Care Home: Mount Pleasant Nursing Home

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What the care home does well People living at the home all have single bedrooms which they are able to personalise with their own belongings to help their rooms feel more homely. People living at Mount Pleasant told us they liked their rooms and the facilities on offer. The kitchen was well stocked and very organised so that various choices could be provided for people living at Mount Pleasant. This included special diets, lots of homemade pies, and lots of fresh fruit and vegetables, with baskets of fruit seen available for everyone in the lounge area. There was a large amount of specialised equipment at Mount Pleasant such as electric beds, pressure relieving mattresses and a number of hoists. Staff felt that they are always supplied with the best equipment to help them to care for people in the right way and to give the best care possible. Staff training and development is progressing and over 50% of care staff held a national vocational qualification in care at level 2. These are nationally recognised qualifications for people working in social care and show they have been assessed as competent to provide good quality care and support for people. This means that a high percentage of the staff at Mount Pleasant have the skills and knowledge to support the people who live there. The training records we saw showed that there is a lot of training available for staff in topics they need to receive regular training in to keep them up to date. This included health and safety, food hygiene, fire safety training, moving and handling, first aid and infection control. This training helps to ensure staff are aware of how to support people safely and helps them to meet their personal needs and requests. The staff records we saw were well maintained and showed us that thorough employment checks are carried out before staff start working in the home. This helps to make sure that the staff are suitable to work with the people who live at Mount Pleasant. The building is well maintained and there are detailed records kept to show that regular checks are carried out to make sure that the building and equipment are safe. These checks include small electrical appliances, water temperatures and fire protection system checks. These regular checks help to make sure that Mount Pleasant provides a safe environment for people to live and work in. People that we met told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. We received three completed surveys from people who live at Mount Pleasant. People told us that they were happy living at the home and said, "Provides good meals, keeps a stable staff, respects personal wishes". Four relatives sent us back surveys and their comments were positive, including: "The staff are very good and communicate with me about any concerns"; "We can enter the home at any time and have always been pleased with the cleanliness of the home. etc"; "Consistency of care - staff team seem to be happy working there and therefore staff turnover is low"; "Communication is excellent and staff are friendly to visitors".Two staff and one health professional responded to us and told us, "Good palliative care, good relationships with relatives" and "We have very good staff who do a good job". What has improved since the last inspection? In the information we had received from the home, they told us that they continued to keep things under review so that the information about the home was always up to date. Improvements had been made to the paperwork being used for care plans to make sure reviews were kept up to date. Staff supervision and training portfolios were being kept up to date to make sure that staff received the guidance and training they needed to provide good quality support and care for the people living at the home. There is a continuing programme of redecoration and refurbishment to make sure the home continues to provide safe and comfortable surroundings for the people living there. In addition, the activities programme is kept under review to make sure there are always activities that people living in the home want to take part in. What the care home could do better: We found some areas that would benefit from further review and input, including a review of staffing levels to make sure that there are enough staff to provide care and support as the people who live at the home become more dependent. Further reference to the areas we felt needed review is is made in the body of this report. We consider that Mount Pleasant provides excellent outcomes for the people who live there so rather than detail what they could improve we would expect that the home continues to review its practice in order to ensure that the very high standard of care provided to the residents at the time of this inspection is maintained and where possible improved upon. Key inspection report Care homes for older people Name: Address: Mount Pleasant Nursing Home London Road Allostock Knutsford Cheshire WA16 9NW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Mount Pleasant Nursing Home London Road Allostock Knutsford Cheshire WA16 9NW 01565722918 01565722014 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mount Pleasant Nursing Home Limited care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 42. Date of last inspection Brief description of the care home Mount Pleasant Nursing Home is a two storey converted and extended property standing in its own grounds in the rural community of Allostock. The home is situated approximately 4 miles from the towns of Knutsford and Holmes Chapel. Accommodation is provided on two floors. Access to the first floor is by a passenger lift or one of the staircases. There is a separate dining room and two lounges on the ground floor with a quiet lounge and on the first floor. The home provides its own hairdressing salon. All bedroom accommodation is en suite. The gardens are wheelchair accessible. There is car parking to the front and side of the Care Homes for Older People Page 4 of 32 0 Over 65 42 Brief description of the care home home. The weekly fees are 475 to 618 pounds. There are additional charges for hairdressing, toiletries, newspapers, chiropody and one to one sessions with a local provider. The statement of purpose, service user guide and the latest inspection report can be provided at the home for anyone to review and look at. Care Homes for Older People Page 5 of 32 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: three star excellent 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: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This visit was unannounced and was just one part of our visit. We also looked at other information we had received about the home. This included information we had been sent from the home in an annual questionnaire. This gives information about how the manager and owners see the services strengths and weakness and future plans developments at the home. A selection of questionnaires were also sent out for people living at the home, families staff and health and social care professionals to find out their views about Mount Pleasant. In total we have received 10 completed surveys from a variety of people and their comments are included in the report. Care Homes for Older People Page 6 of 32 During our visit to Mount Pleasant, we looked at various records and walked round the home. We spoke with people living in the home and some of the staff. We watched how staff interact with the people who live there and how they provide care and support for people. We also looked at various records to see what care and support was being provided for the people who live at Mount Pleasant. Care Homes for Older People Page 7 of 32 What the care home does well: People living at the home all have single bedrooms which they are able to personalise with their own belongings to help their rooms feel more homely. People living at Mount Pleasant told us they liked their rooms and the facilities on offer. The kitchen was well stocked and very organised so that various choices could be provided for people living at Mount Pleasant. This included special diets, lots of homemade pies, and lots of fresh fruit and vegetables, with baskets of fruit seen available for everyone in the lounge area. There was a large amount of specialised equipment at Mount Pleasant such as electric beds, pressure relieving mattresses and a number of hoists. Staff felt that they are always supplied with the best equipment to help them to care for people in the right way and to give the best care possible. Staff training and development is progressing and over 50 of care staff held a national vocational qualification in care at level 2. These are nationally recognised qualifications for people working in social care and show they have been assessed as competent to provide good quality care and support for people. This means that a high percentage of the staff at Mount Pleasant have the skills and knowledge to support the people who live there. The training records we saw showed that there is a lot of training available for staff in topics they need to receive regular training in to keep them up to date. This included health and safety, food hygiene, fire safety training, moving and handling, first aid and infection control. This training helps to ensure staff are aware of how to support people safely and helps them to meet their personal needs and requests. The staff records we saw were well maintained and showed us that thorough employment checks are carried out before staff start working in the home. This helps to make sure that the staff are suitable to work with the people who live at Mount Pleasant. The building is well maintained and there are detailed records kept to show that regular checks are carried out to make sure that the building and equipment are safe. These checks include small electrical appliances, water temperatures and fire protection system checks. These regular checks help to make sure that Mount Pleasant provides a safe environment for people to live and work in. People that we met told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. We received three completed surveys from people who live at Mount Pleasant. People told us that they were happy living at the home and said, Provides good meals, keeps a stable staff, respects personal wishes. Four relatives sent us back surveys and their comments were positive, including: The staff are very good and communicate with me about any concerns; We can enter the home at any time and have always been pleased with the cleanliness of the home. etc; Consistency of care - staff team seem to be happy working there and therefore staff turnover is low; Communication is excellent and staff are friendly to visitors. Care Homes for Older People Page 8 of 32 Two staff and one health professional responded to us and told us, Good palliative care, good relationships with relatives and We have very good staff who do a good job. What has improved since the last inspection? 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 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 32 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 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are checked before they move into the home and information is available about the home so that people can be confident the home is right for them when they move in. Evidence: We looked at the care plans of a number of people living at Mount Pleasant, including the records of one person who had recently moved to the home. Staff had completed checks about this persons needs before they moved in, using the homes paperwork to record all the persons health needs and wishes. They also get a copy of any other assessments that have been completed such as social work assessments. This helps them to assess whether the persons needs can be met at Mount Pleasant, before they move in. All the information gathered is then used to make a plan of care for the person so that when they move in, staff have information on how to provide care in the way the person prefers. The staff told us that they provide people with a copy of information about how the Care Homes for Older People Page 11 of 32 Evidence: home works and who it is for. These documents are called the service users guide and statement of purpose and they provide details about the home, including the facilities and services provided for people living there. Completed surveys that were sent back to us by people living at the home and relatives confirmed that they had received this information before moving into the home, so they knew what to expect when they got there. Care Homes for Older People Page 12 of 32 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. Each person who lives at Mount Pleasant has a plan of care so that their care needs are identified and staff know what to do to make sure these needs are met in the way the person prefers. Evidence: We looked at the care plans of three people who live at Mount Pleasant to see what care was provided to meet their needs. Each one had been recently reviewed. This ensures the plans provided enough information and guidance for staff on how to support the person safely and some contained details on how the person wanted to be supported, which is good practice. Staff were keeping daily records of the care and support they had given to each person and how they had spent their day. Some staff recorded a lot of detail and other staff wrote brief details with limited information about the persons health and personal care. We found in two care plans that important information about the families wishes was recorded on sticky note pad sheets and attached to the care plans. This was discussed with the manager as they needed to review this. The manager told us she was waiting for a date to be confirmed when she could attend training on the Mental Capacity Act and decision making. Care Homes for Older People Page 13 of 32 Evidence: Assessments of the capacity of the people who live at the home to make decisions needs to be carried out and any decisions which are then made on their behalf would need to be recorded to show that they had been made in their best interests, if it has been assessed that they did not have the capacity to make that decision for themselves. We discussed one care plan where we found that the persons condition had changed and although this was recorded in the daily records, no amendments had been made to the care plan to make it clear for staff that the persons needs had changed. Staff were able to tell us about the persons changed needs and how they provided appropriate care but the care plan did not show this and it needed to be updated. This will make sure that the persons plan of care shows accurately what care and support was needed and given by staff to keep them safe and comfortable. We saw that there is a large amount of specialised equipment such as electric beds and pressure relieving mattresses and a number of hoists in the home. Staff felt that they are always supplied with the best equipment to help them to care for people in the right way and to give the best care possible. People living in the home that we spoke with on the day of our visit told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. People told us that they were happy living at the home. Three people living at the home had completed our surveys and told us that the home and the staff, Provides good meals, keeps a stable staff, respects personal wishes. They also made suggestions including, Give more attention to the individual, Give better value for money. Two people indicated they,usually had enough staff available and 1 person felt they, always had enough staff available when they needed them. We received 4 surveys from relatives and people acting on behalf of people at the home. Their comments overall were very positive, including: The staff are very good and communicate with me about any concerns; We can enter the home at any time and have always been pleased with the cleanliness of the home; Consistency of care - staff team seem to be happy working there and therefore staff turnover is low and Communication is excellent and staff are friendly to visitors. Staff described how they support people to see health professionals such as their GP, speech therapist, opticians and dentists when needed. However the records and care plans did not always show how the staff plan for regular contact with these medical professionals to help to keep people healthy. Care Homes for Older People Page 14 of 32 Evidence: We received 1 survey from a health care professional, and 2 from staff who were mostly positive in their feedback and included comments such as, Good palliative care, good relationships with relatives and We have very good staff who do a good job. They also made suggestions including, make sure we are aware of things like MRSA and Im aware of the need for staff to keep up to date and to access training provided by the training officer. We looked at how the medicines are managed in the home. We checked a sample of the medication records. We could see that the local pharmacy had done a thorough audit of the medicines management in 2008 but there was no record of any internal audits being carried out. Regular audits would help to make sure that the medicines in the home continue to be well managed so that the people living there receive their medicines safely as prescribed by their doctors. Care Homes for Older People Page 15 of 32 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. A range of activities and good variety of meals are available so that people living at Mount Pleasant can keep active and enjoy a varied diet to keep them healthy. Evidence: People living at the home we spoke with on the day of our visit told us they were very happy at the home and felt they had various things to do. There were two notice boards in the home which helped to keep people up to date with various things such as menus and activities. On the day of our visit the activities organiser had arranged for members of the local library to visit Mount Pleasant to talk to people living there about their facilities and what they have to offer. People at Mount Pleasant were looking forward to Christmas and everyone talked about their plans, including the recent Christmas fair which everyone said was a great success. Some people helped on the stalls and a lot of people got involved. People felt that now they had their own activities organiser there was more for them to do. Activities available ranged from organised events such as painting and crafts to staff helping them with personal things such as helping them to read their letters and Christmas cards. There is a small quiet lounge at Mount Pleasant and staff told us this is used for mass each week as well as for relatives visiting so they have more privacy. Care Homes for Older People Page 16 of 32 Evidence: We saw in the care plans that we looked at that there was not always enough information about peoples social needs or how these could be met in the home. This should be reviewed to make sure this information is easily available to help plan activities that people would like to take part in. Not long before our visit, there had been a meeting for the people who live at Mount Pleasant to discuss the meals and the activities on offer. However, these meetings were not being held regularly and we recommend that they should be as they provide an opportunity for the people who live at the home to make suggestions for activities they would like to do. Staff we spoke with felt there had been improvements in organising activities for people living in the home and there was a lot more on offer now there was a full time activities organiser for the home. Staff said they would like to get involved more with activities especially trips out but didnt feel that their workload always enabled them to do that. The three completed surveys we were sent from people who live at Mount Pleasant showed that one person always felt they had enough activities and that two thought there were usually had enough activities available. Throughout our visit, we saw staff talking to people respectfully and treating them with dignity. Staff were seen knocking on doors before entering peoples rooms. We noted that some bedroom doors were left open and some people could be seen lying in bed. Staff said they left the doors open so they could keep a check on people. However, with visitors and staff walking past throughout the day, peoples privacy could be compromised and we have recommended that this practice be reviewed with each person whose bedroom door was being left open to check that this was acceptable to them. We looked at menus being used at the home. There are choices available and staff help people to choose their meals. Menus are displayed on the notice board so that people who live at the home and visitors know what choices are available each day. The chef said that snacks and special diets are also provided. The kitchen was well stocked and very organised. Various choices were available, including special diets, lots of home made pies, and lots of fresh fruit and vegetables with baskets of fruit seen available for everyone in the lounge area. In the surveys sent back to us from three people living at the home, people said they Care Homes for Older People Page 17 of 32 Evidence: usually liked the meals served at Mount Pleasant. Care Homes for Older People Page 18 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an effective complaints procedure for the home and staff have received training on safeguarding adults so people living at Mount Pleasant can be confident their concerns will be listened to and that they will be protected. Evidence: Overall the information we received in the three completed surveys people living at Mount Pleasant sent back to us told us that they knew how to raise complaints and concerns about the home. On the day of the visit, people we spoke with confirmed this and told us they are confident that the staff will deal with any concerns they may have. Relatives were also positive about the way staff at the home deal with concerns and told us, The staff are very good and communicate with me about any concerns. The information available about how the home works includes information about the complaints procedure. This tells people how to make a complaint and how these would be dealt with in the home. The manager told us there had been no complaints made during the twelve months before our visit and that if one was made, they would use the incident records to help record peoples comments and concerns. We discussed the benefits of regularly reviewing the management of complaints, concerns and grumbles with everyone at the home. The manager felt they never had complaints; however good record keeping would help to show how people are supported to openly express their views and what action has been taken to resolve any concerns they may have. Care Homes for Older People Page 19 of 32 Evidence: We spoke to some of the staff on duty on the day of our visit and they all had a good understanding about safeguarding adults. The training records showed all but one member of staff had been on safeguarding adults training so they would know how to recognise the signs of abuse and what they would have to do to protect the people living at the home. There had been one referral from the home to the local authority under safeguarding procedures in the twelve months before our visit. The manager explained how it had been managed and resolved. She agreed to review the outcome with the local authority and to keep us up to date with the agreed outcomes. The manager agreed that this referral would need to be recorded on their local incident reports so they have an accurate log of concerns and comments raised. Care Homes for Older People Page 20 of 32 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. Mount Pleasant is well maintained, with a continuing refurbishment programme, so that people living there do so in comfortable, attractive and safe surroundings that are equipped to meet their needs. Evidence: The home is set in its own extensive grounds and has very picturesque views overlooking fields and landscaped gardens. There is a team of two maintenance people for the home and they keep detailed records of how they manage the building and equipment, making sure that it is always safe with any necessary actions taken to reduce any risks. Their records showed regular checks on small appliances, water temperatures, and fire protection system checks. to make sure these were safe. These records and practices showed good management of the environment which helped to make sure that people have a comfortable and safe home to live and work in. We walked round the home during our visit and looked at a number of areas including all the communal spaces such as the lounges and dining room. We found a lovely homely atmosphere in the home and the building was well maintained. People living there told us they liked the home, that they were very comfortable and had everything they needed. Care Homes for Older People Page 21 of 32 Evidence: Everyone living at the home has their own bedroom which they can personalise as they choose to help to make it more homely. We looked at some of the bedrooms and saw they were all kept clean and tidy. Various rooms had evidence of lots of personal belongings such as pictures, ornaments and some personal furniture that people had brought with them when they moved into Mount Pleasant. This helped people to settle into their room and feel more comfortable with their personal belongings around them. Each bedroom had an ensuite toilet and there were several bathrooms and toilets throughout the home for people to use. People told us they enjoyed the facilities on offer bat Mount Pleasant. During our visit the hairdresser was visiting and working in the homes own hair dressing room which is fully equipped to meet everyones needs. Relatives made positive comments about the home including, We can enter the home at any time and have always been pleased with the cleanliness of the home. We noticed that some parts of the home were beginning to look worn, with some woodwork showing signs of scrapes and wear and tear on the first floor. These areas would benefit from re-decoration to match the high standards already achieved on the ground floor, following recent refurbishment. The manager told us there were plans for a major refurbishment programme for all areas of the home. Staff confirmed that this would involve painting and decorating all communal areas and bathrooms on the first floor. As this will have an impact on the people who live at the home, whilst the work is being done, we recommended that the refurbishment programme is discussed with them so they know what is going on and what to expect whilst the work is being carried out. As well as the redecoration of the first floor, the maintenance team has installed electric baths and completely refurbished these areas to a good standard. They were in the process of making a new wet room (shower room) to provide people with a choice of bathing or showering. Communal areas such as the dining room had also been extensively refurbished with new flooring and decor. The staff advised they would be getting new curtains, tables and chairs to complete the refurbishment of the dining room. The manager told us that the first floor and bathrooms would be included in the next phase of the refurbishment programme. The home has a laundry on the ground floor with a team of staff that are employed for Care Homes for Older People Page 22 of 32 Evidence: laundry duties. It is equipped with industrial style machines and was found to be very organised, clean and tidy. Care Homes for Older People Page 23 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet peoples care needs and staff receive a range of training to make sure they can provide good quality care for the people who live at Mount Pleasant. Evidence: The staff files we looked at showed us that before anyone starts work in the home a series of checks are carried out. These include obtaining a completed application form with employment history, two references and a Criminal Records Bureau disclosure. These checks help to ensure that staff are suitable and safe to work with the people living at Mount Pleasant. The managers training records showed evidence of a lot of regular mandatory training covering diverse topics including health and safety, food hygiene, fire safety training, moving and handling, and infection control. This training helps to ensure staff are aware of how to support people safely. Some of the records of staff training we saw showed some gaps and needed updating for a few staff. Over half of the staff working at the home have obtained a qualification in care called a national vocational qualification (NVQ) and there are plans in place for other staff to obtain this award. This is an example of good practice as it exceeds the basic standards which suggest that at least 50 per cent of workforces should have an NVQ Care Homes for Older People Page 24 of 32 Evidence: qualification or equivalent. These are nationally recognised qualifications for staff working in care and show they have been assessed as competent to provide good quality care. We met a lot of the staff on duty on the day of our visit and they told us that most of them had been working at the home for some time. Staff said they were very happy working at the home and felt they had a really good atmosphere. They all felt well supported and fully trained and were regularly offered training to help them do their job. Two staff sent us back completed surveys which were positive about the home and included the following comment: We have a very good staff who do a good job. One person suggested they needed more information on various infections such as MRSA. Some staff said they would like to do training on Parkinsons disease and dementia. We also received a completed survey from a health care professional who was positive about the home. The surveys we were sent from people living at the home identified that one person felt there were always enough staff on duty whilst two thought there were usually enough staff on duty. Staff made various comments and said that at the time of our visit, the staffing levels were good as they only had a few vacancies but at times the work could be demanding. Staff said they would love to be involved in supporting people socially but they felt they did not always have the time. The manager had devised a staffing rota which gave staff information about how many staff they can expect to be on duty each day based on the occupancy figures. Information about staffing levels should be accessible to people who live in the home so they know how the staffing levels are reviewed and managed. Care Homes for Older People Page 25 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mount Pleasant is well managed to make sure that it is a safe place to live and work and that it is run in the best interests of the people living there. Evidence: The registered manager for the home works with a management team consisting of an administrator and a general manager. The manager is a registered nurse and is experienced at running care services for older people. She has been the manager of Mount Pleasant for twelve years and knows the people who live there and the staff very well. The general manager provides her with support for non-clinical issues. The administrator told us that the home does not act as appointee for any of the people living there and peoples relatives or representatives manage their finances with or for them. This is an example of good practice and helps people to have individual choices as to how they manage their own personal money. We discussed the management of the activity fund raising account and the staff funds account. The general manager agreed to review these to ensure they have written policies in place Care Homes for Older People Page 26 of 32 Evidence: to show how they are managed. We looked at a sample of certificates and records which showed us that a series of health and safety checks are carried out on the building and equipment at Mount Pleasant to ensure the home is safe. These include regular checks of water temperatures, fire protection equipment, the gas and electrical installations. In addition, regular health and safety audits are carried out by the homes maintenance team, such as water temperatures and small electrical appliances. The manager ensures there are other checks such as regular reviewing of health and safety within the home, reports on falls, and monthly recorded checks done by the general manager. The general manager carries out monthly audits and reviews all of the information gathered by the registered manager. These records help to show that the home is very well managed and that consistently good standards are maintained throughout the year. The regular checks could also include medications, activities, meals, care plans and complaints. Surveys are carried out each year to obtain the views of the people living at the home and also include their relatives opinions. We saw a selection of the surveys that had been done most recently before our visit but the findings from them had not yet been summarised and the results had not yet been published and shared with people. These checks and surveys help to ensure that the home is being run to the satisfaction of the people who live there and their relatives. They can be used to quickly identify and resolve any problems or concerns that arise as well as helping plan future improvements. We discussed the benefits of making sure that people living at the home and their relatives have regular opportunities to express their opinions about the way the home is run. We saw a copy of the minutes of a meeting of senior staff but there was limited evidence of other regular meetings to include all staff, including domestic staff. Regular meetings for people who live at the home, their relatives/representatives and the staff home would help achieve better communication about the home, how it is running and planned improvements. We did not see any evidence of how staffing levels are decided and how these relate to the dependency and individual needs of the people living at the home. This should be in place to make sure that staffing levels are regularly reviewed so that there are enough staff on duty to meet the needs of the people living at the home. The records about staff supervision that we saw showed that staff receive supervision but not as frequently as the six times per year that the national minimum standards Care Homes for Older People Page 27 of 32 Evidence: recommend. Increasing the number of times staff receive formal one to one supervision would help to make sure they have opportunities to discuss their practice and development needs and receive guidance so they can continue to provide good quality care for the people living at Mount Pleasant. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 of 32 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 All care plans for the needs of people living at the home should be reviewed to make sure they are up to date and provide accurate information for staff to support people in the right way to meet their needs. The care plans should show how people and their families, as necessary, are involved in developing their own care plans so they reflect peoples preferences, and include relevant capacity assessments. Regular management audits should be carried out on the way the medicines are managed in the home to make sure they continue to be managed safely so that people living at Mount Pleasant receive their medicines as their doctors have prescribed. Information about peoples social needs and preferences should be recorded in their care files and ways of finding out their views about activities they would like to do, such as regular meetings and communication, should be found. This will help to make sure that peoples ideas and preferences are taken into account when planning future activities. The practice of keeping bedroom doors open when people Page 30 of 32 2 9 3 12 4 14 Care Homes for Older People 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 are in bed should be reviewed with each person whose door is usually kept open. This will help staff to take any necessary action to try to protect each persons privacy. 5 16 The procedures for recording complaints and concerns, both formal and informal, should be reviewed to make sure that all are recorded together with information about how they were resolved. The refurbishments being planned for the home, especially the communal areas and bathrooms, should be discussed with the people who live there so they can express their opinion, will know what is going on and what to expect whilst the necessary work is being done. Staffing levels should be kept under review to make sure that they reflect the dependency levels of the people who live at Mount Pleasant. Information about staffing levels should be available for people who live in the home so they know how these are reviewed and managed. Consideration should be given to extending the number of regular audits to help make sure that the records, including medication records and care plans, are being kept up to date and the home continues to be a safe place to live and work in. Consideration should be given to increasing the number of one to one supervision sessions for each member of staff to at least six times a year. This will give them more opportunity to discuss their practice and development needs and receive guidance to enable them to continue to provide good quality care for the people who live at Mount Pleasant. 6 19 7 27 8 33 9 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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