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Inspection on 03/08/07 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 3rd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 living in the home spoke positively regarding the support they received. People were also positive about the food provided and the choice of food that is available. Routines were viewed as relaxed and non-institutional. Staff were viewed as kind and caring.

What has improved since the last inspection?

Care planning has improved considerably since the last key inspection. Care plans are now comprehensive and reviewed on a monthly basis.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Mount Pleasant Rosemundy St Agnes Cornwall TR5 0UD Lead Inspector Ian Wright Unannounced Inspection 10:00 3 and 6 August 2007 rd th 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 DS0000008913.V342845.R01.S.doc Version 5.2 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 DS0000008913.V342845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mount Pleasant Address Rosemundy St Agnes Cornwall TR5 0UD 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) 01872 553165 01872 553776 Mr Godfrey William Sear Mrs Susan Ann Sear Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under the age of 65 years (62 years) 3rd May 2006 Date of last inspection Brief Description of the Service: 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. Corridors are wide to suit people who use the service who use a wheelchair. 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. CSCI were not notified of the fee range at the time of inspection. A copy of this and previous inspection reports is available from either CSCI or the registered provider. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Key Inspection took place over seven and half hours over two days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track four people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing two staff about their experiences working in the home. • Informal discussion with other people who use the service and staff. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: This Key Inspection has resulted in eight statutory requirements. Suitable action must be taken regarding these issues within the timescales set. In summary: • All documentation listed in the Care Homes Regulations 2002 must be available for inspection at all times. • Arrangements regarding the storage and management of medication must be improved. • Physical standards of the building must be improved, and a plan for upgrading some of the decorations and facilities must be put in place. • Staff recruitment checks need improvement. • Staff training required by law must be improved. • There must be a quality assurance process in place. • Health and safety precautions need improvement. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 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 DS0000008913.V342845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has a suitable statement of purpose and a service user guide. The registered provider has developed a contract / statement of terms and conditions of residency which looks satisfactory. The provision of suitable information ensures people who use the service are aware of the services the registered provider offers. This information also helps ensure people who use the service are made aware of their rights and responsibilities. However the Commission was unable to determine whether relevant documentation has been issued to people who use the service. The registered provider appears to have a suitable assessment procedure. However there was insufficient information available for inspection to determine whether this has been satisfactorily implemented. Suitable assessment procedures ensure the registered provider only accommodates people whom they can suitably meet their needs. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 9 EVIDENCE: The service user guide and statement of purpose were inspected. The documents are satisfactory. A master copy of the registered provider’s contact / statement of terms and conditions of residency was also inspected and appeared to be satisfactory. The registered provider has an assessment policy. The senior carer and Mr Sear said all residents have been issued with a contract. Assessments were said to be completed by Mrs Sear before people move into the home. However copies of contracts and pre admission assessments were not available for inspection. These records were however available at the previous inspection and were satisfactory. Some of the people who use the service, who the inspector spoke to, remembered a senior member of staff completing an assessment before they moved to the home. Some people who use the service said they were able to visit the home before moving in, and others said a relative visited on their behalf. The service does not provide intermediate care. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is generally good although management of medication needs improvement. This judgement has been made using available evidence including a visit to this service. People who use the service have a satisfactory care plan for which there is suitable evidence of regular review. Suitable care plans help to ensure people who use the service receive all the care they need for example in a consistent manner. There is suitable evidence that staff ensure health care needs are met. Improvement however is required to the medication system – for example regarding the storage of medication- so people who use the service can be assured their medication is managed to a satisfactory standard. People who use the service said they felt staff worked with them in a manner, which respected their privacy and dignity. This was also evident from the inspectors’ observations. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans for some people who use the service were inspected. These appeared to be to a satisfactory standard, and contained suitable information to assist staff to provide care. Care plans contain suitable information such as what assistance people need with personal care, a brief personal history, likes / dislikes and a moving and handling assessment. There is suitable evidence of review of care plans. Although some people who use the service did not appear to be aware of their care plans, all people who use the service said the care they received was appropriate and carried out in a manner according to their wishes and needs. Health care support appears to be satisfactory. People who use the service said they could see a doctor or other medical practitioner when this is necessary. Medical appointments are recorded in care files. The medication system was inspected. Medication is stored in locked cupboards and administered via a monitored dosage system. The operation of the system is only adequate. Administration of medication appears satisfactory for example staff appeared to administer medication appropriately and medication is signed for. However storage and stock management of medication needs several improvements. The following problems were observed: • • • • • • Some prescribed medications were not recorded on the medication sheet and it was not clear if they are now administered or not. Some medication for people who have left the service is still kept in stock. This should be returned to the pharmacist. One item of medication kept in the storage cabinet was past is use by date i.e. Anusol cream which was prescribed in May 2005. If medication is self-administered this should be recorded on the medication sheet. Otherwise it must be signed for to state it has been administered (including creams and inhalers). Some medication did not have a label on it. Stock management needs some improvement, for example, there were some items which should not have been reordered. For example Ibratropium Bromide It was not clear whether the staff who administer medication have received suitable training, as the training files were not available for inspection. It was recorded in the previous key inspection report dated 3rd May 2006 that some improvement was required in this area. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 12 People who use the service spoke positively regarding the attitude of staff, and said staff respected their privacy and dignity. People who use the service said staff always knock on their doors, and post is always received unopened. Staff practices when working with people living in the home were observed to be to a good standard. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. Routines are flexible to meet the needs of people who use the service. Some activities are offered although these should be developed further. Suitable routines and activities ensure people who use the service can have a daily routine that suits their needs and have some opportunities for social activity. People who use the service have opportunity to have visitors and attend religious services so they can maintain some links with the wider community. People who use the service are encouraged to make choices regarding how they live their lives, and can maintain control over their financial affairs. Arrangements for meals are to a good standard so people who use the service enjoy varied and wholesome diet. EVIDENCE: The inspector was able to speak to many of the people who use the service. All said they could get up and go to bed when they wanted to, and that routines were not rushed. A limited number of activities are available for example a weekly keep fit session. A minority of people living in the home said they would like more structured activities. However senior staff said staff had tried to organise other activities but residents had not been very interested. A recommendation was made at the last key inspection in May 2006 to offer day trips to people living Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 14 in the home. It is not clear what action has occurred regarding this recommendation. These matters need to be kept under review, and effort should be made to accommodate at least the minority of residents who would benefit from more structured activities. Many people however said they were happy to spend time in their bedrooms reading or watching TV. For example, the county council library visits the home for at least one person living in the home. People who use the service said they were able to receive visitors when they wished, either in one of the lounges or in their bedrooms. Some people who use the service said they participated in the Christian service, which takes place at the home. People who use the service said they felt they could exercise choice over their lives for example how to spend their time, what they could wear etc. Management look after some small amounts of money on behalf of people who use the service. Suitable records are kept of transactions. Staff do not act as appointee for government financial benefits, for any of the people who use the service. Records are kept of fees paid to the registered provider. The registered provider, currently looks after no valuables belonging to people who use the service. The inspector shared a meal with some people who use the service. Food served was of good quality and there was a choice available of main course and sweet for people. This is excellent as there is often only a limited choice in many care homes. People who use the service all said they were generally satisfied with the food provided. They said there was always enough food and meals were well cooked. A choice of evening tea is also provided, and hot and cold drinks are available throughout the day. Two people said they would appreciate their dinner plates being warmed before the meal was served. This should be implemented for the people who wish for this. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has a suitable complaints procedure. This should assure people who use the service that there are appropriate procedures to deal with concerns or complaints. The prevention of abuse policy and procedure appears to be satisfactory. This should assure people who use the service that there is an appropriate policy to protect them against abuse and poor practice. EVIDENCE: The registered provider has a suitable complaints procedure. Nobody had any complaints or concerns regarding the service they received when the inspector asked them. Most people who use the service had confidence that staff would take their concerns seriously and deal with them to their satisfaction. However some residents did not feel the providers would do anything to improve any matters of concern. Some concerns regarding this are outlined in the ‘Management and Administration’ section of the report. The Commission for Social Care Inspection has received two complaints regarding the home since the last key inspection in May 2006. One of these was partly substantiated (Problems with the controls of the water heater), but this matter appears to have been satisfactorily resolved. Mr Sear said the registered provider had received no complaints. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 16 The registered provider has a satisfactory policy regarding adult protection. The registered provider did alert the Commission to one issue of concern which they dealt with professionally. Many people living in the home described staff as ‘kind’, and the people the inspector spoke to said they were not aware of any poor or abusive practice. Staff the inspector spoke to also said practices within the team were to a good standard. Some staff have received training regarding the awareness and prevention of abuse. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mount Pleasant provides a suitable facility to provide care for elderly people. The building was clean, free from offensive odours and generally homely at the time of the inspection. However, some aspects of the building, decorations and furnishings are beginning to look worn and a programme of renewal and replacement will shortly become necessary if standards are to remain satisfactory. However currently, people who use the service can be generally assured that the home provides suitable facilities to meet their needs. EVIDENCE: The building was inspected. There is suitable shared space for example a large lounge and a dining room. Communal lounges are generally pleasant and homely, although some repainting is required or will be required shortly. Toilet and bathroom facilities are generally suitable although some redecoration and refurbishment is now necessary. For example some of the woodwork needs repainting. There is some retiling required in at least one of the bathrooms as tiles have been cracked by the bath hoist. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 18 Bedrooms are generally decorated and furnished according to individual tastes. However in some cases redecoration is required when this is possible. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. This helps to make the bedrooms individual and homely. Some of the double glazed windows have become clouded with patches of condensation. While this did not concern many of the people living in the home, some residents raised concerns about this with the inspector. The registered provider said he had tried to have the glass replaced under guarantee with the company which installed the windows, but without any success. The registered provider said he would replace all the windows when finances allowed. However as an interim measure, the registered provider should replace the glass where it is badly damaged, and particularly for the rooms where the occupants have raised a concern. The inspector also noted the casing for at least one of the call points was damaged. The registered provider said he was aware of the issue and would attend to the matter. The Commission had to complete a random inspection in December 2006. One of the concerns raised was in regard to there being inadequate hot water available in some of the residents’ bedrooms in the morning. An immediate requirement was issued and appropriate repairs were then completed. It was of concern to the Commission that the provider had not rectified the fault until the Commission took action. The matter was however known about by staff. This may be a sign for the need of the provider to take a more proactive approach to maintenance and renewal than is currently the case. The building was clean and hygienic on the day of the inspection. People who use the service said the home was generally kept clean and maintained appropriately. However some concerns were expressed by a few residents that cleaning was often not thorough enough, and was completed too quickly. Laundry facilities are suitable, and people using the service felt the laundry was carried out to a good standard. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory so people living in the home should be assured they would receive satisfactory levels of support. The registered provider appears to have a satisfactory approach to ensuring staff can obtain a National Vocational Qualification in care. However the lack of availability of records has resulted in the Commission’s inability to verify this. Staffing and training records were not available for inspection. CSCI cannot subsequently assure people using the service that recruitment checks and staff training are to a satisfactory standard. EVIDENCE: On the days of the inspection there were two care staff on duty from 0700 to 2100, with a staff changeover at 1400hrs. There is one waking night person on duty each night. The registered providers live in the neighbouring bungalow and say they assist staff as necessary. Ancillary staff, such as cooks and cleaners, are also employed. The staff roster and record of hours staff have worked (which is kept in a diary) show there are satisfactory staffing provided. For example the registered providers try to provide additional staff on duty where this is possible. The home has had some difficulties in recruiting suitable staff over the last few months, although this matter seems to be resolved. During the difficult period the registered providers completed some shifts, and other staff worked additional hours. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 20 People who use the service were very positive about staff employed in the home. For example residents said staff were ‘kind’, ‘ friendly’, and ‘helpful’, and this was evident from the inspector’s observations. Recruitment and training records were not available on either day the inspection due to Mrs Sear not being present. Concerns have been expressed in a letter from CSCI to the registered provider regarding this matter and Mr Sear’s inability to produce the records. A requirement has been issued to ensure that records are always made available for inspection. The inspector was informed that the senior care thought all suitable employment checks had been completed on new staff (for example a POVA First check and two references). Where a full CRB had not been returned, the senior carer said staff were supervised. One member of staff who recently started to work at the home said she was shadowed by more experienced staff when she first commenced employment. The inspector was unable to ascertain if appropriate action has been taken regarding the previous requirement to improve evidence of staff induction. The registered provider was required to forward a copy of an improved induction checklist to the Commission by 01/06/07. As this was not available for inspection or the checklist has not been forwarded to the Commission this requirement is renotified. One of the registered providers Mr Sear and a senior carer said that suitable training had occurred or was planned. They said all staff have received training in moving and handling, infection control, food handling and adult protection. Senior staff had received first aid training. Two staff have also received training in the Mental Capacity Act. A list of training booked / received was on the wall but this did not really provide sufficient information to state the training had been delivered. Mr Sear and the senior carer also said staff have the opportunity to obtain a National Vocational Qualification in care, but as records were not available the inspector was unable to ascertain how many staff had achieved an NVQ. The registered provider has been notified on three previous occasions regarding ensuring staff receive appropriate training. The provider was notified in the random inspection report dated 7th March 2007 that if they did not comply with the statutory requirement regarding training, enforcement action could follow. Concerns were also expressed at this time regarding staff not having a Protection of Vulnerable Adults check (POVA First) followed by a full Criminal Records Bureau (CRB) check. The Commission has not been able to check compliance regarding this matter. The registered provider has been renotified on several occasions regarding lack of employment checks and regarding ensuring staff have appropriate training. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 21 Failure of the registered provider to carry out appropriate action regarding the statutory requirements within the timescales set could result in enforcement action. A random inspection will be completed in the near future to ascertain all relevant records are available for inspection, and satisfactory action has been taken regarding requirements issued. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered providers have suitable experience and knowledge to manage the home. However the Commission does have some concerns regarding the registered provider’s skills to manage the home. This is, for example, reflected in some of the concerns outlined in this report. The registered provider’s approach to quality assurance needs improvement so, for example, people who live in the home can be assured their views will be listened to and appropriate actions will then be taken. The registered provider has a satisfactory approach to the management of residents’ monies. People who use the service should therefore be confident their monies are suitably looked after if the registered providers are involved in this area of their lives. The registered providers approach to health and safety needs improvement so people who live in the home can be assured they live in a safe environment. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered providers have owned and managed the home for a number of years. Mrs Sear said she has attended a City and Guilds Advanced Management Course, and an accountancy training course. Mr Sear is from an electrical engineering background. There is some evidence the registered providers have managed some situations with skill. For example regarding two adult protection concerns in the last year. People living in the home are also positive about their care, and staff appear to work in a professional manner. There is a pleasant and relaxed atmosphere in the home, and people living there are generally positive about their experiences. However, there are concerns regarding the number of renotifications of some statutory requirements. In some cases enforcement action could result if no action is now taken. Some concerns have been expressed to the Commission about poor organisation in the home. Although many people living in the home were positive about the owners, and the inspector has spoken to relatives who have also been positive, some concerns have been expressed. For example concerns have been expressed regarding the poor response to maintenance requests. Some people have said they have received a dismissive response to their concerns. These issues do need to be addressed by the registered providers so they always deliver a ‘customer focussed’ service, and deal with any concerns or requests in a courteous and positive manner. The registered provider’s approach to quality assurance needs some improvement. There is a quality assurance policy in place, and it appears a quality assurance survey was completed previously in June 2005. Mr Sear or the senior carer on duty said they were not sure if a survey had been completed since this date. Concerns regarding response to maintenance issues and to regulatory requirements also suggest improvement is required in this area. The registered providers have a satisfactory policy regarding the management and handling of monies belonging to people who use the service. The inspector spoke to several people living in the home who said either they or their relatives look after their money. Some small amounts of cash are kept on behalf of people living in the home for which appropriate records are kept. The registered persons have a suitable health and safety policy. The registered provider said they are members of an organisation which monitors health and safety standards in the home. Mr Sear said the company reported that health and safety standards are satisfactory, but he was not able to produce any copies of reports the company had produced. The registered provider said the Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 24 health and safety officer from the local authority had not visited the home recently, but had said standards were satisfactory. A copy of the report was however not made available for inspection. Copies of other health and safety records were inspected. The fire alarm system and emergency lighting appear to be regularly tested by the registered provider. A fire risk assessment is in place. The Cornwall County Council Fire Officer sent two enforcement notices on 28th February 2007 and 1st March 2007. These state the fire risk assessment needs to be amended, and secondly the fire detection and warning systems need to be upgraded. The registered provider has until 27th February 2008 to comply with the notice and has said he will comply with it. The registered provider appears to have suitable health and safety risk assessments in place including one for the prevention of legionella. However there does not appear to be records regarding suitable testing measures. These need to be developed as necessary and available for inspection. Mr Sear, who has an electrical engineering background, checks and services the hoists, electrical hardwire (electrical installation) circuit and portable electrical appliances. Records have been maintained regarding these checks. The Oxford hoist also appears to have been tested by an external agency in July 2007. A statutory requirement for the registered provider to consult with the Environmental Health Department (Health and Safety) regarding the adequacy of these tests was issued. Evidence of this was requested by the Commission. There is however no evidence this has been complied with, so the Commission has written to the Environmental Health Department to request them to carry out an inspection at the home. The previous requirement has also been renotified. A current insurance certificate was displayed in the office of the home. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 25 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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. 1. Standard OP2 OP3 OP29 OP30 OP33 OP31 Regulation 5, 14, 18, 19, 24 Timescale for action The registered person shall 01/09/07 ensure that appropriate records referred to in the regulations are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. For example: • Service user contracts / statement of terms and conditions of residency • Copies of pre admission assessments for all service users. • Staff recruitment and personnel records • Staff training records • Quality assurance systems. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (For example: • Storage of medication needs improvement as DS0000008913.V342845.R01.S.doc Requirement 2. OP9 13(2) 01/09/07 Mount Pleasant Version 5.2 Page 27 3 OP19 23(2)(b) (d) outlined in the body of the report. • Any staff administering medication must have training such as from a pharmacist). The registered person shall 01/11/07 having regard to the number and needs of the service users ensure that— (1) The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; (2) All parts of the care home are kept reasonably decorated (For example: (a) Maintenance and issues outlined in the ‘Environment’ section of the report need to be addressed. (b) The registered provider needs to establish a refurbishment plan for the home. This should include plans for redecoration and refurbishment. A copy of the plan should be sent to the Commission within the timescale set. 4. OP29 19 Schedule 2 The registered person shall not employ a person to work at the care home unless— (a) The person is fit to work at the care home. (b) Suitable records are obtained in respect of staff employed as specified in paragraphs 1 to 9 of Schedule 2 of DS0000008913.V342845.R01.S.doc 01/09/07 Mount Pleasant Version 5.2 Page 28 5. OP29 18. 19 the Care Homes Regulations 2001 are maintained (For example a Protection of Vulnerable Adults Check, a Criminal Records Bureau Check, two written references etc.) These records must be available for inspection. (Deadline of 01/04/07 not met Second Notification) The registered person shall 01/09/07 ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example this must include training as required by regulation such as fire, manual handling, infection control, food hygiene and first aid. (Previous deadline of 01/08/07 not met. Fourth Notification) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive— (i) Training appropriate to the work they are to perform including structured induction training; and (ii) Suitable assistance, including time off, for the 6. OP29 18(c)(i)(ii) 01/09/07 Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 29 7. OP33 OP31 24(1)(2) 8. OP38 13, 23 purpose of obtaining further qualifications appropriate to such work. (For example the registered provider must ensure the induction checklist for new staff is comprehensive and send a copy of the checklist to the Commission for Social Care Inspection within the deadline set.) (Previous deadline of 01/08/07 not met. Fourth Notification.) The registered person shall 01/11/07 establish and maintain a system for evaluating the quality of the services provided at the care home. The registered person shall 01/11/07 ensure that— All parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety; (b) Unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. (c) The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; (d) Equipment provided at the care home for use by residents or persons who work at the care home is maintained in good working order; (For example there must be: (1) The registered (a) Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 30 provider must confirm in writing guidance given by the Environmental Health Department regarding the servicing and testing of manual handling equipment, electrical hardwire (electrical installation) testing and portable electrical appliance testing. (2) Ensure there is evidence that there are suitable measures to prevent legionella in place. Suitable documentation of appropriate testing must be in place. ) (Deadline of 01/06/07 not met. Third Notification) 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 2. Refer to Standard OP12 OP31 Good Practice Recommendations Develop more structured activities for people living in the home if and where there is a demand. Opportunities for external activities should be considered and implemented. The registered provider should complete National Vocational Qualifications in care and management at level 4. Mount Pleasant DS0000008913.V342845.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Cornwall and Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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