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Inspection on 02/10/09 for Mount Pleasant, St Agnes

Also see our care home review for Mount Pleasant, St Agnes for more information

This inspection was carried out on 2nd October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

People who answered our survey were generally positive about many aspects of the home. Some people said they thought it was clean, comfortable and homely. External professionals noted there had been improvement in care over the last few months. Staff were deemed by some people as `friendly and caring` , `helpful` and some respondents said they `try to respond to people`s needs` . We spoke to some people using the service during the visit, who said they were happy with the care they received, and did not think there could be any improvement in the service provided. We briefly spoke to some of the staff on duty who said they were happy in their work and regarding the care delivered to people using the service. The assistant manager said the home was now fully staffed. She said standards regarding staff training had been maintained, new staff had received an induction and a record was kept regarding these matters. The assistant manager said pre employment checks had been completed for new staff. Review of personnel files concluded records however were only adequate. The staff files we assessed were for staff who commenced employment from the end of July 2009. Both files only contained one reference.We will fully review these records at the key inspection. Induction and training records did seem satisfactory, although there was some gaps in training required by law. However, both staff had been in post less than six months, so we trust that by the next key inspection legalrequirements in this area will be met.

What the care home could do better:

Some comments were made in the survey which suggest some need for further improvement. Two people said there should be more entertainment available to people living there. Comments were made that at times there was not enough hot water. A minority of people said the food should be improved, although others said food at the home was good. A comment was made that there should be more staff available as they sometimes were rushed. A minority of the junior staff were viewed, by some professionals, as not being helpful enough providing information about people in the home. However other staff including senior staff were viewed positively by these respondents. We reviewed progress regarding statutory requirements set at the key inspection in April 2009. Insufficient progress has occurred regarding a number of the requirements set, and subsequently we have renotified these in this report. Care plans still need further development. One person`s records were in the registered provider`s home, adjacent to the care home, and therefore not accessible to staff or available for inspection. One person who was at the home for respite (short stay) did not have a care plan. We have previously discussed with the registered provider and senior staff that all people, however long they are resident at the home, must have a care plan. Some care plans were incomplete. Some improvement is required regarding terminology used regarding people`s behaviour and in regard to comments which may be deemed as overly negative or judgemental e.g. `x has been very bad this month, refusing to wash and dress`. We were concerned about storage of medication at the home. We saw one tablet dissolved in a glass on the window sill in the lounge. We also saw another tablet left underneath the medication trolley in the dining room. We raised these matters with senior staff on duty. We did note that the medication trolley was locked, and also fastened to the wall. We noted that medication records appear to be completed correctly. Insufficient progress has been made to finalise a suitable `adult safeguarding` policy and procedure or to develop a quality assurance system. We provided some advice regarding the issues that need to be included in these policies. We set a statutory requirement at the last inspection for radiator covers to be fitted to the storage heaters. We were told at this inspection, by the assistant manager, that these have been ordered. Our key concern at this inspection was the temperature of the home. Both inspectors thought the home was very cold, and certainly was not a satisfactory temperature for elderly and frail people. At the time of the inspection there was no heating on in the home. The controls to regulate the storage heaters have been removed so it is not possible for staff or people using the service to regulate the temperature if the heaters had been on. We have previously been assured that additional storage heaters would be purchased. This did not occur, and at the last inspection we were then assured the convector function had been repaired so should it be cold, the convector function could be switched on to heat the home.One inspector spent some time with people using the service in the lounge of the home. People using the service were observed wearing jumpers, cardigans and having blankets on their knees. Two ladies did not have any tights or socks on and were cold. A number of people we spoke to said they felt cold, and one person said they were going back to their bedroom as they felt cold. We issued an immediate requirement regarding this matter. We asked the registered provider to confirm in writing, after the inspection, what action was taken following the immediate requirement set. We had to telephone twice to remind the provider to do this. The registered provider has now confirmed that the heating is now on `with a member of staff delegated to adjust heating as required by individual residents`. The registered provider said staff had tested the temperature around the home after the inspectors had left and the temperature was 21 degrees Celsius. We were told the knee blankets were more for comfort than to keep people warm. We have since received a complaint from external professionals regarding this, and other matters. This matter had been referred by Cornwall Partnership NHS Trust to Cornwall Council under the Adult Safeguarding procedure. We will complete a further random inspection, on an unannounced basis, to check compliance regarding the immediate requirement that was set. We conclude that there are mixed outcomes in regard to service quality. People using the service, staff and external professionals all report positive outcomes from the service. However there remains significant concerns regarding some aspects of the service which still need to be improved. We will continue to actively monitor this service until we are satisfied further improvement has taken place and this is sustained.

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: 0 2 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 10 2 7 0 1 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 10 What we found: This inspection was completed as we wanted to monitor compliance with the National Minimum Standards following the last key inspection. Up until the last key inspection this service had been rated as poor. We rated the service as Adequate at our last inspection on 1st April 2009. We decided to carry out this inspection to check improvement is being sustained, and people using the service are well cared for, safe and comfortable. We received a satisfactory response to our survey. We received responses from some of the people who use the service, some of the staff and some of the professionals who work with people who use the service. People were generally positive about the service, although some information we have received would suggest there is a need for further improvement in some areas. A summary of the key issues is outlined below. We found some evidence of compliance regarding statutory requirements made at the last inspection for example in regard to staff training. However we have had to renotify the registered provider regarding statutory requirements about care planning, policies and procedures and fitting radiator covers. We set an immediate requirement regarding the heating in the home as it was very cold there when we visited. Information regarding these matters is detailed below. The inspection was completed unannounced by two inspectors and lasted two and a half hours. We were told Mr and Mrs Sear were not available to see us. We met with the assistant manager Barbara Withiel. We inspected the building, spoke to several of the people using the service and reviewed documentation. We reviewed progress regarding compliance with statutory requirements set at the last inspection. What the care home does well: People who answered our survey were generally positive about many aspects of the home. Some people said they thought it was clean, comfortable and homely. External professionals noted there had been improvement in care over the last few months. Staff were deemed by some people as friendly and caring , helpful and some respondents said they try to respond to peoples needs . We spoke to some people using the service during the visit, who said they were happy with the care they received, and did not think there could be any improvement in the service provided. We briefly spoke to some of the staff on duty who said they were happy in their work and regarding the care delivered to people using the service. The assistant manager said the home was now fully staffed. She said standards regarding staff training had been maintained, new staff had received an induction and a record was kept regarding these matters. The assistant manager said pre employment checks had been completed for new staff. Review of personnel files concluded records however were only adequate. The staff files we assessed were for staff who commenced employment from the end of July 2009. Both files only contained one reference.We will fully review these records at the key inspection. Induction and training records did seem satisfactory, although there was some gaps in training required by law. However, both staff had been in post less than six months, so we trust that by the next key inspection legal Care Homes for Older People Page 4 of 10 requirements in this area will be met. What they could do better: Some comments were made in the survey which suggest some need for further improvement. Two people said there should be more entertainment available to people living there. Comments were made that at times there was not enough hot water. A minority of people said the food should be improved, although others said food at the home was good. A comment was made that there should be more staff available as they sometimes were rushed. A minority of the junior staff were viewed, by some professionals, as not being helpful enough providing information about people in the home. However other staff including senior staff were viewed positively by these respondents. We reviewed progress regarding statutory requirements set at the key inspection in April 2009. Insufficient progress has occurred regarding a number of the requirements set, and subsequently we have renotified these in this report. Care plans still need further development. One persons records were in the registered providers home, adjacent to the care home, and therefore not accessible to staff or available for inspection. One person who was at the home for respite (short stay) did not have a care plan. We have previously discussed with the registered provider and senior staff that all people, however long they are resident at the home, must have a care plan. Some care plans were incomplete. Some improvement is required regarding terminology used regarding peoples behaviour and in regard to comments which may be deemed as overly negative or judgemental e.g. x has been very bad this month, refusing to wash and dress. We were concerned about storage of medication at the home. We saw one tablet dissolved in a glass on the window sill in the lounge. We also saw another tablet left underneath the medication trolley in the dining room. We raised these matters with senior staff on duty. We did note that the medication trolley was locked, and also fastened to the wall. We noted that medication records appear to be completed correctly. Insufficient progress has been made to finalise a suitable adult safeguarding policy and procedure or to develop a quality assurance system. We provided some advice regarding the issues that need to be included in these policies. We set a statutory requirement at the last inspection for radiator covers to be fitted to the storage heaters. We were told at this inspection, by the assistant manager, that these have been ordered. Our key concern at this inspection was the temperature of the home. Both inspectors thought the home was very cold, and certainly was not a satisfactory temperature for elderly and frail people. At the time of the inspection there was no heating on in the home. The controls to regulate the storage heaters have been removed so it is not possible for staff or people using the service to regulate the temperature if the heaters had been on. We have previously been assured that additional storage heaters would be purchased. This did not occur, and at the last inspection we were then assured the convector function had been repaired so should it be cold, the convector function could be switched on to heat the home. Care Homes for Older People Page 5 of 10 One inspector spent some time with people using the service in the lounge of the home. People using the service were observed wearing jumpers, cardigans and having blankets on their knees. Two ladies did not have any tights or socks on and were cold. A number of people we spoke to said they felt cold, and one person said they were going back to their bedroom as they felt cold. We issued an immediate requirement regarding this matter. We asked the registered provider to confirm in writing, after the inspection, what action was taken following the immediate requirement set. We had to telephone twice to remind the provider to do this. The registered provider has now confirmed that the heating is now on with a member of staff delegated to adjust heating as required by individual residents. The registered provider said staff had tested the temperature around the home after the inspectors had left and the temperature was 21 degrees Celsius. We were told the knee blankets were more for comfort than to keep people warm. We have since received a complaint from external professionals regarding this, and other matters. This matter had been referred by Cornwall Partnership NHS Trust to Cornwall Council under the Adult Safeguarding procedure. We will complete a further random inspection, on an unannounced basis, to check compliance regarding the immediate requirement that was set. We conclude that there are mixed outcomes in regard to service quality. People using the service, staff and external professionals all report positive outcomes from the service. However there remains significant concerns regarding some aspects of the service which still need to be improved. We will continue to actively monitor this service until we are satisfied further improvement has taken place and this is sustained. 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 6 of 10 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 7 of 10 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 8 of 10 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 1 25 23 The registered provider must 19/10/2009 ensure an appropriate ambient temperature is maintained int he care home at all times. This will ensure people using the service are kept warm at all times 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 9 13 Medication must be stored securely and disposed of appropriately at all times This will ensure the medication belonging to people who use the service is managed appropriately 19/10/2009 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 Care Homes for Older People Page 9 of 10 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 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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