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Inspection on 22/02/06 for Mount Pleasant Nursing Home

Also see our care home review for Mount Pleasant Nursing Home for more information

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Mount Pleasant delivers a good standard of care to its residents. Residents and relatives think highly of staff and described staff as being "very nice all of them" and "nothing`s any problem." The food provided is "very good " and there are a range of activities available which residents can choose to participate in if they wish. Staff regard the home as a relaxed place to work. The home is well managed and there have been few staff changes. The environment is clean, comfortable and well maintained.

What has improved since the last inspection?

An additional therapist visits Mount Pleasant once a week to provided one to one and group exercises. Photographs of residents are attached to medication records to assist nurses to identify residents. Thorough recruitment checks are carried out. A fire risk assessment has been provided.

What the care home could do better:

Care plans should be drawn up within five days of admission to the home to make sure that all care needs are met. Care plans should be provided for all care needs. Residents and/or their families should be consulted during the care planning and review process.There should always be a second registered nurse on duty during the morning shift. The registered manager should undertake NVQ level 4 in management. Care staff should receive supervision at least six times a year.

CARE HOMES FOR OLDER PEOPLE Mount Pleasant Nursing Home London Road Allostock Knutsford Cheshire WA16 9NW Lead Inspector June Shimmin Unannounced Inspection 22nd February 2006 09:35 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 Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 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 Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mount Pleasant Nursing Home Address London Road Allostock Knutsford Cheshire WA16 9NW 01565 722918 01565 722014 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) Mount Pleasant Nursing Home Limited Miss Amanda Short Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (1) of places Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 42 service users to include: * Up to 42 service users in the category of OP (old age not falling within any other category * 1 named service user in the category of PD (physical disability under 65 years of age) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 6th July 2005 2. Date of last inspection Brief Description of the Service: Mount Pleasant Nursing Home is a two storey converted and extended property standing in its own grounds in the rural community of Allostock. The home is situated approximately 4 miles from the towns of Knutsford and Holmes Chapel. Accommodation is provided on two floors. Access to the first floor is by a passenger lift or one of the staircases. There is a separate dining room and two lounges on the ground floor with a quiet lounge and smoking lounge on the first floor. The home provides its own hairdressing salon. All bedroom accommodation is en suite. The gardens are wheelchair accessible. There is car parking to the front and side of the home. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 and a half hours. A tour of the building was undertaken. 9 residents, 3 relatives, the registered manager, a visiting GP and 6 staff were spoken with. Care records for four residents were looked at as well as records on recruitment, medication and fire safety. What the service does well: What has improved since the last inspection? What they could do better: Care plans should be drawn up within five days of admission to the home to make sure that all care needs are met. Care plans should be provided for all care needs. Residents and/or their families should be consulted during the care planning and review process. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 6 There should always be a second registered nurse on duty during the morning shift. The registered manager should undertake NVQ level 4 in management. Care staff should receive supervision at least six times a year. 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. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 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 Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Mount Pleasant provides residents and relatives with information about the home. All residents receive a contract which details the terms and conditions of their stay. EVIDENCE: A variety of information about Mount Pleasant was displayed in the reception area. This included a statement of purpose and service user guide, which are information leaflets about the services and amenities provided. There was also a copy of the most recent inspection report available. The complaints procedure and registration certificate were also displayed. Residents or their next of kin/representative are given a letter on admission, which states that a service user guide and contract are enclosed. A contract for a resident funded by social services was seen and this included full details of the terms and conditions. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11 Care plans describe the care needs of residents and are amended to reflect changing needs. Some care plans are not written on admission, which may mean that some immediate care needs are not being met. The further health care needs of residents are identified and met. Medication is well managed. EVIDENCE: Four care plans were looked at. These included three residents who had recently been admitted to Mount Pleasant and one for a resident who had died. There were no care plans or risk assessments in place for a resident who had been living at Mount Pleasant for only two days. The assessment and daily records indicated that the resident had a number of care needs. These should have been documented on admission to ensure that those needs were promptly identified and actions recorded. A second care plan had been written six days following admission and a third was written the day after admission. The content of care plans was generally satisfactory. However, several care needs were identified in the progress records but did not have an appropriate care plan. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 10 Documentation indicated that residents were referred to GP`s and other health care professionals when necessary. Medication records were looked at and found to be of a good standard. The care plan of a resident who had recently died demonstrated that Mount Pleasant provided good care. There were records of discussion with family members so that they were fully involved and informed. Records also showed that symptoms were well managed and a letter of thanks was received from the family following the resident`s death. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Mount Pleasant provides a wide range of activities, which residents can participate in if they wish. The standard of catering is very good. EVIDENCE: Mount Pleasant employs an activity coordinator who works three to four days a week. In addition, a therapist visits the home once a week to provide one to one and group exercise. Seasonal activities and entertainments are provided. For instance children from a local school choir visit at Christmas. Monthly talks or demonstrations form part of the in-house activities. Other indoor recreational activities include dominoes, memory game, and various other board games. Residents can participate in holy communion or a service once a month when a local clergyman visits. Visitors are welcome at any reasonable time and can join in activities and stay for afternoon tea. The standard of food provided is very good. Menus are rotated on a four weekly cycle. The chef reviews the menus regularly taking into account the preferences of residents. Residents and relatives were generally satisfied with the quality, quantity and choice of meals. Residents can eat their meals in the dining room or their own room. Those who require assistance to eat are supported in a sensitive manner. The menu is displayed on a board in the dining room. Healthy alternatives are always available. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Mount Pleasant has a satisfactory complaints procedure. EVIDENCE: Mount Pleasant`s complaints procedure is clearly displayed in the reception area. The registered manager said that no complaints had been received since the last inspection. Residents and relatives spoken to said that they would know whom to approach if they had any concerns. The complaints procedure is also incorporated within the service user guide (information leaflet) given to residents and relatives on admission to the home. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26 Mount Pleasant offers a pleasant and comfortable living environment for residents. The standard of décor and furnishings is good. The home is kept clean and tidy. EVIDENCE: A partial tour of the building was conducted. Mount Pleasant provides residents with comfortable bedrooms and a range of shared living spaces. The quality of the fixtures and fittings is good. The home has a variety of aids and adaptations, which are suitable for residents with a disability. Residents and relatives said that they were satisfied with their bedrooms and the general cleanliness of the home. They were able to bring in small items to personalise their rooms to give them a more homely feel. There are sufficient numbers of baths and toilets all of which are easily accessible. Mount Pleasant is well ventilated and has adequate heating. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 There are not always 2 first level registered nurses on duty in the morning, which may have a detrimental effect on care. The recruitment process is thorough, thereby protecting residents. Staff are supported to undertake appropriate training. EVIDENCE: There was only one first level nurse, the registered manager, on duty on the morning of the inspection day and it was also a GP`s medical round. Previous staffing rotas indicated that this was happening two to three times a week. The registered manager had tried unsuccessfully to find an agency nurse and had asked an extra carer to do the shift. At other times staffing levels are satisfactory. Residents and relatives were complimentary about the care provided at Mount Pleasant and said that the staff were “kind and caring.” Mount Pleasant encourages staff to undertake training in NVQ qualifications. The registered manager advised that 6 staff have achieved NVQ level 2 in care, two of whom have attained level 3. The recruitment records of a recent new starter were looked at. All relevant documentation was in place including a POVA first and enhanced disclosure from the Criminal Records Bureau. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38 Mount Pleasant is well maintained and managed. EVIDENCE: The registered manager has been matron for eight years and is a first level registered nurse. She has been unable to access a course to undertake level 4 in management. A full-time deputy matron and part time administrator are also employed. The home does not handle money on behalf of residents. Families are invoiced for small expenses such as hairdressing and chiropody. The registered manager has set up files for staff supervision but the process has not yet started. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 16 Fire records were looked at. These indicated that equipment is tested and serviced on a regular basis. Staff undertake an annual fire training refresher course and twice yearly fire drills. Portable electric appliances are tested once a year. A recommendation from the environmental health officer in January 2005 about replacing the kitchen floor has not yet been carried out. High standards of cleanliness were evident in the kitchen. Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 17 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 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 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 X 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 2 X 3 Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? no 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Care plans should be written within five working days of admission to the care home. Care plans should be provided for all identified needs. Residents and/or their families should be consulted during the care planning and review process. Action should be taken to ensure that there is always a second registered nurse on duty on the morning shift. The registered manager should undertake NVQ level 4 in management. Care staff should receive supervision at least six times a year. The kitchen floor should be replaced as recommended by the environmental health officer. 2. 3. 4. 5. OP27 OP31 OP36 OP38 Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Mount Pleasant Nursing Home DS0000018822.V268301.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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