Mountdale Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At this assessment, this key question has improved to requires improvement. This meant some aspects of the service continued to need to improve to ensure people were supported safely.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider told us they had introduced a new document for staff to complete following accidents or to raise concerns. Staff we spoke with told us they would raise health concerns with a nurse who would then escalate these to the GP if needed.

We found the process in place did not always fully review lessons learned or had a system in place to share lessons learned with staff. We could not be confident essential information was shared to prevent accidents or incidents reoccurring.

Before people were transferred to the service a referral was made to see if their needs could be met. One person said, “I had an accident at home and was in hospital before I came here. I am waiting for the hospital to arrange physiotherapy for me. The staff do come in and chat with me because of my limited mobility and they understand that I have had a bad fall and a stroke.”

Staff told us they had a good relationship with the local hospital and received referrals from them. Before people were admitted staff assessed if their needs could be met by the service.

There was a system in place to receive referrals and assess if people’s needs could be met by the service, including having the correct equipment in place for people to use.

People felt safe living at the service. One person said, “It is good here they look after us really well.”

Staff told us they knew how to raise safeguarding concerns. One member of staff said, “If anything happened, I would inform a nurse, or I could go to the manager or CQC. I feel they would act on it.”

Staff were available and attentive to people’s needs. We observed staff supported people safely with moving and handling needs.

The provider had a policy in place for raising and dealing with safeguards. Since our last inspection they had worked with the local authority to ensure all safeguards were raised and investigated to keep people safe.

People and their relatives told us they felt they were well looked after by staff at the service. One person told us, “The staff hoist me well and I have special cushions to sit on.”

Staff understood risks to people and how to support them safely. Staff had been supported to update their training to ensure they had the correct skills and guidance to support people. Additional training had been sourced for staff to complete fire marshal training so that there was always a member of staff available to co-ordinate a fire evacuation.

We observed people were supported safely to manage risks and support their independence where possible. However, we found staff did not always support people to reposition themselves as expected and at the time they were due. Although equipment was in place to prevent pressure area deterioration this practice placed people at an increased risk to their pressure area care.

Since the last inspection there had been an improvement in risk assessments and care plans. We found these now contained the information staff needed to mitigate risks to people. There were detailed personal evacuation plans in place should people need to be evacuated from the service. The service had now fully implemented the electronic care planning system, however we found where risk assessments were showing as needing review the provider needed to have a system in place to ensure these were completed promptly.

People and relatives told us the environment had been improved and redecorated. One relative said, “The decorating has brightened it up a lot, it's better. It's more presentable all over. The wallpaper and paint was peeling off the walls but no longer.” Although another relative told us, “Some areas are wrongly used for storage, like the conservatory and some of the bathrooms and toilets, has a lot of space taken up with wheelchairs.”

The provider told us they had undertaken work to make improvements both internally and externally at the service. This had included redecoration and the purchasing of new equipment.

We observed the service had been made brighter with redecoration and wall art added. The service was cluttered in places with equipment such as wheelchairs, cushions and hoist slings inappropriately stored. Some signage had been added however, these were text on paper and easily removeable, additional signage with pictures would help people navigate the service safely, especially for people living with dementia. Large clocks with dates had been added to help orientate people to the time.

The provider employed a maintenance person for the day-to-day maintenance of the service. There were a number of checks in place including water testing, electrical appliances and lifting equipment. However, we found environmental checks and audits were not effective as they did not address such issues as the inappropriate storage of equipment.

People told us they were supported by staff who were kind and caring. One person said, “The staff here are very good with buzzers, they always come quickly when you need them.” Another person said, “The staff here are very helpful and kind and nice to us all.”

Staff gave us mixed feedback about whether they felt they had enough staff to support people. Staff generally agreed they had a good team and enough staff to provide care, however some staff felt during the suppertime service staffing levels could be pressured. This was due to a member of care staff being used at this time to prepare the evening meal for people and additional staff for this task was not always provided.

We found staff were visible throughout the inspection and available to meet people’s needs promptly. However, we found activities were limited and were not person centred and engaging for all people.

The provider told us that they were fully recruited for staff and had a consistent staff team. Improvements had been made with recruitment processes and we found there were now safe recruitment practices in place. Appropriate checks were in place before staff started work including providing full work histories, references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had received updated training and additional training where needed to enhance their skills. Staff had regular supervision and meetings, where actions were identified and needed there was no plan in place how these actions would be met or follow up recorded.

Staff had received training in infection prevention and control (IPC). There was access to personal protection equipment (PPE) around the service for staff to use.

We observed on the first day of inspection issues with IPC. This included hoist slings being stored in a bathroom/toilet area. This placed them at risk of contamination when the toilet was used. There was also a rusty toilet frame in use around a toilet. Rust allows for bacteria to grow and is an IPC risk. The provider addressed these issues, removed the hoist slings and replaced the toilet surround by the second day of inspection. Issues highlighted at the previous inspection had been addressed.

The service had a policy in place for IPC and completed IPC audits. However, the audits had not identified or actioned the issues we found on the first day of inspection so we could not be assured they were effective.

People received their medicines when they needed them from nurses. One relative said, “The staff now recognise when [person name] is in pain and give them their medicines.”

Staff told us they were able to give people their medicines on time and when they needed them. The electronic medicine system they had in place also flagged if a medicine had not been given when due.

We found medicine that should have been destroyed following people dying had not been destroyed and remained at the service for a further 4 weeks. A nurse told us they usually destroy medicines after 7 days of a person passing but had needed to wait for destruction kits and had found they had not had time to complete this task. Where people were on anticoagulant medicine and were a high risk of falls, we found this had not been recorded in their care plans. When people are on anticoagulant medicines if they fall, they are at a greater risk of internal and external bleeding which would need additional medical follow up. This should be clearly identified in care plans, so all staff know what intervention is required. We recommend the service adds direction into care plans for anticoagulant medicines and actions staff should take if a person has an injury or fall. There were no audits in place of medicines other than recording medicine totals. If audits were in place they may have identified these issues.