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Inspection on 27/01/09 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 27th January 2009.

CSCI found this care home to be providing an Poor 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

The people who use the service, who we were able to speak with, spoke positively about their care, the staff who work with them and the food provided. The care staff appear to do what they can to meet people`s needs, and were observed on the day of the inspection working well as a team. We note some improvements have occurred regarding the statutory requirements issued at the previous inspection. For example: (1) Glass has been replaced in windows where previously this was `clouded` and in some cases made it difficult to see out of. (2) The registered provider said an electrical hardwire test had been completed on the electrical circuit. However, the certificate has not been received so we cannot validate the electrical circuit is now safe. (3) The medication system was working to a satisfactory standard on the day of the inspection. (4) Records show that fire equipment is being tested at frequencies required by the fire authority. (5) There is now satisfactory storage of controlled drugs. (6) There was a satisfactory supply of hot water and the home was warm. We have had concerns regarding these matters in the past. (7) One bedroom, where we had raised concerns about the decorations, has been repainted and carpeted. When we met with Mrs Sear on 29th September 2009 she said she was keen to comply with the requirements which have been set.

What the care home could do better:

The purpose of the inspection was to review progress since the last key inspection. From the evidence we gathered, we conclude there is still further action that needs to occur to ensure statutory requirements issued at the last key inspection are met: (1) Statement of terms and conditions of residency / contract. Five of the people-who have been admitted to the service since the last inspection did not have a copy of this information on their files, and we do not know if it has been issued. We note some of these people have been admitted on a respite basis. However they should receive this information. Other people currently using the service did have a copy of this information on file.(2) Pre admission assessments-We did not find evidence for people admitted since the last inspection that a pre admission assessment had been completed before they moved to the home. We note some of these people have been admitted on a respite basis. However an assessment still needs to be completed. For example in regard to one person, there was a copy of an assessment when the person was admitted in March 2008. The person had several stays since, but there was no reassessment of the person`s needs. (3) Care Plans. We noted there has been some progress in issuing a new version of care plans for some people using the service. However, in some cases the care plans were only partially completed. For example in regard to one person, a manual handling assessment was not completed. Two people did not have a care plan, and their daily records were completed on one sheet. Reviews of care plans of some of the more established people are not being completed. The timescale for action regarding this requirement is 01/02/09. (4) We carried out enforcement action against the home by serving a statutory requirement notice regarding maintaining privacy and dignity of people using the service (as outlined in our report dated 14th October 2008). We have not received the plan how such matters will be dealt with in future. This was requested by 18th December 2008. (5) The deputy manager said new policies and procedures regarding complaints, adult safeguarding, training and quality assurance are under development. We accept the deadline for action regarding these requirements is 01/02/09. (6) We note from staff records that a `health and safety induction` has been completed for some staff. An induction checklist was completed for two members of staff who have commenced employment since the last inspection. However, there was no documentary evidence of induction for a third person who works as a cleaner. We would expect ancillary staff would receive some form of basic induction, and this would be documented. (7) Satisfactory pre employment checks have been completed for two members of staff who commenced employment since the last inspection. However, checks were not satisfactory for the other member of staff who have commenced employment since the previous inspection. A POVA First check was completed but at the inspection there is no evidence a full CRB check had been obtained. However the registered provider wrote to us immediately after the inspection to state the CRB had been returned but not filed. The person had two references. One of these was from a friend. The second reference was also from a friend and colleague who also works at the home. The registered provider said a professional reference could not be obtained due to the person previously being self employed. We inspected an application form for a person who is due to commence employment shortly. This was not completed to a satisfactory standard. For example there was no employment history given for the person. We previously issued a statutory requirement notice via our enforcement department, regarding the registered provider completing pre employment checks to a satisfactory standard. From the evidence gathered at this inspection, this does not appear to have been fully complied with. We will be renotifying the registered provider regarding this matter for the ninth occasion.(8)Training- There is no evidence that any training has occurred since the last inspection in October 2008. For example there are staff without basic training such as up to date moving and handling training, first aid or fire training etc. Some of these staff may work on night shifts on their own. The training provided e.g. regarding moving and handling is unsatisfactory and could put people using the service and staff at risk. However, we note the timescale for action is 01/02/09. We did see a copy of a list of training planned in regard to manual handling, first aid, food handling, and infection control. This training will be delivered from 27th January 2009 to 5th March 2009. It appears this will not ensure all of the staff will have all the training required by law. It is essential all staff receive the required training if enforcement action is to be avoided. (9) Monies managed on behalf of people using t

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD zero star poor service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: 2 7 0 1 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 en-suite 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 access to transport links into the main city of Truro. The range of fees at the time of Care Homes for Older People Page 2 of 13 Brief description of the care home the inspection were £308-£410. A copy of this and previous inspection reports is available from either CSCI, for example at our website at www.csci.org.uk or from the registered provider. Care Homes for Older People Page 3 of 13 What we found: We completed this inspection in three hours. The inspection was completed by two inspectors who has visited the home previously. The purpose of the inspection was to check compliance with the statutory requirements issued at the key inspection on 14th October 2008. At this inspection we inspected the building, spoke informally to several of the people who use the service, inspected records and spoke to the deputy manager regarding what action had occurred since the last inspection. After the inspection we spoke to a district nurse regarding the service, and the Care Manager at Cornwall Adult Social Care (social services) regarding the service. We met with the registered provider on 29th January 2009 to clarify progress since the last key inspection. What the care home does well: What they could do better: The purpose of the inspection was to review progress since the last key inspection. From the evidence we gathered, we conclude there is still further action that needs to occur to ensure statutory requirements issued at the last key inspection are met: (1) Statement of terms and conditions of residency / contract. Five of the people-who have been admitted to the service since the last inspection did not have a copy of this information on their files, and we do not know if it has been issued. We note some of these people have been admitted on a respite basis. However they should receive this information. Other people currently using the service did have a copy of this information on file. Care Homes for Older People Page 4 of 13 (2) Pre admission assessments-We did not find evidence for people admitted since the last inspection that a pre admission assessment had been completed before they moved to the home. We note some of these people have been admitted on a respite basis. However an assessment still needs to be completed. For example in regard to one person, there was a copy of an assessment when the person was admitted in March 2008. The person had several stays since, but there was no reassessment of the persons needs. (3) Care Plans. We noted there has been some progress in issuing a new version of care plans for some people using the service. However, in some cases the care plans were only partially completed. For example in regard to one person, a manual handling assessment was not completed. Two people did not have a care plan, and their daily records were completed on one sheet. Reviews of care plans of some of the more established people are not being completed. The timescale for action regarding this requirement is 01/02/09. (4) We carried out enforcement action against the home by serving a statutory requirement notice regarding maintaining privacy and dignity of people using the service (as outlined in our report dated 14th October 2008). We have not received the plan how such matters will be dealt with in future. This was requested by 18th December 2008. (5) The deputy manager said new policies and procedures regarding complaints, adult safeguarding, training and quality assurance are under development. We accept the deadline for action regarding these requirements is 01/02/09. (6) We note from staff records that a health and safety induction has been completed for some staff. An induction checklist was completed for two members of staff who have commenced employment since the last inspection. However, there was no documentary evidence of induction for a third person who works as a cleaner. We would expect ancillary staff would receive some form of basic induction, and this would be documented. (7) Satisfactory pre employment checks have been completed for two members of staff who commenced employment since the last inspection. However, checks were not satisfactory for the other member of staff who have commenced employment since the previous inspection. A POVA First check was completed but at the inspection there is no evidence a full CRB check had been obtained. However the registered provider wrote to us immediately after the inspection to state the CRB had been returned but not filed. The person had two references. One of these was from a friend. The second reference was also from a friend and colleague who also works at the home. The registered provider said a professional reference could not be obtained due to the person previously being self employed. We inspected an application form for a person who is due to commence employment shortly. This was not completed to a satisfactory standard. For example there was no employment history given for the person. We previously issued a statutory requirement notice via our enforcement department, regarding the registered provider completing pre employment checks to a satisfactory standard. From the evidence gathered at this inspection, this does not appear to have been fully complied with. We will be renotifying the registered provider regarding this matter for the ninth occasion. Care Homes for Older People Page 5 of 13 (8)Training- There is no evidence that any training has occurred since the last inspection in October 2008. For example there are staff without basic training such as up to date moving and handling training, first aid or fire training etc. Some of these staff may work on night shifts on their own. The training provided e.g. regarding moving and handling is unsatisfactory and could put people using the service and staff at risk. However, we note the timescale for action is 01/02/09. We did see a copy of a list of training planned in regard to manual handling, first aid, food handling, and infection control. This training will be delivered from 27th January 2009 to 5th March 2009. It appears this will not ensure all of the staff will have all the training required by law. It is essential all staff receive the required training if enforcement action is to be avoided. (9) Monies managed on behalf of people using the service-record keeping since the last inspection regarding this matter has not improved so we are renotifying this requirement. (10) Some of the storage heaters were very hot to touch and need to be covered in line with HSE regulations. The reason for the regulations is to prevent scalding; for example if a person fell against a radiator. The registered provider needs to arrange this. The Commission for Social Care Inspection will continue to monitor compliance with the regulations. We will carry out a further internal management review of this service. The home is also currently subject to an ongoing adult safeguarding investigation led by Cornwall County Council Department of Adult Social Care. The Commission for Social Care Inspection will contribute to this. If there is not significant improvement with compliance to the Care Homes Regulations 2001 by the next key inspection, which will occur within six months of the last key inspection, we will consider taking further enforcement action. 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 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 2 5 All people who use the service must receive a statement of terms and conditions of residency or contract when they move to the home. (Previous timescale of 01/12/08 not met. Second Notification) This will ensure they are aware of their rights and responsibilities. 02/02/2009 2 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. 3 10 12 1. You are required to ensure 27/02/2009 that a system is put in place so that emergency maintenance work can be carried out without effecting peoples privacy and dignity. 2. You are required to compile a plan that describes Care Homes for Older People Page 7 of 13 how you will achieve this. 3. You are required to make this plan available for inspection. (Timescale of 18/12/2008 not met Second Notification) This will help to ensure people living in the home receive a service where they are treated with respect, privacy and dignity at all times. 4 16 22 The registered provider must 01/02/2009 have a suitable complaints procedure (for example containing the information outlined in the national minimum standard and the body text of the report). This will help to ensure if people have a complaint there is an appropriate procedure for concerns to be addressed. 5 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 6 29 19 The registered provider must 01/02/2009 ensure suitable checks are performed on all new staff working in the home as outlined in the regulations (for example POVA First check, CRB/POVA check, two Care Homes for Older People Page 8 of 13 written references). Guidance issued by CSCI, and other statutory authorities must be followed. (Previous timescale of Statutory Requirement Notice 1/8/08 not complied with. Subsequent renotification 1/12/2008 not met Seventh Notification). This will help ensure people who use the service are protected from people who are unsuitable to work with the vulnerable 7 29 18 The registered provider shall 02/02/2009 ensure there are appropriate induction arrangements in place for all new staff, there is a comprehensive induction checklist, and induction is appropriately docuented. (previous deadline of 01/12/08 not met. Ninth Notification) This will help to ensure people who use the service are supported by sutably trained and skilled staff 8 30 18 The registered provider 01/02/2009 must: 1. Develop a training policy. This must outline what training differing grades of staff will receive, and when, during their employment. 2. Develop a training profile for individual members of staff which includes training received, and further training required. 3. Ensure all staff receive the training they require according to regulation and the policy. 4. Ensure staff are not placed on duty, untrained and in situations where they and people using Page 9 of 13 Care Homes for Older People the service are put at risk. (Previous deadline of 01/09/08 not met. Second Notification) This will help to ensure people who use the service are supported by suitably trained and skilled staff 9 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 10 35 13 Appropriate records must be 27/02/2009 maintained regarding any monies and valuables kept on behalf of people using the service. This should include receipts and records of all transactions. Peoples monies should not be pooled together. (Timescale of 01/12/2008 not met Second Notification) This will help to ensure there is suitable evidence that any expenditure on behalf of people who use the service is legitimate, and any risk of financial abuse of peoples monies is minimized. 11 38 13 A copy of a satisfactory 01/02/2009 electrical hardwire certificate Care Homes for Older People Page 10 of 13 must be obtained. (Timescale of 01/09/08 not met Second Notification) This will ensure the electrical circuit in the home is safe, and there is less health and safety risk to staff and people who use the service. Care Homes for Older People Page 11 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, 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 25 12 Fit radiator covers to storage 01/07/2009 heaters This will help to ensure the risk of scalding is minimised 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 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. 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