Mount Pleasant House

Updated 1 July 2023

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Mount Pleasant is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spent time observing their interactions between people and with supporting staff. We spoke with 7 people who used the service about their experience of the care provided. We spoke with 6 members of staff. This included the newly appointed manager, provider, care staff and auxiliary staff.

We reviewed a range of records. This included four people’s care records, and medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection visit, we spoke with 5 relatives. We also spoke with 2 staff members regarding their experience of working at Mount Pleasant.

Updated 1 July 2023

Mount Pleasant is a care home which provides care and support for up to 19 predominantly older people. At the time of this inspection there were 18 people living at the service.

The service is a detached property in its own grounds. It has two floors with access to the upper floor via stairs, chair lift or a passenger lift. Seventeen rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges and an open plan dining room with seating areas. There is a rear garden and patio area with seating.

People’s experience of using this service and what we found

The inspection was prompted following concerns we received about the changes of management of the service and the impact on the care people received. At the time of the inspection, the manager had been in post for a month and was not registered with the Care Quality Commission (CQC). The manager had submitted their application with CQC but had agreed to defer it whilst they gained further experience at the service.

There had been a number of manager changes over the last 2 years at the service. Feedback from staff, and from the review of records and care documentation evidenced there was poor oversight of the service which was affecting aspects of the operation of the service. Audits to oversee the service were not always fully effective in identifying areas for improvement.

Relatives were also concerned about the impact of the management changes on the service. Relatives commented “The day-to-day care of my mother has generally remained good however due to the frequent changes in manager I feel there has been a lack of continuity.”

Care plans and risk assessments had been reviewed but when peoples care needs had changed, they were not always updated promptly on the person’s care plan or risk assessment. This could lead to people receiving inconsistent care.

Some people could find it difficult to express themselves or manage their emotions. This could lead to distressed behaviour which could put them, or others at risk. People's care plans did not always inform, direct or guide staff in the actions to take when people were becoming anxious and how to support them. As staff had no guidance when a person became anxious, this meant that there was no consistent understanding or approach in how to support people.

The medicines system was not robust. The recording of medicines received at the service and administered were not consistently completed. This could lead to potential errors. Some people were prescribed medicines to be taken when required, there was a lack of guidance when this medicine should be administered. Staff did not record the reason for giving a when required medicine or whether it was effective.

Staff told us there were not enough staff on duty to undertake all duties. The provider did not have a dependency tool to calculate the staffing levels needed to support people’s care needs. However people told us that staff responded in a timely manner when they called for assistance.

People using the service and their relatives told us they felt they were cared for by the core staff team who were skilled, caring and respectful. We observed many kind and caring interactions between staff and people. Staff spent time chatting with people and knew the people they supported well.

Due to the changes in leadership this had impacted on the level of staff support and some training.

The provider had effective safeguarding systems in place and all staff had a good understanding of what to do to help ensure people were protected from the risk of harm or abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The food provided by the service was enjoyed by people.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately

Staff were motivated and fully focused on ensuring people's needs were met.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Good (published 29 November 2018).

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the lack of leadership and oversight of the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We found 2 breaches of regulation in relation to staffing, medicines and lack of leadership and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.