Archived: Mount Pleasant Care Home

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.

We carried out this unannounced inspection of Mount Pleasant Care Home on 30 May 2017. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection of 7 and 8 December 2016 when the service was rated as inadequate. At this time seven breaches of regulations were found overall.

The services was put into Special Measures because we judged people were at risk from harm because the provider's actions did not sufficiently address the on-going failings in the service and we had found there was insufficient management oversight regarding how the service was run.

The registered manager was also the provider and had worked in this role for many years. 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 and associated Regulations about how the service is run.

At this inspection we found the registered manager had re-established themselves in more direct day to day control of the service. Work had been carried out in conjunction with Cornwall Council’s quality assurance team to address the concerns highlighted from the last inspection. An action plan had highlighted areas for improvement and progress had been made with this although there remained areas that required further work.

At this inspection, we had concerns about some aspects of how the service was operating. For example, in the morning we found two pots of paint stripper and a scraper with a razor blade attachment had been left unattended on a garden table. As people were free to access this area, this posed a risk to people’s safety. We also saw a boiler room door with a clear sign stating it should be kept locked. This was left open and unlocked throughout the day. Staff were unaware of these two potential hazards. We have made a recommendation regarding making sure the premises is kept safe from potential hazards.

Medication administration was safe and but some records (MAR) had not been appropriately completed and medication audits were not being completed.

The service had sufficient capable staff on duty to meet the needs of the people that used the home. People commented that they were attended to in a timely way. Comments included, "They always make sure my call bell is within reach”, "Nothing is too much trouble for the staff” and "It's just a lovely, quiet, warm atmosphere around the home."

Care planning processes had been improved. Care plans and risk assessments had been re-written for everyone supported by the service. However, we found that diabetes care management plans remained vague and unclear with no clear guidance for staff about appropriate dietary options for people with this condition. We have made a recommendation about the management of long-term conditions.

There was little evidence that people had begun to be involved in the process and review of their care planning. We observed that staff always verbally checked that people consented to care and support before providing this. However, there was no documentation in place to evidence that the service were working in line with the Mental Capacity Act (2005). People were not supported to have maximum choice and control of their lives; the policies and systems in the service do not support this practice.

The three most recent staff employed did not have records of a formal induction and the Care Certificate, or any equivalent process, was not implemented by the service. Staff confirmed there were limited induction processes in place.

Staff training was not up to date for all staff for first aid and fire training. We found no evidence of practical manual handling training. Staff confirmed they were shown by a senior staff member how to use equipment such as hoists.

A formalised system to provide staff with regular supervision had been implemented. At the time of inspection there was no evidence of recent staff appraisal procedures. Staff confirmed they had not received appraisals but had begun to receive supervision. This was not consistently being recorded.

The premises and the general environment were maintained to a good standard. Fire extinguishers and smoke detectors were located throughout the building. Equipment such as wheelchairs were appropriately maintained and wheelchairs previously identified as missing foot rests had been replaced.

There were no malodours present. New carpets in communal areas and some bedrooms had been replaced.

We found water temperature records were not routinely being recorded for baths and only one bath thermometer was in use across two bathrooms.

There were a limited amount of activities offered to people who lived at Mount Pleasant. The service user guide stated that people would be offered ‘a wide range of leisure activities to enable each resident to express themselves as a unique individual’. There was no evidence that this was occurring. The service provided some structured activities to people such as weekly armchair exercises and skittles. People told us there were few activities offered on a regular basis. Comments included, "There's not much activities going on" and "I sleep a lot because there's nothing much to do". People told us they enjoyed watching television, reading, crosswords and word searches.

We found little understanding from staff about what meaningful activities might be for a person living with dementia. The service had a number of people living with dementia who were unable to regularly engage in the few activities offered. We observed little social interaction for people who were unable or chose not to leave their rooms. The service did not support people to attend activities outside of the service.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

The inspection report and findings were published in March 2016 and the provider has a legal requirement to display the ratings of the report for the public to see no later than 21 calendar days after it has been published on CQC’s website. The provider failed to do this. We were told by the provider that they were aware of this requirement.

After the January 2016 comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook a second two day comprehensive inspection on 27 and 28 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements. Prior to this inspection we received information of concern about medication handling practices at the service.

This report covers our findings in relation to the topics outlined above and a full report on all key lines of enquiry completed during this inspection.

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 18 people living at the service at the time of our inspection.

The registered manager is also the provider and has worked in this role for many years. 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 and associated Regulations about how the service is run.

Prior to our inspection on the 28 January 2016, we had been notified that the provider had taken a three month leave of absence from the position. At the inspection on 27 and 28 July 2016 we were informed that the provider/registered manager had not returned to the post. The service was being managed by the Head of Care. CQC did not receive a notification regarding an extended absence of the registered manager from the expiry of the last notification in June 2016. Significant periods of absence from a service must be notified, reviewed and a proposed date for return or alternative and acceptable management arrangements put into place.

CQC had received an action plan outlining the action the service would take to improve the areas identified at the inspection on 28 January 2016. During this inspection we found the provider had failed to undertake most of the identified actions, which they had confirmed in writing as being completed.

Prior to this inspection CQC had received information of concern regarding the service’s ability to provide appropriate pain relief to a person living at Mount Pleasant. This had resulted in a safeguarding referral to the Local Authority being made by CQC. The service had not followed their own policy regarding when incidents should be reported to the local authority as safeguarding and also failed to notify CQC regarding the incident.

During this inspection we looked at how the service managed medicines and the arrangements for providing appropriate medicines during the night. We found allegations that staff could not access required medicines for pain relief for one person, following an event when paramedics requested that pain relief be made available, were substantiated. This was because night-staff were prevented from accessing people’s medicines which were locked in the office. Staff were unaware of the procedure for accessing medicines by contacting a senior member of staff when required.

We found there was a system in place to order, store, administer and dispose of people’s medicines. However, the service did not have a system to record and handle medicine errors and there was no medicines auditing systems to ensure accuracy. On two occasions, staff found administered medicines, which had not been taken, in a person’s possession. Staff, who worked overnight at the service and were responsible for people’s care, had not received medicines training while working at Mount Pleasant Care Home and did not have access to medicines when they were required. Medicines records did not follow best practice advice and were without photographic ID to aid staff in identifying medicines were administered to the correct person.

Amendments to medicine records did not follow best practice guidance to ensure changes were witnessed by two members of staff and signed to evidence this.

We found risk assessments and personal emergency evacuation plans (PEEP’S) had not been completed. Where risk assessments were in place they were not updated when people’s needs and capabilities changed. We found fire doors where the alarm had been switched off and could be easily opened to access the outdoors. Staff confirmed that people who did not have the mental capacity to keep themselves safe, had been able to use the fire door to go outside unsupported by staff. There was no risk assessment to keep people who were independently mobile and living with dementia safe from leaving the premises unseen. The provider refused to re-alarm the doors stating that it would restrict the movement of staff and others from easily accessing the outside.

People’s needs were not always assessed and care plans did not give enough guidance to staff on how people wanted to be supported. People and their relatives were not routinely involved in on-going reviews of their care.

The provider, management and staff did not have a good understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and were not knowledgeable about the requirements of the legislation. This meant people did not have their capacity to make decisions appropriately assessed or receive the legal protections offered by the Deprivation of Liberty Safeguards.

The service did not have a functioning quality assurance system. This meant the service were not sufficiently robust in detecting when people’s needs had changed. Care plans were not in existence for some people and where they were they were in need of updating and inconsistent in the information they provided. The service did not use audit processes to check that procedures were carried out consistently and to a good standard. This was evident in the care planning and review process and in medicines management.

The culture of the service was essentially caring and it was clear staff were committed to providing good care. However, staffing levels were relatively low and there was not always time for staff to do more than basic care for people.

The service was not personalised to the individual and did not encourage people to make choices about their lives. For example, although there was no longer a ‘bath rota’ in place as seen at the last inspection, instead staff were told by senior staff who would need a bath that day. People’s personal care, particularly toileting was done on a time rota rather than when people chose to go to the bathroom. We were told this was due to time constraints and the limited number of staff on duty to support such choice.

The service did not provide staff supervision or appraisal to support staff. We found significant gaps in staff training, including infection control and medicines management. Management said this was due to insufficient funds having been available to provide required training.

Over the course of the two day inspection, there was a calm and friendly atmosphere in the service. It was clear staff were busy but they took the time to encourage people to independently walk around areas of the building and interacted with people in a caring and respectful manner. People and their relatives who we spoke with said they were happy with the service.

Relatives and visitors were made welcome. A relative said, “We are always made very welcome when we come. The staff are lovely and my [relative] has told us they are happy here, so what more can you ask for?” People had opportunities to take part in a range of social activities, such as armchair exercises and religious services. However, we found little understanding from management about what meaningful activities might be for a person living with dementia. The service had a number of people living with dementia who were unable to regularly engage in the activities offered.

Work had been completed to repair the entrance porch, which had been in a poor state of repair at the last inspection. Cleaning schedules had been developed, to ensure consistent standards of cleanliness at the service. However, the cleaning schedules had not been used. We found poor standards of cleanliness in the kitchen. Throughout the rest of the service we found a generally good standard of cleanliness. People’s rooms were personalised and decorated to suit their needs.

There was a complaints procedure in place and the provider had responded appropriately to complaints.

During the inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009 (Part 4) People were at risk from harm because the provider’s actions did not sufficiently address the on-going

The registered manager is also the provider and has worked in this role for many years. 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Mount Pleasant Care Home on 7 and 8 December 2016. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection of 27 and 28 July 2016.

Following the inspection in July 2016 it was agreed that the provider would take a more active role as the registered manager at the service. Prior to July 2016 the provider had taken a leave of absence from the position of registered manager. This period of absence had extended from January 2016 until the July 2016 inspection. CQC did not agree that the alternative management arrangements put in place for the first six months of 2016 had been adequate. During this inspection we were told the provider was still not working as an active registered manager.

The Head of Care for the service, who had taken the role of deputy manager during the provider’s absence, had stepped down from this role following the July 2016 inspection. The provider had requested a member of care staff support the service with a review and updating of certain processes at the service. This arrangement ended in November 2016. The service did not have adequate management arrangements in place for the period from the January 2016 through to the December 2016 inspection and the CQC continues not to have been informed of suitable management arrangements being put in place. This meant that in the absence of the provider, there was no clear management accountability for how the service was run.

During this inspection we found the provider had failed to undertake most of the identified actions required from our previous inspections in order to become compliant with the breaches of regulations identified in July 2016.

The service did not have enough staff on duty to meet the needs of the people that used the home. There were periods when there were not enough staff on duty to meet the needs of all of the people at the same time. People commented that they at times had to wait long periods for a staff member to be available to meet their needs.

The role of activities coordinator had not been filled when the last coordinator left the post. There was little structured activity being supported in the home and people commented on the lack of stimulation. The activity that was supplied was not chosen by people according to their interests. We found little understanding from staff about what meaningful activities might be for a person living with dementia. The service had a number of people living with dementia who were unable to regularly engage in the few activities offered. The service did not have enough staff available to support people to go out of the home.

Premises and equipment were not appropriately maintained. For example we found wheelchairs were being used without foot rests because the footrests had gone missing and one of two ovens used to cook all the meals was broken. The carpets in the service were heavily worn, stained and were in an unacceptable condition. Staff were unclear about when repair and replacement of these fittings and equipment would take place and the provider was not available to tell us when repairs and replacement would happen.

The provider has overall responsibility for the quality of management in the service and the delivery of care to people using the service. The provider has repeatedly not achieved this at Mount Pleasant Care Home and has been rated as Requires Improvement at both of the inspections carried out in July 2016 and January 2016. At the inspection in July 2016 we had serious concerns about the lack of adequate management of the service and the well-led section was rated as Inadequate. At each inspection there have been breaches of the regulations and we issued two Warning Notices after the inspection in July 2016.

At the inspection in July 2016, we had concerns about the management of medicines. At this inspection we found continued concerns about how the service managed medicines. We found not all staff who worked over-night at the service had received appropriate training and assessment to administer medicines safely.

Medication administration records had been amended without written authorisation from a medical professional (MAR) and safe recording practices, such as double signing hand written entries as an accuracy check, had not been followed.

We found a stock of controlled drugs (CD) had been received into the service but had not been recorded into the CD record log. This meant requirements for handling CD drugs were not being adhered to. There was a medicines audit system in place; however, this had failed to pick up errors and omissions in medicines management.

At the inspection in July 2016, we found management were not operating a supervision or appraisal system to support staff; and there were no staff meetings or opportunities for the staff team to meet together to discuss working practices at the service. During this inspection we found the situation remained the same. No action had been taken to begin a formalised staff support system.

At the inspection in July 2016 we found the service was not operating an effective quality assurance process to regularly assess and monitor the quality of service people received. At this inspection we found some action had been taken to gather people’s views of the service. However, no appropriate action had been taken to assure every person had an up to date care plan or monitor errors on medicine administration records. This meant there continued to be an ineffective quality assurance system in operation at the service.

At this inspection we found the service did not have robust records and data management systems. This was identified as a concern at inspections in July 2016 and January 2016. This extended to multiple areas of the running of the service including risk assessments, care planning, medicines management recording, infection control recording and the lack of quality assurance recording. This meant the service could not evidence that good practice was followed.

Five people who lived at the service did not have a care plan in place. This meant people did not have documented, individualised plans of care designed to meet their specific needs. Care plans are a means of communicating and organising the actions of the staff team. Other care plans were found to be in need of review and did not reflect the current needs of the people they were about. Four care plans, including risk assessments had been rewritten. However, where risk assessments were in place they were not updated when people’s needs and capabilities changed. People’s needs were not always assessed and care plans did not give enough guidance to staff about how people wanted to be supported. People and their relatives were not routinely involved in on-going reviews of their care.

The service was not operating a safe and robust recruitment system. For example we found one staff member had begun working at the service without any references being taken to verify they were of good character. This meant the provider could not be assured new employees were appropriate to begin working in the care sector.

During the inspection we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider’s actions did not sufficiently address the on-going failings in the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.

On the day of the inspection there were 19 people living at Mount Pleasant Care Home. The service was last inspected in September 2014 when the service was meeting the regulations inspected.

Services are required to have a registered manager and at the time of our inspection the owner of the service was also the registered manager. 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. The service manager had submitted a notice to the CQC that the registered manager would take a leave of absence from the service for three months. Management arrangements during this time were the responsibility of the office manager.

Risk assessments and personal emergency evacuation plans (PEEP’s) were not always updated when people’s needs and capabilities had changed. People’s needs were not always assessed and their care plans did not give enough guidance to staff on how people wanted to be supported. People and their relatives were not routinely involved in the on-going reviews of their care.

Premises were not properly maintained. The front porch, which was also the main entrance to the service, was damp and had black mould patches on the walls and ceiling. Cleaning of equipment such as manual handling equipment was not routinely carried out. People’s rooms were personalised and decorated to suit their needs.

Appropriate systems were in place to order, store, administer and dispose of people’s medicines. However, there was no system in place to record medicine errors. There was no medicines auditing used to ensure processes were accurate and following best practice. Not every staff member who administered medicines had been fully trained in safe medicines administration.

Staff and management did not have a good understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and were not knowledgeable about the requirements of the legislation. This meant people did not have their capacity to make decisions appropriately assessed or receive the legal protections offered by the Deprivation of Liberty Safeguards.

The quality assurance management systems were not sufficiently robust in detecting when people’s needs had changed and care plans were in need of updating. The service did not use audit processes to check that procedures were carried out consistently and to a good standard. This was evident in equipment cleaning processes and in medicines management.

While the culture of the service was essentially caring it was not always personalised to the individual and did not encourage people to make choices about their lives. People were not always treated with dignity and respect when choosing how independent they wanted to be while living at the service. For example, people were discouraged from having a key to their room. People could not choose when to have a bath as there was a rota in place for people to have a bath once a week. People’s dignity was not respected because communal net underwear was used.

On the day of our inspection there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. One person said, “It’s good as far as I am concerned. Staff are very ready to help you when you need it and there is always a nice atmosphere.” A relative said, “Staff are very helpful and friendly.”

Relatives and visitors were made welcome. A relative said, “The staff are all so friendly, lovely and helpful. We pop in whenever we want and they’re always very welcoming.” People had opportunities to take part in a range of social activities offered at the service. There was a complaints procedure in place and the provider had responded appropriately to complaints.

Staff employed at the service were familiar with the safeguarding and whistleblowing procedures. There were sufficient numbers of staff available to meet people’s care and support needs. Recruitment processes for care staff were robust. However, checks were not completed for volunteers working in the service.

People told us they thought the staff had the right skills and knowledge to meet their care needs. The service provided regular supervision and an appraisal system to support staff. This did not extend to senior staff such as the office manager and deputy manager in charge of care, who did not receive supervision.

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

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, on the day of the inspection we judged the service was safe.

People we spoke with were generally positive about the staff who worked with them. People told us staff were caring and supportive. For example people said staff were 'nice,' 'they are very good here', 'do a great job, they do it well,' and'very attentive'.

We inspected the staff training and supervision records. We saw staff training was up to date and staff received regular supervision and appraisal to ensure they were competent and supported in their roles.

Records were generally to a satisfactory standard. Care plans were appropriate and there was evidence of review.

Is the service effective?

Yes, on the day of the inspection we judged the service was effective.

People who used the service all had an individual care plan which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

People said staff met their needs and responded promptly when people needed assistance. People had access to relevant professionals such as doctors, district nurses, chiropodists and opticians when required.

Is the service caring?

Yes, overall, on the day of the inspection we judged the service was caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were generally taken into account and respected.

People who used the service said staff were caring and professional. One person told us, 'The staff are lovely. This is a good little place'.

Is the service responsive?

Yes, overall, on the day of the inspection we judged the service was responsive.

People we spoke with said staff treated them with respect and dignity. The care practice we observed, on the day of the inspection, was professional and supportive. Comments we received from people who used the service included 'They are lovely here. I don't have a great ability to get about much anymore but the staff are lovely and pop in and out and if I need anyone in a hurry I just press my buzzer and they're here quickly'.

There were limited activities available to people who lived at the home. People had mixed opinions of the effect of this. Some people were satisfied while others commented there was not much to do and they would like more opportunity to participate in activities in the home and in the community.

Is the service well-led?

Yes, on the day of the inspection we judged the service was well led.

The registered provider was also the registered manager and worked in the home. Although unavailable on the day we inspected, we did speak with the office manager and three care staff who told us they believed the home was well led. One staff member told us, 'We run a tight ship here. We care about the residents and want the best for them. We do our best and people are generally happy. If they aren't happy we encourage people to tell us and we try to sort out any problems'.

Staff told us and we saw documentary evidence that monthly care staff meetings took place to allow staff to discuss areas pertinent to their work.

We found there were suitable arrangements in place for obtaining, and acting in accordance with, the consent of people who lived at Mount Pleasant Care Home in relation to the care and treatment provided for them.

The atmosphere in the home was warm and welcoming and there was a sense of fun. We saw in the way people interacted with each other and with staff that people felt involved and safe at Mount Pleasant.

We saw there was appropriate referral and care planning documentation used at the home in respect of people who lived at Mount Pleasant. The care plan format may not have been structured in an easily accessible way.

Mount Pleasant Care Home operated effective systems designed to assess the risk of and to prevent, detect and control the spread of infection.

People who lived at the home were safe and their health and welfare needs were met by staff that had been appropriately recruited and were appropriately qualified, skilled, experienced and of good character.

We arrived at the home at 5pm and spoke with nine people who used the service. People told us they were satisfied with the care they received and that staff were kind and helpful.

We found the home was warm in the communal areas and bedrooms.

We talked with people who used the service and with three members of staff. No one raised any concerns to us about the levels of staffing. One person said sometimes they had to wait for staff to be able to come and help them as the staff may have been busy elsewhere but this person confirmed to us they did not feel they had to wait too long.