by the manager. We saw that staff had received appropriate training for their roles and that they were properly supervised and appraised.

We found that care plans were comprehensive and person centred. We saw care being delivered with kindness and sensitivity. People told us that they felt safe in the home. We found that there was a comprehensive safeguarding policy in place and that staff were familiar with it.

We found that that staff understood the need to obtain people's consent for their care and treatment. However, people's consent was not consistently recorded.

There was a suitable complaints procedure in place and we saw evidence that complaints were responded to in an appropriate way.

We spoke with 11 people who use the service, three relatives and five staff. People who were able to share their experiences of living at The Mount were positive about the care that they receive. They told us that that they were well cared for and that the care staff were “very good”. People said that they were happy with their rooms and that they were encouraged to bring in some of their own possessions from home to help personalise them. People told us that they enjoyed their meals and that they were provided with a varied choice of food. They told us that their rooms were kept clean, that staff respected their privacy and dignity and that their visitors were always made welcome. One person said, “Nothing could be done better here, the staff are lovely and I have plenty to eat and drink”. Another person said, “It’s not a hotel they have a business to run, but the staff are cheerful and do their best”.

Feedback from relatives was mixed. Two people were very complimentary about the care that their relative received. They told us that they were fully involved in the assessment and care planning and review process. They were happy with the staffing levels and considered that staff were quick to respond to any health care needs. Comments received included, “We were fortunate to get mum in here, she is cared for very well. The meals are really good – like a hotel, the staff are very very good and the manager is nice and approachable”. “The care my wife receives is marvellous. I couldn’t wish for anything better. The staff are very helpful and I’m kept well informed, I wouldn’t find another place like this”. Another person considered that their relative was isolated and that “the home had failed in their duty of care” following a recent accident at the home.

Most of the staff we spoke with told us that they enjoyed working at the home and that they are provided with many training opportunities to develop their skills and knowledge. They considered that the care plans are reflective of people’s individual needs and provided good examples of how they promote privacy and dignity. They told us that they received formal supervision to discuss their work practice, performance and identify any training needs. They told us that regular team meetings are held in addition to handovers so that they are kept informed about any changing needs. Comments included, “I really like working here. We work well as a team and the manager is supportive and approachable. I’d recommend the home to anyone”. “The residents and staff make it a lovely place to work, although it can be disorganised and communication between the team could be improved”.

“I enjoy the challenge”.

Five people expressed concern about staffing levels given the dependency levels of the people accommodated and the layout of the home. One person said, “Sometimes there are not enough staff on duty at night. Staffing levels are reduced but they still have the same number of us to look after. I’m sometimes kept waiting when I call the bell”. Another person said, “People’s needs are not always met as we are so busy”.

This inspection took place on 23 and 25 February 2015 and was unannounced.

The Mount & Severn View provides accommodation, personal and nursing care for older people and people living with dementia for a maximum of 58. There were 56 people living at the home when we inspected.

The home had a registered manager in post who was present for our inspection. 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 told us that they felt safe living in the home. Staff told us that they had received safeguarding training and knew how to protect people from potential abuse. They were also aware of their responsibility of reporting concerns of abuse to the manager and other agencies. There were sufficient staff on duty to keep people safe. We saw that staff were nearby to support people when needed. Staff had access to risk assessments that told them how to support people in a safe way. Accidents were monitored and action taken to reduce further risks.

People told us that they were involved in their assessment and care planning and this ensured they receive care and treatment the way they liked. Staff told us that they were supported by the manager and had regular supervision and training. People’s consent for care and treatment was obtained and where people lacked capacity a best interest decision had been made to ensure they received the appropriate support.

People told us that they were happy with the meals provided to them and we saw that where necessary people were supported to eat their meals. People told us that they had access to other healthcare services when needed and a record was maintained of when healthcare professionals had visited.

People told us that staff were caring and treated them with respect. We saw that people were supported in a kind and caring manner and this was done in a way to promote their privacy and dignity.

Staff were aware of people’s past history and their interests and this information was included in their care records. People told us that they had access to various social activities in and outside the home and staff supported them to pursue their interests. People were aware of how to share their complaints and concerns. Complaints were recorded and showed what action had been taken to address them.

People told us that they were happy with the service and were involved in regular meetings that enabled them to have a say in the way the home was run. Staff said that the management team were supportive and listened to their views. The service provided was regularly monitored and quality audits were carried out to ensure people received a safe and effective care and treatment.