Inspection on 23/10/06 for Mount Pleasant Care Home

This inspection was carried out on 23rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mount Pleasant Care Home 04/11/08

Mount Pleasant Care Home 28/09/05

Mount Pleasant Care Home 18/05/05

Mount Pleasant Care Home 28/10/04

Mount Pleasant Care Home 25/05/04

Mount Pleasant Care Home 29/04/03

Mount Pleasant Care Home 07/01/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mount Pleasant Care Home Off Hollow Lane Winshill Burton On Trent Staffordshire DE15 0DR Lead Inspector Janet Morrow Key Unannounced Inspection 23rd October 2006 11:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mount Pleasant Care Home Address Off Hollow Lane Winshill Burton On Trent Staffordshire DE15 0DR (01283) 546777 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Willow Care Limited Vacant Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (5) of places Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of Service Users 50 of which no more than five persons maybe in the category PD over the age of 55, and the remaining persons to be in the category of OP. Plus Three (3) Day Care Places 2. Date of last inspection 28th September 2005 Brief Description of the Service: Mount Pleasant is a Care Home registered to provide personal care and accommodation for up to 50 people in the category of Older Persons. Mount Pleasant is also registered to provide 5 places for people with a physical disability. Mount Pleasant is a purpose built building which is located on the outskirts of Burton-on Trent. The home is set in spacious grounds, and has a car- park. The home has all single rooms, all with en-suite facilities. A variety of lounge and dinning room space is provided. There are sufficient bathing facilities to meet the needs of the service user group. Information provided by the company in June 2006 stated that the scale of fees for 2006 were £350 - £405 per week. There are additional costs for hairdressing, social activities, chiropody, private telephones, room service and personal items. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over eight hours. Eight residents, four members of staff, one visiting professional and the acting manager and provider were spoken with. One relative was contacted by telephone during the visit. A tour of the building was undertaken. Three residents’ care records and three staff files were examined. Written information provided by the home informed the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 6 Care records need to be more detailed and a comprehensive plan of care must be prepared for all residents. Failure to do so has the potential for care needs to be missed. All care records must contain the information listed in Schedule 3 of the Care Homes Regulations 2001 to ensure that legal requirements are met. It should also be made clear that residents have been consulted about their care and how it is to be provided. There was some inconsistency in the use of codes on medication administration record (MAR) charts. These need to be applied consistently to minimise the risk of errors. All staff employed in the kitchen must have an up to date food hygiene certificate. This was raised as an issue at the previous inspection in September 2005. Recording of residents’ personal finances must be accurate to show whose money is being held. A greater variety of options at the tea-time meal and availability of fresh fruit would enhance the food provided. Quality assurance processes would be improved by obtaining the views of visiting professionals and relatives. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient admission information available, which established that the home could meet residents’ needs. EVIDENCE: Three residents care files were examined and all had an assessment in place, including information from the assessment and care management process, where applicable. Some of the information on one file was basic with minimum details. There was also no information in the initial assessment on social and religious preferences. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 9 Residents spoken with stated that their care needs were met and a visiting professional also confirmed this and stated that the home provided a ‘high standard of care’. Staff spoken with were also confident that they could meet the needs of current residents. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health care needs were met but additional detail on care records would enhance the care provided. EVIDENCE: Three residents’ care files were examined and all had a basic care plan in place and two had a detailed care plan that contained useful information. However, one file did not have a detailed care plan and it did not show what action was being taken to address identified needs. Another was not dated so it was not possible to know whether or not care needs were recent or if they had changed. The system for recording care needs was unclear, with changes being recorded in a daily log and not on the care plan itself. This had the potential to cause confusion about which care needs were current and what changes, if any, had occurred. None of the care plans were signed so there was no evidence to suggest that residents had been consulted about their care. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 11 The files showed that access to health professionals was available and a visiting professional spoken with stated that they were called out appropriately and that the home sought advice when necessary. They also stated that relevant information was always available to assist them and that ‘good care appeared to be a priority’ for the home. All residents spoken with stated that their care needs were well met and that staff were ‘kind and helpful’. A quality assurance survey completed by a resident stated that their ‘physical condition had improved’ since being at the home. Warm relationships between staff and residents were observed and residents clearly had confidence that any problems would be addressed. A relative also stated that staff were ‘helpful and understanding’. Medication administration record (MAR) charts were examined and showed that these were, on the whole, accurate and corresponded with the dosage system. However, codes were not being used consistently to show why a medicine was not administered and there was no explanation why one resident had not received their morning medication on a specified date. Two people had not checked, signed and dated handwritten charts. This had the potential for errors to occur. The medication refrigerator temperatures were recorded on a daily basis and were within safe limits. A copy of the Royal Pharmaceutical Society Guidelines was available and the acting manager knew that medicines should be retained for seven days in the event of a death. There were no controlled medicines in storage although Temazepam was stored under controlled conditions. The record and the amount of Temazepam held corresponded accurately. The acting manager stated that all senior staff had undertaken medication training and this was confirmed on the written information provided by the home. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities, meals and contact with the community were all well managed, which ensured that residents had a good quality of life and control over their lives. EVIDENCE: Residents’ individual routines were varied. Some chose to spend time in their rooms. Others were observed chatting and undertaking hobbies such as reading and doing jigsaws. Games were in evidence and residents spoken with stated that they had the opportunity to participate in them. A new café/bar facility was being used and two residents spoken with made use of the facility regularly and enjoyed having a drink in the afternoons. The provider stated that there were plans to make more use of the facility and cited some of the social activities that had taken place in it, such as ‘cheese and wine’ and ‘Irish coffee’ events. Those residents spoken with confirmed that they had thoroughly enjoyed these activities and looked forward to future events. The written information provided by the home stated that there were daily inhouse activities available such as games and painting and that musical events Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 13 occurred once or twice monthly. There were also gentle exercises sessions on a fortnightly basis. Contact with the local community was maintained and a relative and visiting professional spoken with both stated that they were always made to feel welcome. The written information supplied by the home also stated that local religious ministers visited the home on a regular basis. The senior carer on duty was not aware of how to contact specialist advocacy services although the management stated the acting manager knew how to contact them and that solicitors represented the views of some residents. Meals were well organised and varied and all residents spoken with stated that they enjoyed the meals. Menus provided by the home prior to the inspection showed that the meals offered were nutritious and wholesome. The serving of the tea-time meal was observed. Several residents spoken with during the meal stated that they enjoyed the food but would appreciate more variety, as it was ‘mostly sandwiches’ for the tea-time option. However, menus indicated that a choice was available. Specialist diets such as diabetic were catered for. Although a record was kept of what food residents had eaten, the kitchen staff were not sure how long this was maintained for and could only provide the record for the previous day. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were handled objectively and safeguarding adult procedures observed, which ensured residents were listened to and protected. EVIDENCE: The written information provided by the home stated that there had been three complaints received during the last twelve months. There had been no complaints received at the office of the Commission for Social Care Inspection since the last inspection in September 2005. The complaints procedure was seen. This was clear and stated that complaints should be taken to the manager or owner in the first instance. A relative and residents spoken with stated that they were confident of a courteous response to any concerns taken direct to the acting manager or owner. The home had Derby and Derbyshire Local Authority Social Services adult protection procedures in place. Staff spoken with confirmed that they had received training in safeguarding adults and this was also confirmed on the written information supplied by the home. The senior carer was responsible for organising further training for staff and was aware of the home’s responsibilities in reporting any incidents. The written information provided by Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 15 the home stated that there had been no allegations of abuse in the last twelve months. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was very well maintained and well decorated with a range of communal areas for a variety of uses, which provided comfortable and appealing accommodation for residents to enjoy. EVIDENCE: Mount Pleasant was clean, tidy and well maintained at the time of this inspection. Residents and relatives commented favourably on the comfortable accommodation provided. There was sufficient communal space for activities and the new café/bar area added an extra dimension to the facilities on offer. There was sufficient equipment to assist residents with mobility problems such as handrails, bath hoists, wheelchairs and raised toilet seats. Wheelchairs were Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 17 stored in alcoves around the home. The call system had been upgraded to provide a portable system for those residents who requested it. This was in the form of a neck pendant enabling residents’ to call for assistance without having to reach for a call bell. Telephones were also available for those residents who requested them at an additional charge. The laundry was viewed and residents’ clothes were well cared for. Residents spoken with stated that they were pleased with the way their clothes were laundered. The home had a washing machine with a sluicing facility and staff interviewed stated that they had undertaken infection control training. This was also confirmed on the written information provided by the home. There was no odour and hygiene standards were high. Residents, a relative and a visiting professional all commented on the quality of the accommodation offered and a resident survey seen stated that the home provided ‘a lovely sociable environment’. The home is therefore commended for its commitment to providing high quality accommodation. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient well-trained staff to ensure residents’ needs were met. Recruitment procedures were robust which ensured that residents were safeguarded. EVIDENCE: The written information provided by the home included a rota for May 1st 2006 - May 28th 2006. This showed that there were five care staff on the morning and four on the afternoon shift, plus the manager. There was an additional staff member to assist with bathing on the afternoon shift. There were two members of staff plus a sleep in member at night. There were three domestic staff and one cook and one kitchen assistant on duty each day Monday to Friday. This was consistent with the rota seen for the day of the inspection and the number of staff on duty during the visit. The training information provided by the home stated that training in health and safety areas occurred. Training on care related issues such as medicines and dementia had also occurred during the last twelve months. Staff spoken with confirmed that they had undertaken this training and that access to relevant courses was good. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 19 The written information supplied by the home stated that 75 of care staff had achieved a National Vocational Qualification (NVQ) to level 2 and staff spoken with confirmed that this training was undertaken. This meant that the home had exceeded the minimum standard of 50 of staff being qualified to National Vocational Qualification level 2. Three staff files were examined. All had relevant recruitment information in place, including Criminal Record Bureau checks, two written references and a full employment history. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well run with the health and safety needs of all involved in the home being addressed, which ensured that the home was run in the best interests of residents. EVIDENCE: The home did not currently have a registered manager although the acting manager had been the deputy for a number of years and was experienced in the care of older people. The provider stated that the home was continuing to try and recruit a manager. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 21 A quality assurance process was in place although this tended to use informal comments and verbal feedback. An annual survey of residents’ views took place and the most recent feedback was generally very positive and favourable and the provider was looking at ways to address any issues raised. He stated that there were plans to upgrade the en-suite facilities and a new boiler was to be installed to improve the provision of hot water in specific parts of the building. Some of the comments seen in the survey stated that residents were ‘looked after well’ and that staff were ‘kind and considerate’. However, visiting professionals had not been surveyed as part of the quality assurance process. Three residents’ financial records were examined. These were in order and the cash held corresponded accurately with the written record. There was secure storage for money and receipts were available for purchases made and valuables held. However, one purse containing cash was unlabelled in the storage area and staff were unaware of who it belonged to. Records were generally up to date and accurate. However, care records did not fully met the requirements of Schedule 3 of the Care Homes Regulations 2001 due to omissions in care plans. The health and safety of all involved in the home was addressed. The written information supplied by the home showed that maintenance checks were up to date; for example, gas safety was checked in February 2006, fire equipment in May 2006, emergency lighting in May 2006 and the lift in May 2006. Staff spoken with also stated that equipment was in working order and any repairs were attended to promptly. Staff spoken with confirmed that they undertook mandatory health and safety training in fire safety, infection control, first aid, moving and handling and food hygiene and this was also stated in the written information provided by the home. However, one member of the kitchen staff was working without a food hygiene certificate. This was raised as an issue at the last inspection in September 2005. Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X 3 X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement The Registered Person must prepare a written plan as to how residents’ care needs are to be met. The Registered Persons must ensure that all medication not administered is recorded on the medication administration record (MAR) charts by the use of codes to explain why it was not administered. Timescale for action 01/12/06 2. OP9 13 (2) 01/12/06 3. OP35 16 (2) (l) The Registered Persons must 01/12/06 ensure that all valuables or money handed in for safekeeping is recorded and checked in accordance with the policies and procedures of the home. Previous timescale of 31/10/05 not met. Timescale extended. Residents’ records should contain 01/01/07 all the information specified in Schedule 3 of the Care Homes Regulations 2001. All staff employed in the kitchen must hold an up to date food hygiene certificate. DS0000020058.V317361.R02.S.doc 4. OP37 17 (1) (a) 5. OP38 13 (4) (c) 01/01/07 Mount Pleasant Care Home Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The catering staff should keep the food taken by residents for a period of time for monitoring purposes. This is previous recommendation and has not yet been addressed. Assessment documentation should contain details on religious and social needs. All care plans and care entries on records should be dated and signed by the person writing the record. Care plans should be updated where there are changes in needs. Care records should have evidence that residents have been consulted about their care. Handwritten medication administration record (MAR) charts should be signed and dated by two people. Choices on the menu should be made more explicit to residents to ensure they are aware of available options. The views of visiting professionals should be obtained to assist in improving the quality of the service. 2. 3. 4. 5. 6. 7. 8. OP3 OP7 OP7 OP7 OP9 OP15 OP33 Mount Pleasant Care Home DS0000020058.V317361.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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