Inspection on 04/11/08 for Mount Pleasant Care Home

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mount Pleasant Care Home 23/10/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mount Pleasant Care Home Off Hollow Lane Winshill Burton On Trent Staffordshire DE15 0DR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Smith     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Mount Pleasant Care Home 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): Willow Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 50 0 old age, not falling within any other category physical disability Additional conditions: 0 5 The Provider may provide the following category of service only:- Care home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Physical disability persons aged 55 years and over Code PD (maximum number of places - 5) The maximum number of service users who can be accommodated is: 50 Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 32 Brief description of the care home Home is set in spacious grounds, and has a car park. The Home has all single rooms, all with ensuite 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 manager at this inspection stated that the scale of fees for 2009 ranged from £434 to £475 a week. There are additional costs for chiropody services, telephone line and telephone bill, hairdressing, newspapers and magazines, toiletries and escorts to hospitals for planned appointments. Transport for organised social events/ trips out are funded through the residents fund or caring homes. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections, undertaken by the Commission for Social Care Inspection is upon outcomes for people and their views of the service provided. This process considers the Homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. This inspection visit was unannounced and took place over a period of approximately 8.5 hours. In order to prepare for this visit we looked at all of the information that we have received, or asked for, since the last inspection of the Home in October 2006. This included: Care Homes for Older People Page 6 of 32 The Annual Quality Assurance Assessment. This is a document completed by the Registered Providers of the service that focuses on how well outcomes are being met for people using the service. What the service has told us about things that have happened in the service. These are called notifications and are legal requirements. Any Other Visits that we have made to the service since the last key inspection in 2006. Relevant information from Other Organisations, and what Other People have told us about the service. Surveys returned to us by people using the service, from the relatives of those staying in the Home, and from the staff working in the Home. For this inspection of the service the Commissions Residents questionnaire (a survey mentioned above) was sent to ten people staying in the Home, and three were returned. Ten questionnaires were also sent to the relatives of those staying, and again three were returned. Ten questionnaires were also sent to staff, and again three were returned. During this visit to the service case tracking was used as a system to look at the quality of the care provided. This involved the sampling of a total of four peoples records, being a cross-section of people staying in the Home. Discussions were held with those people, where possible together with a number of others, about the care and services provided. Their care plans and care records were also examined, and their private bedrooms and communal facilities were seen. Discussions were also held with any relatives that were visiting during this visit to the service. In addition, discussions were held with the Deputy Manager of the service about its general operation. Discussions were also held with staff about the arrangements for peoples care, and also about the staffs recruitment, induction, deployment, training and supervision. What the care home does well: What has improved since the last inspection? What they could do better: Before new people are admitted to the service, the Manager needs to provide them with a letter stating that the service is able to meet their needs in respect of their health and welfare. This is to ensure that people are formally aware that that service is able to meet their needs and offer them a place. A written plan of care needs to be competed for each person, to ensure that all staff are aware of all the needs of each person staying. Risk assessments also need to be completed on all people staying in the Home. This is needed to ensure that staff are aware of the risks involved in caring for each person. People staying in the Home need to be consulted about their care, see their plans of care (if they are able) and the care plan needs to describe that this has taken place at regular intervals of time. This is to ensure that people staying, or their representatives, are fully involved in the process of establishing their needs and expectations, and so ensure they are at the centre of the planning process. The management of medication provided to those staying in the Home needs to be greatly improved. This is to ensure that people staying are receiving appropriate medication at all times. Care Homes for Older People Page 8 of 32 Individual supervision needs to be provided for all care staff. This is to ensure that the training needs of staff are always fully met and to ensure that the needs of all those staying in the Home are addressed. All necessary staff need to receive mandatory training in First Aid, Food Hygiene and Infection Control. This is to ensure that the needs of those staying are fully met, plus the needs of the operation of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All new people moving to the Home were appropriately assessed prior to their admission, so that they were reassured that their needs would be met. Evidence: The Registered Providers had provided a good statement of purpose for the service together with a Residents Guide, which informed people staying in the Home, and their relatives, of what the service provided. The Residents Guide contained information on how, if necessary, people staying could contact the Commission, the local Social Services Dept and the local Health Authority. In the Annual Quality Assurance Assessment, completed by the Manager, she had written - Prior to admission, all relevant comprehensive information regarding the prospective resident is taken from as many areas as possible, to ensure the home is going to be able to meet their needs. A pre-assessment is undertaken by the manager Care Homes for Older People Page 11 of 32 Evidence: at the residents own home or hospital, with either just the prospective resident or supported by family members. The assessment can also be completed at Mount Pleasant if preferred. ... We believe the pre-assessment is the most vital tool in getting a placement right and so have a very comprehensive one. This assures us, and the resident, that an inappropriate placement is avoided. This forms the basis for a Care Plan which is geared towards the individual. The records of four people staying in the Home were examined during this visit and a copy of the statement of terms and conditions of residency or a contract, if purchasing their care privately, were available to examine. This ensured that peoples legal rights were protected. However, the Manager did not confirm in writing, to the person moving to the service, that the service was able to meet the persons needs in respect of their health and welfare. When new people were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting each person; a copies of which were seen. However, as will be seen in the next section of this report, the details recorded of the initial assessment of new people moving to the Home in some instances lacked detail. Standard 6 does not apply to this Home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of care were not appropriately completed to record peoples personal care needs. A robust system of recording the distribution of medication were also not in place to ensure that peoples wellbeing was not adversely affected. Evidence: Four records of people staying in the Home were examined, or case tracked, to ensure that suitable records were being maintained. Two satisfactory initial assessment records were seen, a third was very poorly completed and the fourth was not completed at all. No individual plans of care were seen in any of the files looked at. Risk assessments were completed in three of the files, but none was provided in the fourth file. This places people at risk of not having their needs identified or met. Formal six monthly reviews of care were not being undertaken, as no record could be found in any of the four files examined. However, satisfactory daily records were Care Homes for Older People Page 13 of 32 Evidence: maintained by the Homes staff, and the files were well laid out with different sections. No signatures of those staying were seen in any of the files and the Deputy Manager agreed that the files were not shown to those staying on a routine basis. The records of peoples health needs were observed and a satisfactory record was found to be maintained. All medication and the method of distributing it to people staying in the service was examined. This showed that a record was kept. However, the following issues needed to be addressed: When people staying in the service were prescribed with creams, this was to be carried out by the care staff. However, no record of this was maintained. On the Medication Administration Record (MAR) sheets senior staff had simply entered a G, which according to the MAR sheet meant see over leaf but no details had been provided. In two places on the MAR sheets the pharmacist had written that one whole tablet was to be taken, but the MAR sheet had been altered, by staff, to say half a tablet was to be taken. This was not supported by the name of the GP who authorised the change in medication, nor was it supported by the signatures of two staff, and nor did it have the date on which the change had taken place. The vast majority of entries on the MAR sheets were typed by the pharmacy. However, a number of entries were hand written by staff. These were late entries that occurred as a result of a Doctors visit, but these were found not to have been completed correctly. They should all, again, have been signed by two staff, to ensure they were correctly completed, they should have been provided with the date the medication was to start and stated the Doctor who authorised the medication. On two MAR sheets the pharmacist had written Take one daily, but this had been altered by staff to a PRN medication (to be taken when necessary). This was again not supported by reference to the GP etc who had authorised the change in medication. The provider was aware that there were issues around medication administration, and a senior manager was in the home on the day of this visit, carrying out a medication audit. Discussion was held with people staying in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and Care Homes for Older People Page 14 of 32 Evidence: respect. As a result, they felt very safe in the Home, and had a strong sense of well being. One Resident said - The majority of staff always ask How do you want if done and then do it that way for me - another person said - Yes, staff allow me to use the bathroom in the way I want, while making sure I am safe. The three questionnaires returned by people staying in the Home all indicated that they were very satisfied with the care provided. The three relatives who completed questionnaires were also very pleased with the care provided by the service. All staff were observed to be very caring in their dealings with people in the Home, and spoke to them in a caring manner. In the Annual Quality Assurance Assessment completed by the Manager she wrote We ensure we can meet all residents needs to maintain a quality lifestyle, which is not too different from what they have been used to. We make sure the home can meet health care needs identified by the pre-assessment visit ... . We can arrange access to specialist medical care ... . Where possible the resident is assisted to retain all previous health care professionals, involved in their care, prior to admission. Weight, tissue viability, nutrition and prevention of pressure sores is closely monitored and acted upon immediately if there is any concern. ... We strongly promote old fashioned values of respect and politeness. Staff respect residents wishes and strive to maintain dignity in the way the care and assistance is given. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferred lifestyles were respected, and people were given a wholesome and appealing diet in pleasant surroundings, that enhanced their well being. Evidence: People were asked about the activities provided. Those spoken with said that they did not take part in the activities, preferring to remain in their bedrooms. However, both of them were aware that there was an Activities Coordinator who arranges activities, in the mornings. This was also confirmed by staff when they were later spoken with. The staff said that the Activities Coordinator organised such events as bingo, board games, dominoes, jigsaws, singing, and going out in groups and as individuals. The Deputy Manager was also able to say that a second Activities Coordinator was to start within the next few weeks, and will work in the afternoons. People said that they decided when they got up and went to bed. One person said Yes, I can always choose when I get up and go to bed, staff are very helpful with this. Another person said - On coming to the Home I had two baths a week, but I now have three baths a week! However, someone else said - I usually have a bath once a week, but often I can go 10 days without a bath. I would like a bath twice a week if possible. Care Homes for Older People Page 16 of 32 Evidence: Relatives and friends of people staying in the Home were able to visit at any time, and could always be seen in private. One person said - Yes, they come in to my bedroom to see me - and - Yes this is encouraged, I can see my relatives in my room or in private somewhere else. The staff spoken with also said that relatives could visit at anytime. They said that people could choose where they wanted to see their relatives, in one of the lounges, or in the persons bedroom. People were able to say that the service provided good meals and that - There is a choice at all meals, you can always choose. If you dont like what is on the menu, you can have something else like an omelette - and - Yes a choice is always available. A questionnaire came around recently asking what we would like to see on the menu. Staff also confirmed that a choice was always provided at every meal. People and staff said that drinks and snacks were always provided between meals, and that people could also ask for additional drinks at anytime. Mealtimes were never rushed, which was witnessed during this visit. Two members of staff was asked, independently, when people needed assistance to managed their meal, how many people they might help at the same time. They both said that people did not usually need assistance. However, they both said that they would only assist one person at a time. In the 3 questionnaires completed by people, they all said that they were very satisfied with the care, meals and entertainment provided, for example - Kitchen staff are very good to me, due to my funny tummy. Relatives, who completed the questionnaire, were also pleased with care provided in these three areas. The Manager, in the Annual Quality Assurance Assessment wrote - Residents views are respected and where possible their choices are acted upon providing those choices do not impact upon other residents lives. ... We will try to accommodate rooms on the same floor for residents who have made particular friends, where possible, to make visiting easier. We have many varied activities on a daily basis catering for all tastes. On assessment, residents preferences for activities are noted and incorporated into the daily routine. We circulate a monthly newsletter with up and coming attractions and planned trips out. We have regular visits from local churches and communion can be taken on request. Arrangements can be made for residents to attend local churches or any other places of worship if desired. We have a notice board on each floor and a list of the weeks activities is displayed at the beginning of the week. There is also a menu for that week pinned to the notice board. There is other information regarding advocacy and minutes from the last residents meeting. A copy of the last inspection report is also available. Visitors are welcome at the home at anytime and drinks are Care Homes for Older People Page 17 of 32 Evidence: always available. Residents can choose to entertain visitors in the privacy of their own room or by using areas off the lounges, which are quieter. ... We support families holding celebrations and can arrange parties for special occasions, preparing specialist food and entertainment. The Activities Coordinator visits all the residents on a daily basis to invite them to the daily planned activity or just for a chat to make sure they are alright. - All of the issues covered here were found to be in place in the service. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints made to the service were addressed to meet peoples needs. The protection policies and procedures provided meant that people were well protected. Evidence: People spoken to said that if they had a complaint to make they would tell the Manager or a senior member of staff - I would tell the Manager or Deputy Manager, but I have never chosen to do it - and - I would tell the Deputy Manager, I did complaint once, and it was all sorted out. In the Annual Quality Assurance Assessment, completed by the Manager, she had written - An open door policy is promoted throughout the home. The management team are all here on a regular daily basis and are accessible to both residents and staff. We have a complaints procedure which complies with regulations. On admission, residents are given a copy of the Statement of Purpose which addresses the complaints procedure and provides relevant telephone numbers that may be used/needed. We have staff induction, which includes sections on how to report instances of abuse, or even suspected abuse. - The Home was found to be operating to the standards listed here. The Commission had not received any notice of complaint since the last inspection of the Home in October 2006. Care Homes for Older People Page 19 of 32 Evidence: During the past eight months the service had received 5 complaints or concerns, which were reviewed during this visit, and all were found to have been appropriately completed. There were good procedures for both written and verbal complaints. The Registered Providers complaints procedure detailed that all complaints would be responded to by the Manager within at least 28 days, which was found to be the situation in the cases listed above. There was a Safeguarding Adults procedure in place, and records showed that staff had received training on this. The service also had a Whistle Blowing policy, although staff spoken to were unaware of this policy. The Whistle Blowing policy meant that a procedure was in place to allow staff to inform the Manager of any inappropriate actions by other staff. The Deputy Manager confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. Staff said that they understood that people staying in the Home might, on occasion, show challenging behaviour, but only one of the staff spoken with said that she had received training on the best way to resolve these situations. The Deputy Manager said that a policy was available to staff stating that they could not benefit from peoples wills, which was also understood by the staff spoken with. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was well maintained throughout, providing all people with a safe, comfortable environment in which to live. Evidence: A tour was made of the public areas of the Home, and included six of the bedrooms. The building was pleasantly decorated throughout, and the lounges and dining rooms were pleasant to sit in. The bedrooms seen provided sufficient space and provision for each person. The Registered Providers had also provided appropriate furnishings in all locations seen during this visit. Bedrooms were also very pleasantly decorated, by each person, with pictures of their lives prior to moving into the service. Toilets were easily available to everyone, were clearly marked, and were provided with handrails where necessary. A call system was also available throughout the building. All radiators were appropriately guarded, and could be controlled within each bedroom. Care Homes for Older People Page 21 of 32 Evidence: There were appropriate sluicing facilities, and laundry was washed at appropriate temperatures. In the Annual Quality Assurance Assessment, completed by the Manager, she had written - The home is purpose built with all rooms having en-suite facilities. ... All rooms have a call system next to the bed, to summon assistance if required. Residents also have the option of wearing a pendant if preferred. All rooms are able to be locked from the inside. All rooms have a lockable drawer in the bedside table. All rooms have two chairs available for residents to have visitors. Residents are encouraged to personalise rooms and bring their own furnishings and fittings. ... All ensuites are cleaned daily and the home maintains an odour free atmosphere. ... The hallways are wide and have handrails all the way round to promote mobility and independence. This visit to the Home confirmed that these services were provided by Registered Providers and Manager. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care staff were not consistently trained to ensure that peoples needs were met. Evidence: At the time of this visit to the Home it was found that under 50 of care staff held a qualification of at least NVQ level 2 in Care; 35 . One of the staff who was interviewed said that she already held an NVQ level 2 in Care, and the second said that she was currently undertaking this qualification. The records of two new staff employed during the past 12 months were examined to see whether all relevant information about them had been obtained. It was found that almost all information had been obtained. A full employment history had not been obtained for one of the staff members. All other information was found to be satisfactory. Care staff spoken with were able to confirm that they had been given copies of the General Social Care Council’s code of conduct and practice. The Deputy Manager said that all new staff were provided with induction and foundation training, which was confirmed by staff. She also said that all care staff were provided with at least three paid days training a year, which again was confirmed by staff spoken with. In the staff questionnaires all said that induction training and ongoing training were provided at a good level. Some of the records of this training Care Homes for Older People Page 23 of 32 Evidence: was seen. All staff also had an individual training and development assessment and profile. In the Annual Quality Assurance Assessment, completed by the Manager, she had written - Caring Homes (the company that owns Mount Pleasant) has a robust recruitment procedure which ensures all the staff are fully checked through CRB and POVA prior to commencing work at the home. All staff receive a clearly defined job description and thorough induction and shadow shifts to ensure they are fully conversant with the residents and homes routines. ... All staff involved in care are provided with the G.S.C.C. code of conduct booklet as part of their induction. - Again, it was found that this was an accurate description of how the Home operates. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements were not sufficiently robust to ensure that residential care was maintained at a positive standard. Evidence: The Manager was not available at the time of this visit to the service. The records of the monthly inspections of the service, carried out by a senior manager, were examined, and were found to be satisfactory. In the senior managers record of events she had highlighted issues relating to the plans of care and medication, noted earlier in this report, but at the time of this visit they had not been resolved. The Deputy Manager was able to show the annual development plan for the service, which was adjusted on a monthly basis. This development plan reflected the aims and outcomes for people using the service. Surveys had been undertaken with people using the service, on their opinion of the operation of the service, although the results of the survey had not been published. The opinions of peoples families and friends, Care Homes for Older People Page 25 of 32 Evidence: and of GPs and District Nurses had also been surveyed for them to comment on how well they thought the service was achieving goals for those staying. The service held a number of accounts of peoples personal money. Two of these were examined and it was seen that this was managed effectively for those staying in the Home. Staff members were asked about the supervision they received from the Manager or other senior staff in the Home. They said that since the start of their employment they had only received one supervision session each. The Deputy Manager agreed that regular, personal supervision was not being provided. The mandatory training required by the Regulations was examined. This showed that training in Moving and Handling and Fire Safety had been provided for all necessary staff. However, training was needed for many staff on First Aid, Food Hygiene and Infection Control. However, there were good records of the staff training needs, and the Deputy Manager was confident that this training deficit would be resolved within the coming months. Training was also discussed with the care staff spoken with. One said that she had received all mandatory training except for Food Hygiene training. The second member of staff, who had not worked in the service for longer than approximately 9 months, said that she was awaiting training in First Aid and Food Hygiene. In addition to the above areas of mandatory training, the Homes records showed that training was also offered to staff in Safeguarding Adults, Customer Service, Report Writing, COSSH, Conflict Management, Medication, and Health and Safety. From copies of the Registered Providers maintenance schedule, forwarded to the Commission prior to the inspection, it was found that all necessary maintenance and repairs were being appropriately addressed. The Deputy Manager was able to show that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. With the assistance of the Fire Service, fire safety notices were also posted in relevant places around the Home. The Annual Quality Assurance Assessment completed by the Manager said - The manager is supported by a regional manager with whom, at least, monthly meetings take place, and who is responsible for completing the Regulation 26 reports. ... The home operates an open door policy and has good communication with residents, their families and the staff. ... Staff also have appraisals yearly to identify training needs. Care Homes for Older People Page 26 of 32 Evidence: Resident questionnaires seek views on whether the home is meeting agreed objectives set down by Aims & Objectives and in the homes statement of purpose. Policies and procedures are in place to ensure residents financial affairs are safeguarded. - It was found, during this visit, that the Registered Providers and Manager ensured that the issues listed here were provided. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 All potential users of the service must be provided with a letter that states the service is able to meet their needs. This will ensure that only people whose needs can be met are admitted to the service 06/05/2009 2 7 13 Risk assessments must be completed on all people using the service. This is needed to ensure that their welfare is maintained at all times. 31/01/2009 3 7 15 A written plan of care must be competed for each person using the service. This to be done to ensure that all staff are aware of the full needs of each person. 31/01/2009 4 9 13 Medication (including creams) must be given/applied to people as 16/01/2009 Care Homes for Older People Page 29 of 32 prescribed, and the records completed to support this has occured. This is to ensure that people are receiving the correct medication at all times. 5 36 18 Individual supervision must 31/01/2009 be provided for all care staff. This is to ensuring all work professionally and that communication with people using the service promotes wellbeing. 6 38 18 All necessary staff must receive mandatory training in First Aid, Food Hygiene and Infection Control. This training is needed to ensure that all staff have the knowledge to meet the needs of people staying in the Home, and to ensure that the Home is run to satisfactory standards. 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 People using the service should be consulted about their care, so that they are fully involved in the process of establishing their needs and expectations, and ensure they are at the centre of the planning process. Formal reviews of care should be undertaken at 6 monthly intervals. Those taking part should at least include staff from the Home, the person themselves and their relatives, particularly the ‘personal representative’. The review of care should be shown to the person staying in the Home (or representative) for signature. One of these reviews, Page 30 of 32 2 7 Care Homes for Older People each year, could be conducted by the Social Services Dept, although the Manager should provide formal written input to the review of the welfare and care provide to the person staying in the Home. 3 7 The initial assessments of all new people moving to the Home should be completed in full detail by the new Manager. A system for auditing the administration of mediction on a regular basis should be introduced. Staff should not alter the entry made by the pharmacist, unless it is supported by the name of the Doctor who authorised the change, that the two staff who altered the MAR sheet sign it, and that the MAR sheet is dated with the date of the change. People staying in the Home should be able to have a bath or shower, at least once a week, but usually more often than once a week. Over 50 of care staff should be trained to NVQ level 2 in Care. A full employment history should be obtained for all new staff, so that any gaps in employment can be explored, recorded and risk assessed. The surveys undertaken with those people staying in the Home, on their opinion on the Homes operation, should be published and distributed to those staying and to their relatives. 4 5 9 9 6 12 7 8 28 29 9 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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