This inspection was carried out on the 2 December 2015 and was unannounced.
Mount Pleasant residential home is a privately owned residential care service located close to the rural village of Norley. The service is based over two floors and is registered to provide accommodation for up to 24 people who may require nursing or personal care. Local amenities are a short distance away from the service in the village. At the time of our inspection there were 21 people living at the service.
At the last inspection on 3 June 2015 we found that there were a number of improvements needed in relation to: management of medicines, staff support and training and notification of changes and significant incidents. We asked the registered provider to take action to make a number of improvements. After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by the 12 October 2015. However, whilst the registered provider has made some improvements, they had not fully met their own action plan. We found a number of breaches and continued breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. We also identified some additional concerns. You can see the action we have told the provider to take at the end of the report.
The service does not have a 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. Since our last visit the service now has a nominated individual.
The service has a manager in place who has recently applied for the registered manager’s position. We were informed during our visit that the manager had been unavailable at the service for a period of eight weeks. The registered provider had failed to ensure that sufficient measures had been implemented to ensure that important information was reviewed and actioned in the event of the manager being absent from the service.
People felt safe at the service and told us that staff were quick to respond to them if they needed help and support. Relatives informed us that staff kept them up to date with any concerns and they felt happy with the care people received. Prior to our inspection we had been informed of a safeguarding incident that occurred at the service since our last visit. The registered provider had failed to notify us of this concern.
The care plans, including risk assessments, did not always record people’s needs accurately. Records were not personalised to reflect people’s individual preferences about how they would like their care and support to be provided. Supplementary records including food and fluid charts were not always completed in detail to reflect what people had consumed on a daily basis. This meant that the registered provider was not able to safely protect people from the risks of dehydration and inadequate nutrition.
During our visit we found that sufficient checks were not made on pressure relieving equipment. Three people used pressure relieving mattresses and the appropriate assessments to establish the correct pressure levels required had not been completed. The manager informed us that checks on this equipment were not completed at the service.
Risks to people health and safety were not always identified by the service. Accidents and incidents were not monitored effectively. The registered provider did not undertake regular reviews to identify risks, patterns or changes to care needs. There were no actions identified to keep people safe from harm.
Water temperatures had not been monitored since July 2015 by the registered provider and thermometers were not in place in the bathrooms. The manager informed us that staff used their elbow to test the temperature of the water prior to people having a bath. We asked the registered provider to take immediate action to address this concern.
Pull cords for the call alarm systems were not in place in the bathrooms and a number of bedrooms at the service. Therefore, people were unable to raise an alarm in the event of an emergency to gain the attention of staff on duty.
People did not always receive their medication as prescribed. People’s medication administration records (MAR) had been appropriately signed when medication was given. Medication was stored in a safe and secure way. However, care plans for PRN (as required) medication were not in place for staff guidance. This meant that people could be administered more medication than required. The manager informed us that this would be reviewed immediately.
The registered provider had not undertaken supervision, appraisal or appropriate training with staff to ensure that they had the skills and knowledge required to support people. The lack of support and training available to staff could put people at risk from receiving unsafe care and support.
Staff showed a basic understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered provider did not have a policy and procedure in place with regards to the MCA. Staff practice showed that consent was sought from people prior to care and support being provided. Care plans did not reflect how people’s consent; ability to make specific decisions and decisions made in their best interests was considered.
The quality assurance system at the service was not effective and had not been completed since July 2015. Issues we found as part of our inspection had not been identified by the registered provider. Audits that had been completed prior to July 2015 did not identify any actions for improvement or timescales for completion. Quality assurance systems did not protect people from harm or unsafe care. Policies and procedures contained out of date information and did not reflect current practice, law and legislation. We saw that the manager had started to review these documents.
The mealtime experience promoted a positive experience for people. The dining room atmosphere was calm and relaxed and meals served were nutritious and well presented. Resident’s committee meetings had been introduced on a monthly basis to listen to the views of people regarding meals, activities and general feedback about the service.
Staff treated people with dignity and promoted choice and independence at all times. Staff knew people well and had a good knowledge of how people would prefer to be supported. Staff were kind, caring, patient and respectful of people’s privacy.
The registered provider had implemented safe systems for recruitment since our last visit. Appropriate checks had been completed with the Disclosure and Barring Service (DBS).
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 timeframe. If not enough improvement is made within this timeframe so that 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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 it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.