Mount Vernon Terrace

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Peoples needs and rights were not being fully supported. Peoples care and treatment was ineffective due to their health, care, well-being, and communication needs not always being assessed with them and relevant external teams. Peoples care plans and risk assessments were not always kept up to date and required review. The management and staff team lacked a good understanding and knowledge of the mental capacity act, including capacity and consent. Some staff were unclear of how to support people living with fluctuating capacity. Staff were aware of people’s preferences and respected these in a person-centred way. People were aware of their rights around care and treatment. The service was in breach of legal regulation as they failed to ensure care and treatment was appropriate, met people's needs and reflected their preferences. The provider was also in breach as they failed to ensure the treatment of service users must only be provided with the consent of the relevant person.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that they were not always involved with planning and reviewing their care. One person said, “I have never been asked to any reviews of my care plan.” This left people exposed to the risk of decisions being made about them without their involvement. Coproduction should always be considered where people have the capacity to make decisions about the care and support they wish for.

Support staff on duty during our site visit were observed not interacting with people in a therapeutic or meaningful manner which was disappointing to observe. We saw staff had a good knowledge of people and their individual needs, although the wider care team had not signed to say they had read and understood people’s individual care plans and risk assessments. This left people at risk of harm, as staff may then lack knowledge of what immediate action to take if a person’s needs appeared to have changed. We were concerned that prompt referrals had not been made to health and social care teams when required.

Staff had access to documents on how to support people. Where people’s needs changed, these care planning documents had not always been updated so staff could understand people’s changes in needs. For example, where a person’s mobility had reduced, we found the service had not made a referral to an external health team for occupational therapy input for equipment review. Where a person had experienced a seizure, their care plan and risk assessment had not been updated following this event, despite the person being admitted to hospital. This left the person exposed to the risk of staff not understanding if their risk profile or support needs had changed. The service had not robustly implemented best practice guidance for the management of people’s specific identified needs. For example, where people lived with Epilepsy, the guidance for escalating to the emergency services if a person had experienced a prolonged seizure, was not being followed by the service. People’s communication needs were recorded and understood by staff. This allowed staff to communicate with people, to have a clear understanding of the person’s needs.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Feedback we received from people indicated the service worked in partnership with external agencies. However, we found the care plans, risk assessments and activity planners for people had not been regularly updated when a review had taken place. This left people living at Mount Vernon Terrace with potential unmet needs. We found a lack of therapeutic, meaningful engagement available for people. People gave mixed feedback about the support they received from staff and the lack of meaningful activities which were offered for them. One person said, “I feel the home provides me with good care, the only thing I would like to see more of is trips out. We recently went to Skegness.” The person told us how much they had enjoyed this day out. Another person said, “The staff are good, they are very polite to all of the residents and get on well together. The food is fairly good that is served here, although it would be nice to go out to restaurants more. I would like to see more day trips occasionally. We have been to play basketball and golf and I would like to start football training myself.” Another person said, “I feel people are supported to be independent and are encouraged to do as much as they can for themselves. If you want to cook something for yourself the staff will provide support.”

Staff members we spoke with told us about the positive relationships they had with people and their external health and social care teams. One member of staff told us, “It is amazing but quite challenging. Residents are friendly, they see us as family, we have trust.”

Referrals were not always made to external teams to help mitigate risks effectively. For example, people who had experienced falls and injuries had not been referred to professionals for specialist input to help mitigate this risk. Where referrals had been made, these had not always been followed up in a timely manner by the service or updated in people’s care plans. This left people exposed to the risk of not receiving safe and effective support.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People felt they were supported by staff in their best interests, and in the least restrictive way. One person said, “The staff are kind and caring, they do respect my dignity and privacy, and they do ask for consent before supporting me. I can access the community and attend various therapy groups in the city.” Another person told us, “The staff always ask for permission before providing personal care.”

All of the staff we spoke with understood the importance of respecting people’s wishes and asking for consent prior to providing support or personal care. We observed staff knocking on people’s doors and waiting for a response prior to entering. People were addressed by their preferred names and pronouns by staff in a respectful manner.

The service failed to ensure they were working within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. Where they lack mental capacity, any decisions made on their behalf must be in their best interests and as least restrictive as possible. We found appropriate legal authorisations were not in place when needed to deprive a person of their liberty. Contradictory assessments had been completed by the registered manager to assess people’s capacity to consent to specific areas of their care. Documents contained inconsistencies and confusing narratives. This showed the service lacked a clear understanding of the MCA. Processes in place had failed to ensure people were always supported to make decisions about their care and treatment within the principles of the MCA. People’s capacity to understand decisions had not always been assessed. Mental capacity assessments completed had not followed the principles of the MCA (2005). One person had an MCA in relation to having bed rails in place. This concluded the person had capacity, however a best interest decision was still completed. Screening tools used to assess people’s capacity used inappropriate terminology, such as the word ‘control’. Applications were not completed or submitted appropriately. One person had a Deprivation of Liberty form completed by the Registered Manager in February 2024. There was no MCA completed to support this. There was no evidence this had been sent to the Local Authority. Discussions with the management team provided clarity this person would not be free to leave should they wish to. Therefore, this person was unlawfully deprived of their liberty. Documents were not always appropriately completed where people had restrictions placed on them.