Mount Pleasant House

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.

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.

There was a registered manager in post who was responsible for the day-to-day running of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 14 September 2017. In September 2017 we found people’s rights were not fully protected, because there were no assessments of capacity or best interest processes for people who required assistance with decision making.

People’s risk assessments lacked guidance for staff on addressing the identified risk. People had care records in place, but these contained limited personalised information. People’s care records contained limited guidance for staff on meeting their assessed needs. People had access to activities within the services, but these were basic and some people told us they felt bored. Monitoring systems had not identified the issues we found in relation to Mental Capacity Act compliance, records and activities.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

The registered manager had introduced formal systems to assess people's capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices. This meant the service was now meeting requirements of regulations.

Since the last inspection the registered manager had ensured all care plans had been reviewed and reflected the current needs of people using the service. Risk assessments were regularly reviewed with evidence of changes in people’s needs and how staff should respond to them.

The registered manager had reviewed and made changes to care records to ensure they were personalised to the individual and detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support.

Since the last inspection the registered manager had explored a range of activities which would support people’s recreational needs.

The registered manager had reviewed and updated monitoring systems to ensure quality and safety of the service was being reviewed.

Accidents and incidents were being reported and recorded as they occurred. These were audited to ensure any trends or patterns were evident and the service learned from them to make changes to mitigate risks to people.

People told us they were happy with the care they received and believed it was a safe environment. The atmosphere was calm and relaxed. People moved around the building choosing where to spend their time and who with. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, GP’s and physiotherapists.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. There was training available to all staff which met the diverse needs of people being supported. Staff were supported through formal and informal supervision.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s rights were not fully protected through the correct use of legal frameworks. We found that the service was not meeting the requirements of the Mental Capacity Act (MCA).We were told that some people lacked capacity to make certain decisions, however there were no mental capacity assessments for these people and not best interest processes. The provider had not submitted applications to the Supervisory Body for authorisations under the Deprivation of Liberty Safeguards (DoLS), despite people lacking capacity and not being free to leave. We noted there was no policy on the MCA or DoLS.

People’s records contained minimal personalised information. For example, information about their background, history, likes or dislikes. Although records identified areas where people were considered to be at risk or needing support, there was minimal, guidance for staff on what action to take to minimise risks or meet people’s assessed needs. Care records contained some terminology which was not respectful.

People had access to activities within the service, however these were fairly basic, such as dominos, bingo and films. Some people told us they were bored and would like more to do. We observed a group of people waiting for a staff member who was scheduled to play a game of dominos with them. They were keen to participate and clearly enjoyed the activity. We have made a recommendation about this in the report.

The registered manager undertook a series of checks and audits to monitor the quality of the service. Whilst they had been effective in some areas, they had not identified the concerns we found in relation to records, activities and compliance with the MCA.

People and their relatives told us the service was safe. People were supported by staff who understood how to recognise and report any signs of suspected abuse or mistreatment. Staff had been safely recruited, and had undergone checks to help ensure they were suitable to work with people who were vulnerable. During the inspection, we observed suitable staffing levels. This meant staff were available to meet people’s needs in an unhurried way. People had their medicines as prescribed and on time.

People were supported by staff who had undergone training to help ensure they could meet their needs effectively. Staff were supported by an induction process which including shadowing more experienced staff. All staff were supported by an ongoing programme of supervision as well as an annual appraisal.

People and their relatives told us the staff were kind. We witnessed positive, caring interactions between people and staff. Staff spoke about the people they supported with fondness and affection. People’s dignity was protected by staff who were respectful and compassionate. The atmosphere at the service was pleasant and relaxed and people appeared comfortable and at ease. People’s confidential information was securely stored.

People’s health care needs were effectively managed and monitored at the service. There were suitable numbers of staff on duty to provide care. If people became unwell, the service made prompt referrals to doctors or specialists. People had access to a range of health and social care professionals including social workers, chiropodists and district nurses.

People told us they enjoyed the food. Meals appeared plentiful and people were offered a range of alternatives. Special dietary requirements were catered for. Relatives were made welcome at the service. People were encouraged to maintain relationships with those who mattered to them and there were no restrictions on visiting times.

The registered manager promoted an ethos of openness and transparency. The registered manager operated a cycle of quality assurance surveys and the results were analysed to help drive improvement. Feedback was sought through a range of forums including residents’ and relatives’ meetings.

You can see what action we told the provider to take at the back of the full version of the report.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff demonstrated a good knowledge of the care needs of the people that lived at the home.

People were protected from abuse by staff who were knowledgeable about this area.

We saw that medication practices were followed to a good standard. Medication administration was conducted according to policies and was stored correctly.

Staff stated they felt supported by the manager and we saw there was an effective system in place to ensure the staff were supported, trained and recruited in a robust and professional manner.

Records required by regulation had been completed and were accessible to staff. They were securely stored.

Staff demonstrated a good knowledge of the care needs of the people that lived at the home.

People were protected from abuse by staff that were knowledgeable about this area.

The home was clean and maintaned. We saw that records regarding the Control of Substances Hazardous to Health (COSHH) required updating.

Staff stated they felt supported by the manager and we saw there was an effective system in place to ensure that the staff were supported.

The manager had sought the views of people that lived in the home and visitors to ensure the quality of service had been maintained.