Care Home: Mount Pleasant Care Home, Newton Abbot

What the care home does well Good information about the service is provided to current and prospective residents and their representatives in the homes Statement of Purpose, Service Users Guide and brochure. Detailed individual needs assessments are drawn up prior to admission which are built upon to enable the home to develop plans of care which are regularly updated to meet peoples changing needs. Peoples physical health and psychological health is monitored and timely referrals are made to the professional health care services as and when necessary. Social activities are arranged and the staff are encouraged to spend time talking with the people who use the service. A relative told us that she visited the home daily and was always made to feel welcome. The cook knows what food people like and dislike and is able to cater for people with special dietary needs. People told us that they would know how to make a complaint. Complaints are recorded and appropriate action is taken to resolve them. Several rooms have been refurbished to a very high standard. Dedicated housekeeping staff are employed to ensure that the premises are kept clean throughout. Safe practices are used to recruit new staff and all of the care staff are required to attend training courses and take National Vocational Qualifications. The manager is very experienced and well qualified to run a care service. What has improved since the last inspection? Since the last key inspection the home has produced a Statement of Purpose, Service Users Guides and a Brochure. Care planning practices have improved and plans of care are now clearly presented and easy for the staff to follow. Several rooms have been refurbished to a very high standard as part of a programme to refurbish the whole home. Staff recruitment checks have been improved and are now good and an induction training programme has been introduced for all new staff. A quality assurance system is now in place to enable the management to gain feedback on the quality of the service from the residents and their representatives and to enable them to have an input into the development of the service. What the care home could do better: A small number of gaps were seen in the medication administration record sheets. Some of the rooms are still in need up grading. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mount Pleasant Care Home, Newton Abbot 26 Mount Pleasant Road Newton Abbot Devon TQ12 1AS     The quality rating for this care home is:   two star good service 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. Lead inspector: Judy Hill     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Mount Pleasant Care Home, Newton Abbot 26 Mount Pleasant Road Newton Abbot Devon TQ12 1AS 01626353351 01626201474 davackltd@aol.co.uk 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) : Davack Ltd care home 14 Number of places (if applicable): Under 65 Over 65 0 14 dementia mental disorder, excluding learning disability or dementia Additional conditions: 14 0 The maximum number of service users who can be accommodated is 14. The registered person may provide the following category of service only; Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental disorder, excluding dementia or learning disability aged 65 years and over (Code MD(E)) Date of last inspection Brief description of the care home Mount Pleasant Care Home is registered to provide accommodation and care for a maximum of fourteen people who are over sixty-five years of age and who have dementia or a mental illness. The home is approximately half a mile from Newton Abbot town centre, which is a large town with a good range of shops and other local facilities, including a mainline railway station. Care Homes for Older People Page 4 of 27 Brief description of the care home Written information about the home is available in a Statement of Purpose, Service Users Guide and Brochure. These documents and previous inspection reports are available from the home on request. Copies of previous inspection reports are also available on the Care Quality Commission website. The fees are 420 pounds a week and additional charges are made for professional hairdressing, chiropody and massages. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection concluded with a visit to the home that was carried out on 29th April 2009. The information contained in this report was gained in conversation with the registered manager, the staff who were on duty at the time of the home visit and some of the people who live at Mount Pleasant. We also spoke to relatives of two of the residents. Before the site visit was carried out we send an Annual Quality Assurance Assessment to the home which the registered manager completed and returned to us. In addition to this we sent ten surveys to the home to distribute to the residents and ten to distribute to the staff. Three surveys were completed and returned to us by residents, Care Homes for Older People Page 6 of 27 with assistance from their families and five were completed and returned by the staff. Prior to the site visit we also reviewed notifications that we had received from the home since the last inspection and reviewed the last inspection report. During the site visit we requested and were given copies of the homes Statement of Purpose, Service Users Guides and brochure and looked at some of the records that are kept at the home. We case tracked the care of three of the people who use the service by looking at their plan of care and discussing how their care needs were being assessed, reviewed and met by the staff. We also looked at staff recruitment and staff training records. We also looked at medication records and storage and staff rotas. What the care home does well: What has improved since the last inspection? Since the last key inspection the home has produced a Statement of Purpose, Service Users Guides and a Brochure. Care planning practices have improved and plans of care are now clearly presented and easy for the staff to follow. Several rooms have been refurbished to a very high standard as part of a programme to refurbish the whole home. Staff recruitment checks have been improved and are now good and an induction training programme has been introduced for all new staff. A quality assurance system is now in place to enable the management to gain feedback on the quality of the service from the residents and their representatives and to enable them to have an input into the development of the service. Care Homes for Older People Page 8 of 27 What they could do better: 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The home has a written Statement of Purpose, Service Users Guides and a brochure. Copies of the Statement of Purpose and Brochure are given to prospective residents and their representatives and are kept in the entrance hall at the home so that the people who use the service and visitors to the home can access them at any time. Each of the residents is given a Service Users Guide and these were seen in some of the residents bedrooms. Case managers employed by Social Services or Care Trusts carry out an initial needs assessment with the people they place at the home and these are sent to the home before a placement is considered. This is to enable the manager to assess if the Care Homes for Older People Page 11 of 27 Evidence: service provided will meet the prospective residents needs. People privately funded will have their needs assessed by the manager before admission. In both cases the initial needs assessment will be built upon to provide the home to with sufficient information to draw up a plan of care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: During the site visit we looked at some of the care plans that the staff use to enable them to provide the care that people need. These were clearly presented and easy to follow. The home is not registered to provide professional nursing care and does not do so. However, as the home specialises in providing a service for people who are in an advanced stage of dementia, people are not always able to say if they are feeling unwell and regular observation checks are carried out and recorded by the registered manager and staff. All of the people who are currently using the service have the same GP and the registered manager told us that he carries out monthly health checks. The staff have received training in caring for people with dementia, including dealing Care Homes for Older People Page 13 of 27 Evidence: with aggressive behaviour. During the site visit we observed the registered manager and staff working with people and they did so with patience and understanding, being careful to protect their dignity. Several people are incontinent but no obvious evidence of this picked up during the site visit, which indicates that the staff manage continence well. Some of the people who use the service are not able to move around as much as they need to. This could place them at risk of developing pressure areas. To provide a safeguard against pressure sores developing, the registered manager has provided in house training on tissue viability and the prevention of pressure sores. All of the people who use the service were seen to be clean and well groomed. This indicates that the quality of care in terms of helping the residents to maintain their personal hygiene is good. Because the residents all have short term memory problems, all of their medication is administered by the staff. For security, medicines are stored in a locked trolley that is chained to a wall. The staff who handle medicines have received training to do so. Since the last inspection the home has started to use a pharmacy controlled system to order, administer and record the residents medication. A spot check was made of the medication administration records and these were found to be clear and up to date. We did, however, pick up a small number of gaps in the medication records, where the person administering the medication had not signed the record of used a coding system to indicate that items of medication had not been taken as prescribed. In the report of the last inspection we noted that some of the bedroom, bathroom and toilet doors were not lockable. Suitable locks have now been fitted to some of the doors and plans are in place to provide additional locks as and when the rooms are refurbished. The staff are respecting the privacy of the residents by ensuring that they knock before entering their bedrooms. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to participate in social, occupational and recreational activities. Evidence: The care staff are encouraged to spend time with the people who use the service and to engage them in occupational, recreational and social activities. We were told that these activities include games, craft sessions, Bingo and exercise. Parties are held to celebrate special events, including birthdays, Bonfire night and Christmas. A professional singer visits the home every two months to entertain the residents. One member of staff is qualified to provide massage and reflexology. Private treatments can be booked as an optional extra, along with professional hairdressing and chiropody. Small group outings are arranged in the summer. Outings can include trips to the seaside at Dawlish or Teignmouth, or visits to the zoo. Care Homes for Older People Page 15 of 27 Evidence: Individual residents are occasionally taken shopping or for short walks by the manager and staff. Some people also go out with friends and families. A clergyman visits the home once a month to provide a service for the residents. The people who use the service can receive visitors at any time and can entertain them in the communal lounge or in their bedrooms if they prefer. We spoke to the wife of a resident who said that she visits the home daily and is very happy with the care provided and with the warm welcome that she always receives from the staff and manager. We spoke with the cook who demonstrated that she has very good knowledge about peoples dietary likes and dislikes. She bases the success of any meals on the amount that is left on peoples plates and changes the menu plans if a meal is not popular. If individual people do not like the set meal, an alternative that they do like will always be made available. The home is currently catering for people who are diet controlled diabetics and the cook said that she has had no problems providing them with a suitable diet. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Even the smallest of complaints are taken seriously, dealt with appropriately and recorded. This, along with staff training, policies and procedures protects people from the threat of abuse. Evidence: Information about how to make a complaint or raise a concern about the service provided is included in both the Statement of Purpose and Service Users Guide. The three surveys were that were completed and returned to us by relatives of the people who use the service on their behalf all tell us that people would know how to make a complaint or raise a concern if they were not happy with the service provided. Surveys completed and returned to us by five members of staff told us that the staff would know what to do if someone told them or indicated to them that they had a concern or complaint. A book is kept to record all complaints and concerns in and the action taken to resolve the issues raised. Although a number of entries had been made to this record all of the entries referred to issues that were easily put right. No major complaints had been recorded. Care Homes for Older People Page 17 of 27 Evidence: The registered manager and staff have received training on the Protection of Vulnerable Adults and policies and procedures are in place to protect the people who use the service from abuse. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is still work to do, good progress is being made to refurbish the interior of the home to a very high standard. When the refurbishments are complete Mount Pleasant will provide a very comfortable home for the people who live there. Evidence: The current providers took over the business as a going concern in October 2007. Although the home appeared to be in good structural repair, the current owners were aware that most of the rooms needed to be refurbished to bring them up to a good standard. Although there is still considerable work to do, good progress has been made and the office, dining room, kitchen, one bathroom, that has been turned into a wet room and several bedrooms have been refurbished to a very high standard. Personal tastes have been considered when the bedrooms were redecorated. We were told that the colour schemes used were chosen by the people who occupy the room or in consultation with their families. There is a light, spacious and comfortably furnished lounge and a recently refurbished dining room. There are plans to change the carpets in these two rooms because they are heavily patterned and not suitable for people with dementia. Care Homes for Older People Page 19 of 27 Evidence: The home has a recently converted wet room, which is suitable for people with limited mobility to use with minimum assistance. Bath aids are provided in the bathrooms so that the staff can assist people with bathing safely. Since the last inspection the kitchen has been upgraded to an exceptionally high standard. The laundry facilities are designed to disinfect laundry at a low temperature. Dedicated housekeeping staff are employed and the standard of cleanliness maintained throughout the home is good. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All of the staff are well trained and have the skills and support they need to provide a very high standard of care for the people who use the service. Evidence: The staff turnover is very low but when a vacancy does occur the management use safe staff recruitment practices to ensure that new staff are suitable to work with the people who use the service. New staff receive induction and foundation training to Skills for Care Standards and on going training in health and safety related areas, such as First Aid, Fire Safety, Health and Safety, Food Handling, Manual Handling and Medication. Specialist training in dementia care is also provided. The management insist that all of the care staff complete a National Vocational Qualification (NVQ) at Level 2 in Care or above and when staff have completed an NVQ at each level they are rewarded with promotion to a higher grade. In recognition of good practice the home has received an Investors in People Award. Dedicated housekeepers and cooks are employed so the care staff are able to devote Care Homes for Older People Page 21 of 27 Evidence: most of their time to the care of the residents. The staff seen and spoken with during the inspection all demonstrated that they have the commitment and skills to work well with the people who use the service and the relationship between the manager, staff and residents was relaxed and friendly. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Mount Pleasant benefit from living in a safely maintained and well managed home. Evidence: The registered manager, Sian Littlechild, is also the co-owner of Davack Ltd, which is the registered service provider. Sian trained as a nurse and has considerable experience of providing care for people who are elderly and confused. She has completed her National Vocational Qualification at Level 4 in Care and her Registered Managers Award. A policy is in place to illustrate how information will be gathered to enable the management to carry out annual development reviews of the service. This includes reviews of care plans and personal risk assessments, staff meetings, Maintenance reviews and risk assessments and regular audits of records. Care Homes for Older People Page 23 of 27 Evidence: A copy of the homes Annual Quality Assurance Report is kept in the entrance hall of the home. This shows that questionnaires had been used to gain feedback on the service provided from the people who use the service, their relatives, district nurses, GPs and case managers. The manager told us that it is the policy of the home not to handle money for the people who use the service. All of the people who use the service require some help to maintain their financial affairs and this is provided by families or legal representatives. Any day to day expenses incurred, for example for professional hairdressing or chiropody, are paid for by the home and included in the monthly bills for the service. All of the required and recommended policies and procedures are kept in a folder at the home and are accessible to the staff. We saw that a record sheet is kept with the policies and procedures, which the staff sign to identify that they have read and understood them. Regular maintenance and service checks are carried out to ensure that gas and electrical appliances are safe and to ensure that the fire detection and fire safety equipment is maintained in good order. Care Homes for Older People Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered service 22/05/2008 providers must ensure that the medication administration recording sheets are signed every time an item of medication is administered and that if medication is not administered as prescribed a system is used to identify why. Care Homes for Older People Page 25 of 27 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 9 13 The registered providers 30/05/2009 must ensure that the medication administration recording sheets are signed every time an item of medication is administered and that if medication is not administered as precribed the coding system is used to identify why. This is to ensure that medicines are handled safely. 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 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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