Archived: Mount Pleasant Care Home

Updated 21 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 9 October 2017 and was unannounced. The inspection was undertaken by two adult social care inspectors and an expert by experience. An expert by experience is a person who has experience of using or caring for someone who uses this type of service. Their area of expertise was in older people’s care.

Before the inspection we reviewed information held about the service including previous inspection reports and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spent time with 11 of the 13 people who lived at Mount Pleasant Care Home. We also received feedback from one representative of a person living at the service. Following the inspection we spoke with two external professional who had experience of the service.

We looked around the premises and observed care practices. We also spoke with the provider, office manager, four care staff and two staff responsible for preparing food. We looked at five records relating to the care of individuals, staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service.

Updated 21 December 2017

Mount Pleasant Care Home provides accommodation for up to 22 people who require care and support. The service mainly provides support for older people and people living with dementia. There were 13 people living at the service at the time of our inspection; this included 10 permanent residents and three people who were staying at the service for periods of respite care.

This was an unannounced inspection, carried out on 4 October and 9 October 2017. The service was last inspected in May 2017 when it was rated as ‘Requires Improvement’. The rating from this inspection is ‘Inadequate’.

There was a history of the service failing to meet the requirements of the Regulations of the Health and Social Care Act Regulations 2014.

There have been on-going concerns with the management of Mount Pleasant Care Home. The provider of the service is also the registered manager and at previous inspections we found the management arrangements and oversight of the service, had not ensured that people were being provided with quality care that met their needs. Enforcement was taken against the service in August 2016 and following this, a proposal to cancel the provider’s registration was made in January 2017 and the service was placed into Special Measures after a rating of Inadequate.

As part of the Commissions on-going monitoring process, CQC continued to inspect the service; with the knowledge that the service had been supported by Cornwall council’s service improvement team, we re-inspected in May 2017 and judged the service had made progress on the issues previously identified. In May 2017 the service was rated as Requires Improvement. As part of the service action plan, CQC received assurance from the provider that they intended to return to an active leadership role at the service.

Following this inspection it is clear that management oversight of the service has not been sustained.

Despite significant issues with the leadership of the service that had been highlighted over successive inspections, the provider had not prioritised the management of the service. The provider was not present at the beginning of the inspection and made it clear to inspectors that it was not convenient for her to attend the inspection due to another appointment. The importance of a management presence at the inspection was stressed to the provider who rearranged appointments to be available during the inspection.

Arrangements for managing the service were not effective. No-one working at the service could operate the computer system in the absence of the office manager. The provider was in breach of the Data Protection Act 1998 which is designed to protect personal data stored on computers or in a paper filing system, by permitting a person who was not employed by the service to access the computer system.

Staffing arrangements at the service had not ensured sufficient, competent and skilled staff were available at all times to meet people’s needs. Two staff were employed from 7am to 9pm each day to meet the needs of 13 people. Two people required two care staff to assist them with mobilising when being supported for personal care. This meant when the two staff on duty were helping one of these two people there were no staff available to support the remaining 12 people. People told us they did not feel staff had time to spend with them or always supported them in a timely fashion.

The service had experienced a high turnover in staff and had resorted to regular use of agency staff to cover shifts. The service relied on three senior staff and two care staff to cover all day time shifts and two night staff who shared the waking night shift between them. This meant the service did not have a consistent core staff group to work at the service. The office manager also helped with care shifts when necessary. We were told recruitment for new staff was on-going.

We had concerns about the level of competency and skills of staff available to meet people’s needs. For example, on one occasion there was no senior carer available and a recently employed member of staff and a member of agency staff were responsible for the care of 13 people. This included administering medicines, which neither staff member was trained to do.

During the inspection we had concerns about the conduct of a senior staff member concerning information they were supposed to have passed to management and other staff about the inspection. We discussed these concerns during the inspection feedback. However though the provider had serious concerns about this member of staff no disciplinary action had been taken.

There was no induction policy or process in place for temporary staff. Induction to the service for permanent staff was considered ineffective and did not provide staff with the knowledge of policies and procedures required to do their job. For example, staff told us they were not given time to familiarise themselves with people’s care plans and were expected to follow the lead of more experienced staff without the knowledge of the specific care plan and any associated risk assessments. Staff comments included “I don’t recall anything that could be called an induction really. I was straight into two shadow shifts. I wasn’t given an opportunity to read policies and procedures or to read people’s care plans. I’ve been told about people’s needs as I’ve gone along.”

Training was provided but was not always effective. For example, despite repeated reassurances from the provider, about making practical manual handling training available to staff, this had not been done. All other training was conducted using a social care television package. Staff commented, “They could do with more hands on training because e-training isn’t always effective.”

Recruitment processes were not robust. Records were disorganised and did not always contain necessary documentation such as a full employment history. One member of staff did not have recruitment records including relevant recruitment checks to evidence they were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks.

There were little meaningful activities available for people. People told us they were ‘bored stiff’ and we saw the majority of people stayed in their rooms with no social stimulation.

Three people had moved into the service for a period of respite care. One person had no care records available and a second person’s records reflected a previous respite stay; and were not up to date.

There was no evidence of capacity assessments or best interest discussions taking place for people who lacked capacity to make certain decisions for themselves. Systems for recording consent were not robust. It was not always clear when Lasting Power of Attorney (LPA) arrangements were in place. We saw records signed on behalf of people by relatives who did not have appropriate LPA authority to do so. Management did not have a clear understanding of the requirements of the Mental Capacity Act 2005.

Accidents and incidents that had taken place since the last inspection had not been audited to identify any patterns or trends. There was no record of specific action that had been taken to address any incidents. This meant the risk of re-occurrence was not reduced.

There were inadequate governance arrangements in place to monitor and assure the quality of the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this time frame, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures .

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.