Random inspection report
Care homes for older people
Name: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD one star adequate service 01/04/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ian Wright Date: 1 6 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD 01872553165 01872553776 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Susan Ann Sear,Mr Godfrey William Sear care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Conditions of registration: 0 To accommodate one named service user under the age of 65 years (62 years) Date of last inspection Brief description of the care home Mount Pleasant is located near the centre of St. Agnes. The registered providers are Mr G Sear and Mrs S Sear. Mount Pleasant provides accommodation and personal care for up to 22 older persons. The accommodation is on one level; there is full access around the home for people who use the service. There are 20 rooms of which 18 are for single occupation and two shared rooms. The majority of bedrooms have an ensuite toilet and washbasin facilities. Communal areas and rooms are decorated and furnished to a satisfactory standard. The kitchen area is clean and organised. The house is set in well laid out gardens, with pleasant views of the town and countryside. There is satisfactory parking for visitors. The home is close to local amenities with
Care Homes for Older People Page 2 of 13 0 1 0 4 2 0 0 9 Brief description of the care home access to transport links into the main city of Truro. The range of fees at the time of the last key inspection on 1/4/09 was £308-£410. A copy of this and previous inspection reports is available from the Care Quality Commission via our customer services team or website. Alternatively the registered provider should be able to provide a copy. Care Homes for Older People Page 3 of 13 What we found:
This inspection was to check compliance with the immediate requirement set at the random inspection we completed on 2nd October 2009. The immediate requirement was for the registered provider to ensure an appropriate ambient temperature was maintained in the care home at all times. We set this requirement as when we completed the inspection on 2nd October 2009 we found the temperature in the home to be unsatisfactory. For example a number of people who use the service said they were cold, and there was no heating on in the home. Since the random inspection we received a number of concerns. These include there being an unsatisfactory supply of hot water, there being unsatisfactory provision of food for people with diabetes, and concerns about a dog grooming business running from the site. We have also received concerns about lack of activities for people using the service. When we arrived at the home we requested to see the registered providers but we were told they were unavailable to see us as they were on holiday. Mrs Barbara Withiel (assistant manager) assisted us with the inspection. We also met with Ms D Dalgliesh (NHS Community Matron) and Tamsin Watson (Social Worker- Cornwall Department of Adult Social Care and Support) who were separately investigating these concerns under Cornwall Councils Adult Safeguarding Procedures. In summary we found: (1) When we spoke to some people using the service during the visit they said the heating was now on in the communal areas of the home but there was no heating in peoples bedrooms. Some people said they would like for the heating to be on now in their bedrooms. People said they could not control the heating. (2) We found there was an insufficient supply of hot water in several of the bedrooms. (3) Guidance issued by the Healthcare Trust regarding meals for people with diabetes appears to now be followed. However, we are concerned about care planning and recording regarding people with these needs. (4) Some activities for people using the service are available but these still need further development. (5) A dog grooming business does operate from the registered providers adjoining premises, but this is operated separately from the care home. What the care home does well: What they could do better:
Heating We noted the temperature in the quiet lounge of the home when we arrived was 20.5 degrees Celsius. This was acceptable. We noted that most, but not all of the storage heaters were on in the communal areas of the home. However no heating was on in the majority of the bedrooms. We spoke to several of the people who live in the home, and
Care Homes for Older People Page 4 of 13 the majority of people expressed no concern about the temperature in the home. However, one person said to us that it does get cold in the evening and they have to put extra layers of clothing on when they went to bed to keep warm. All of the people we spoke to said they had no control regarding the temperature of the heaters or the ability to switch them on or off. These were all switched off at the wall, and the controls to regulate the temperature on the heaters in the bedrooms and communal areas had all been removed. It is important people using the service can have control over the temperature in the home. It therefore is essential it is possible for people to control the temperature of heating in their bedrooms without having to ask staff. Subsequently the controls of the heaters need to be put back on, or replacements for these controls obtained and fitted. It should be the homes policy and practice that the heating is always on, in all areas, from 1st October to 1st April, unless it is cold outside that time period, when it should subsequently also be on. People should then be able to switch off the heating in their bedrooms should they not want it on. The heating system in the home is now very dated and should be upgraded/ replaced. The registered providers Mr and Mrs Sear have previously said they would do this, but have not carried out any action. We are concerned about the efficiency of the current system, and particularly whether the home will be heated to a satisfactory temperature particularly when it is cold. We will continue to monitor compliance with the immediate requirement notice we served on 2/10/2009 (i.e. the registered providers must ensure a suitable ambient temperature is maintained in the care home at all times). We will consider taking enforcement action regarding this matter should there be further concerns. We have also notified Cornwall Council Environmental Health Department of our concerns, and the matter is also being considered under Cornwall Council Adult Safeguarding procedures. Hot Water We assessed the temperature of hot water in the home following concerns raised to us. We have received a number of concerns regarding the availability of hot water in the home on a number of occasions. We understood from the information provided to us by the registered provider that this matter had now been resolved. We tested the hot water in several bedrooms in the home, and were concerned regarding the following: *Room 12, Room 13, Room 20-The flow of the water from the hot water tap was very slow, and water coming out of the outlet was not hot for between two-four minutes of continuous running. There was a second basin in room 13. The tap was loose, and there was no water at all coming from the tap. *Room 14. There was not water at all from the hot water tap at all. The occupant said they would have to usually wait for up to half an hour for the water to appear. *Room 15. The tap had a push button head. There was a very poor flow from the tap of cold water only from the hot tap. We asked staff how they would assist occupants of these rooms to wash. We were told that the problem had been reported to the registered provider but staff did not know
Care Homes for Older People Page 5 of 13 what action would be taken. Staff told us that the current procedure to wash people would be that one member of staff would stay with the person using the service, while a second member of staff would go and get a basin of hot water from another room. We think this situation is unacceptable. We are concerned that the commission has raised concerns about the supply of hot water on several occasions, and a permanent solution has not been found to resolve the problem. We have also notified Cornwall Council Environmental Health Department of our concerns, and the matter is also being considered under Cornwall Council Adult Safeguarding procedures. Provision of Food for People with Diabetes. We were told by the NHS Community Matron that health professionals were now satisfied that the registered providers were providing appropriate meals to people with diabetes. A concern had been reported to the various statutory bodies that at least two people who were insulin dependent were not being provided with appropriate foods that they needed due to their condition. Health professionals are very concerned regarding the potential risk to peoples unstable diabetes particularly if these people are not strongly encouraged to adhere to a suitable diet. Subsequently the registered provider must ensure these people are always offered an informed choice of meals available to them. The registered provider must ensure suitable ingredients are provided to care and catering staff so they can provide diabetic alternatives for the people concerned. A suitable choice of food must always be offered to the people using the service who have diabetes or other special dietary needs. If the people concerned do not wish to adhere to special diets this must always be documented in the persons risk assessment / care plan, and preferably discussed by the registered provider with healthcare professionals. We assessed the Nutritional Screening Assessment for one person with diabetes. This was written by staff in the home. The assessment had been incorrectly completed. It also contained contradictory information to what was in the persons care plan. The person concerned had lost significant weight in one month. Subsequently staff should have completed an action plan according to the assessment tool. Appropriate action should have included liaising with the district nurses / GP regarding the situation. This was not done. The district nurses picked the concern up due to a routine reassessment of the persons needs. The registered provider should have provided clear instructions, in the persons care plan, regarding what action staff needed to take to encourage the person to follow an appropriate diet. We understand this matter is being followed up under Cornwall Councils Adult Safeguarding Procedure. Activities for People Living in the Care Home When we completed the inspection there were no organised activities taking place. No activities were planned for that day. We have discussed the provision of activities with the registered provider on several occasions. The registered provider has said it has been difficult to motivate people to participate in organised activities. People we have spoken to in the past have not said they wanted any organised activities. However, as outlined in the random inspection report dated 14/10/2009 some people said to us that they would now like more organised activities. It is important that the registered provider continues to look at ways to encourage people using the service to participate in activities they would enjoy. This may include small group work, trips to the supermarket, beach or cafe, staff having time to help people with correspondence or have a social chat, bingo,
Care Homes for Older People Page 6 of 13 exercises etc. The registered provider needs to explore more opportunities being made available to people. We will follow this matter up at the next key inspection. In the interim, the registered provider needs to look at ways at developing this aspect of the service. This should be done through resident meetings, one to one discussion with individuals concerned and their representatives, and the care planning process. Dog Grooming Business We received concerns regarding the operation of a dog grooming business in the grounds of the premises. The business operates from the grounds of the owners accommodation which is adjacent to the care home. We had not been informed of this matter by the registered provider. We have no objection to the operation of the business as long as: (1) The registered providers continue to manage the care home on a full time basis. If they need to spend less time regarding the operation of the care home, as is outlined in the Care Home Regulations 2001, they must employ a registered manager to manage the care home. (2) The operation of the dog grooming business does not interfere in any way with the operation of the care home. For example customers do not enter the care home or interrupt its operation. We would advice there is clear signage to the dog grooming business so customers do not knock on the door of the care home. (3) The operation of the dog grooming business does not interfere with the lives of people living in the care home (for example in regards to increased noise etc.) We have informed the Environmental Health Department at Cornwall Council regarding the operation of this business from the premises. Following these concerns, CQC will contribute to the Adult Safeguarding process regarding the concerns raised about this home. We will also continue to monitor compliance regarding the Care Homes Regulations 2001, particularly in regard to the concerns raised above. We will take enforcement action, regarding the above concerns, should this be deemed necessary. 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 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain 01/02/2009 suitable detail to inform and direct staff to provide care to people using the service. Care plans need to be reviewed at least monthly. (Previous timescale of 01/08/08 not met Second Notification) Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 2 18 13 The registered provider must 01/02/2009 have a suitable adult safeguarding policy. Matters outlined in the report must be addressed. Previous timescale of 01/09/08 not met. Second Notification Having an appropriate policy will help to give people who use the service, and other stakeholders, more assurance that agreed multi agency procedures will be followed when necessary 3 25 12 Fit radiator covers to storage 01/07/2009 heaters This will help to ensure the Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action risk of scalding is minimised 4 33 24 Further develop the quality 01/02/2009 assurance system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. Previous timescale of 01/09/08 not met 2nd Notification This will help improve service quality and help minimise risks to staff and people who use the service Care Homes for Older People Page 9 of 13 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, 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 15 16 The registered provider must 01/11/2009 ensure: *Suitable care planning procedures and documentation must be in place in regard to people with complex health care needs (e.g. diabetes). *Appropriate food stuffs must be provided to care / catering staff so they can cater for people with special dietary needs (such as diabetes). *People with special dietary needs must be provided with a suitable choice of foods / meals (e.g. people with diabetes.) *Suitable liaison occurs with health care professionals regarding people with special health care needs (e.g. diabetes) This will help to ensure that the health care needs of people living in the home are suitably monitored / promoted and met. Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 2 25 23 People using the service 01/11/2009 must be able to have control over the temperature in their bedrooms (e.g. to switch heaters on/off and regulate the temperature.) This will help to ensure people using the service have satisfactory heating and ventilation in all parts of the care home used by them 3 25 23 The registered provider must 01/11/2009 ensure an appropriate ambient temperature is maintained in the care home at all times. (IMMEDIATE REQUIREMENT SET ON 2/10/09) This will ensure people living in the home are kept warm 4 25 23 The registered provider must 01/12/2009 ensure there is a sufficient supply of hot water, at all times, thoughout the care home, and available to people using the service. This will ensure people using the service have hot water available to them, in their rooms and communal areas at all times. This will help to ensure peoples health and personal care needs are met. Care Homes for Older People Page 11 of 13 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 2 12 25 Explore opportunities to expand day activities available to people who use the service. Replace the storage heaters in the home with a central heating system to ensure there is suitable heating and hot water for people using the service at all times Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
