About the service: Mount Pleasant Care Home is a residential care home that provides personal care to 14 older people, some of whom were living with dementia.

People’s experience of using this service:

The service met characteristics of Good in all areas.

¿ People told us they felt safe and well cared for by staff who were kind and caring. We observed warm interactions and staff treated people with kindness and care. People were supported to express their views and given choice and control in their day to day lives.

¿ People were treated with dignity and respect. Staff spoke respectfully to people and showed a good awareness of people's individual needs and preferences.

¿ People were supported to take their medicines in a safe way. However, we saw when creams and liquid medicines were opened the dates were not always recorded to ensure they were discarded within the required time range. We made a recommendation to the provider about this.

¿ We received information leading up to our inspection about unsafe moving and handling techniques. Our inspection found this was unsubstantiated. We observed staff moving people in a safe way and as described in their care plans.

¿ People told us they felt safe living at the service. Systems were in place to promote people's safety and safeguarding procedures were followed.

¿ Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified.

¿ We received information leading up to our inspection that accidents and incidents were not being dealt with or recorded accurately. Our inspection found that this was unsubstantiated. Robust systems were in place to monitor and learn from incidents and accidents.

¿ People's care was personalised to their individual needs. Care plans and risk assessments were person-centred and reflected people’s likes and dislikes to ensure staff had the information they needed to provide responsive care.

¿ There was enough staff on duty at the right time to enable people to receive care in a timely way.

¿ There were procedures in place to ensure potential staff were suitable to work at the service.

¿ Staff received appropriate training and support to enable them to perform their roles effectively.

¿ People were supported by staff to maintain good nutrition and hydration. People were able to choose from food that was homemade and well presented.

¿ People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems at the service supported this practice.

¿ Staff worked well with external professionals to ensure people were supported to access health services and had their health care needs met.

¿ The service provided a variety of activities in line with people's interests and encouraged people's involvement.

¿ The environment was comfortable and was adapted to meet people's needs.

¿ The service had good management and leadership. The registered manager was visible working with the team, monitoring and supporting staff to ensure people received the care and support they needed.

¿ There were systems in place to monitor the quality and safety of the service being provided. People's views of the service were sought through surveys and informal chats. A complaints procedure was in place and people knew what to do if they had a concern of any kind.

Rating at last inspection: Good (Report published 29 October 2016)

Why we inspected: This inspection was brought forward in response to information of concern raised about the safety and management of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This unannounced inspection took place on 13 and 14 September 2016.

Mount Pleasant is a care home, registered to provide accommodation for up to 14 people needing personal care. People living at the home are older people, most of whom are living with dementia.

The home was spread across two floors. Some bedrooms were located on the ground floor but the majority were situated on the upper floor and accessed via stairs with a stair lift. The home had two double bedrooms. There were communal areas including a dining room and two lounge areas where people could sit. People had access to two pleasant outside decked areas with comfortable furniture in which to relax.

The home had a registered manager that was also the registered provider. 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 last inspected Mount Pleasant in August 2015. At that inspection we found the home was in breach of its legal requirements with regard to following recruitment processes and ensuring that people received the foods and fluid they needed. During this inspection in September 2016, we found the necessary improvements had been made.

Due to their health conditions and complex needs not all people were able to share their views about the service they received. Those that could speak with us told us care was provided with kindness and we observed that people's privacy and dignity was respected. People enjoyed living at Mount Pleasant and they considered it their home. People received care that enabled them to live their lives as they wished and people were supported to remain as independent as possible. Staff knew the people they were supporting well. Relatives we spoke with described the staff as very good and caring.

The home had a robust recruitment process in place. Appropriate checks were carried out before staff began working at the home to ensure they were fit to work with vulnerable adults. Staff had received appropriate induction, supervision, appraisal and training, which allowed them to fulfil their roles effectively and develop trusting relationships. Staff understood their roles and responsibilities and would seek people's consent before they provided any care or support. There were sufficient numbers of staff to support people safely and staffing levels were adjusted to meet people's changing needs and wishes.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. There were systems in place to protect people from abuse. There was an up to date safeguarding policy in place for staff to access with contact details for the local safeguarding adults team.

Staff respected people's rights to make their own decisions and choices about their care and treatment. People's permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well. Where people may need restrictions on their liberty and freedom in order to keep them safe applications had been made to the local authority to make sure people were not unlawfully restricted.

Staff were knowledgeable about people's needs and how to meet those needs and care records were detailed and accurately reflected the care people received. The care records showed the personalised care people required to help staff consistently meet people's needs and we saw staff followed these.

We saw care plan documentation contained risks assessments which covered areas such as pressure area care, moving and handling, nutrition and falls/mobility. Each risk assessment had a corresponding 'risk plan' which detailed contr

This inspection took place on 24 August 2015 and was unannounced.

Mount Pleasant is a care home, registered to provide accommodation for up to 14 people needing personal care. People living at the home are older people, most of whom are living with dementia.

The home has 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.

Staff did not always receive the support and training they needed to do their job, and staff recruitment procedures were not always robust enough to ensure people were protected. However, there were enough staff on duty to meet people’s needs. Staff were positive about their work supporting people living with dementia.

Food and fluid balance charts were not always being totalled or completed fully by staff. This meant that the home could not always be confident that people had received the food or fluid they needed to maintain their health. Staff told us that people had been given drinks throughout the day and we saw this in practice.

People were not always being protected from risks at the home. We identified concerns over a lack of some action plans to mitigate risks, and some risk assessments were out of date. Some audits were not in place or being carried out regularly. This meant that the home could not always assure themselves about the quality of the service provided.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. Applications had been made for Deprivation of Liberty Safeguards authorisations for people living at the home, and the home were awaiting the outcome. Staff were not always carrying out or recording ‘best interest’ assessments in accordance with the principles of the Mental Capacity Act 2005.

Staff understood their responsibilities with regard to safeguarding people, and told us they would act upon any concerns that they had. People were treated with respect and caring by staff, who understood their needs. Relatives told us they were able to visit the home and continue to provide care for their relation in partnership with the staff, which they found a huge comfort. There was a policy and procedure in place for dealing with any concerns or complaints. People we spoke with told us they felt able to raise any concerns with the registered manager or staff and be confident they would be dealt with fairly.

People had access to community healthcare services to meet their needs. Care plans were personalised and showed how people’s interests and information about previous lifestyle choices had been used to support and develop activities for them at the home. Medicines management systems were safe, and work was under way to improve the premises and further adapt it to make it suitable to meet the needs of people living with dementia. We have made a recommendation that the home seek advice on storage systems for some medicines.

The registered manager had involved people in having a say about how the service was operated and was involved in the daily delivery of care.

On the inspection it was seen that the service had a condition on their registration that was not appropriate to the care being delivered. The registered manager agreed to make an application to have this removed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

An inspection on 9 November 2012 identified that improvements were required in two areas. These areas were care worker's knowledge relating to the safeguarding of vulnerable adults and the organisation and completion of care records. The provider submitted an action plan after the inspection telling us how they would make the necessary improvements. During our inspection visit on 16 April 2013 we found that the provider had made improvements in both these areas.

People who used the service told us that they felt safe. Relatives of people who used the service told us that they felt their relatives were safe at Mount Pleasant. They expressed confidence in the home's ability to deal with concerns. Some people who were affected by dementia were not able to communicate with us but we observed that they appeared relaxed around staff. Staff had received up to date training in the safeguarding of vulnerable adults. They were able to identify types of abuse and how to report or escalate concerns.

Records were fit for purpose and contained information which supported safe care delivery. Improvements had been made in the organisation of records. This meant that information could be located promptly when required. Records were stored securely and retained appropriately in accordance with legal requirements.

The provider had effective systems for monitoring the quality of the service. They had responded to feedback and had an ongoing programme of improvements.

When we visited the home thirteen people were living there. People were affected by varying degrees of dementia. They were unable to talk to us in detail about their care. We observed staff interacting with people in a relaxed, friendly and respectful manner. Staff engaged in a range of social activities with groups and individuals.

We spoke with four relatives of people who lived at the home. They said that home met specific care needs well. One person told us "I have been here at all times of day and at night too. The care has always been very good". The relatives all commented that it was a friendly, welcoming home. They were involved in discussing changes to people's needs and to the care delivered.

People's care needs were assessed and instructions were given on how these should be met. Detailed records were made in relation to each person's care. However, some information was held in more than one record and not clearly organised. This meant that updated information might not be located quickly.

Staff were very positive about their work. They received a range of training to support them to deliver care. This included training in safeguarding vulnerable adults and recognising abuse. However, they did not always recognise when referrals should be made. This meant that people were not always protected from the risk of abuse.

The home had systems for quality assurance. We saw evidence that improvements had been identified and were being acted upon.