We inspected this service on 14 November 2016. This was an unannounced inspection. At our previous inspection on the 27 May 2015 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. This was because risk assessments and care plans were not fully completed to guide staff on how to support people when they demonstrated behaviour that put themselves or others at risk. At this inspection, we found improvements had been made in this area, however further improvements were needed in other areas of the service. We saw that behaviour management plans were in place where needed. This provided staff with guidance on how to support people in a consistent way but staff had not been provided with training to support people who demonstrated behaviours that put themselves and others at risk. This had been recognised by the registered manager, who was in the process of organising training for the staff team.

The service was registered to provide accommodation for up to 50 people. The home specialises in caring for older people including people living with dementia. At the time of our inspection there were 34 people using the service.

The service had 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 felt safe with the staff that supported them and told us that the staff were available to them. Staff understood what constituted abuse or poor practice and systems were in place to protect people from the risk of harm. Medicines were managed safely and people were given their medicine as and when needed. The provider had undertaken thorough recruitment checks to ensure that as far as possible, they employed staff that were suitable to support people.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. Staff understood people’s needs and preferences and in most areas were provided with training and supervision, to support and develop their skills.

Staff gained people’s verbal consent before supporting them with any care tasks and helped them to make their own decisions when possible. Where people were unable to make decisions independently they were supported in their best interests and in accordance with the Mental Capacity Act.

People were supported to eat and drink what they liked. Where concerns were identified, people received support from health care professionals to ensure their well-being was maintained. Health concerns were monitored and people received specialist health care intervention when this was needed.

Staff were caring in their approach and supported people to maintain their dignity and privacy. People were supported to maintain relationships that were important to them and to take part in social activities. The provider sought people’s opinions to bring about change.

Quality monitoring checks were completed by the provider and registered manager and when needed action taken to make improvements. People knew how to complain and we saw when complaints were made these were responded to in line with the provider’s policy.

This inspection took place on 27 May 2015 and was unannounced.

Mount Pleasant is a care home that provides residential care for up to 50 people. The home specialises in caring for older people including those with people living with dementia. At the time of our inspection there were 46 people in residence.

A registered manager was 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. The registered manager was not at the home when we visited, so we spoke with the acting general manager who was deputising in their place.

People were happy and told us that they felt safe. Staff were able to explain how they kept people safe from abuse, and knew what external assistance there was to follow up and report suspected abuse. Staff were knowledgeable about their responsibilities and trained to look after people and protect them from harm and abuse.

Staff were recruited in accordance with the provider’s recruitment procedures that ensured staff were qualified and suitable to work at the home. We observed there to be sufficient staff available to meet people’s needs and worked in a co-ordinated manner.

Medicines were ordered, stored and administered safely.

Staff received an appropriate induction and ongoing training for their job role, and all could speak a range of English and Asian languages. Staff had access to people’s care records and were knowledgeable about people’s needs that were important to them.

Staff communicated people’s dietary needs appropriately, which protected them from the risk of losing weight. People’s care and support needs had been assessed and people were involved in the development of their plan of care. People told us they were satisfied with the care provided.

People were provided with a choice of meals that met their dietary needs. There were drinks and snacks available throughout the day and night. The catering staff were provided with up to date information about people’s dietary needs.

We noted that the food came out of the kitchen plated, so there was no opportunity for people to help themselves to vegetables and other accompaniments. Staff brought out gravy and asked people where they wanted it. We saw staff gave gentle prompting for people to eat throughout the meal and people used adapted cutlery and crockery that ensured they remained independent when eating.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives.

We observed staff speak to, and assist people in a kind, caring and compassionate way, and people told us that care workers were polite, respectful and protected their privacy. We saw that people’s dignity and privacy was respected which promoted their wellbeing.

Staff had a good understanding of people’s care needs, though some documents within the care plan document lacked detail and explanation. There was an overall inconsistency throughout the person centred care planning process, which lead to care planning not being consistent and different plans working in harmony.

People told us that they had developed good relationships with staff.

People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions.

People told us that they were able to pursue their hobbies and interests that was important to them. These included the opportunity to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff told us they had access to information about people’s care and support needs and what was important to people. Care staff were supported and trained to ensure their knowledge, skills and practice in the delivery of care was kept up to date. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.

Staff sought appropriate medical advice and support from health care professionals. Care plans included the changes to peoples care and treatment, and people attended routine health checks.

People were confident to raise any issues, concerns or to make complaints. People said they felt staff listened to them and responded promptly.

People who used the service and their visiting relatives spoke positively about the open culture and communication with the staff. We noted that the provider interacted politely with people and they responded well to him. When we spoke to the provider, it was clear he knew people and their relatives, by the way in which they conversed.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. Care staff understood their roles and responsibilities and knew how to access support. Staff had access to people’s care plans and received regular updates about people’s care needs.

There were effective systems in place for monitoring of the building and equipment which meant people lived in an environment which was regularly maintained. However the internal audits and monitoring of person centred planning did not reveal areas that were not fully detailed.

Staff were aware of the reporting procedure for faults and repairs and had access to external contractors for maintenance and to manage any emergency repairs.