This inspection was carried out on the 1 and 2 August 2018 and was unannounced on the first day and announced on the second day.

Mount Pleasant nursing home is set in its own grounds and is located in the rural community of Allostock, Knutsford. The home supports 40 older people who require personal and nursing care in the main building. Since our last inspection the registered provider has built a ten-bedded annexe for people living with dementia called Scowcroft. At the time of our inspection there were 10 people living in Scowcroft and 38 people living in the main building.

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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good. The service is rated Good as it met all the requirements of the fundamental standards.

People, relatives, staff and healthcare professionals spoke positively about the staff and management team. They described feeling safe living at the home and being supported by kind and caring staff.

Recruitment systems at the home were safe. All staff had completed an induction as well as mandatory training in accordance with best practice guidelines. Staff were supported by the management team through supervision and appraisal. Staff told us that they felt well supported.

Safeguarding policies and procedures were in place and staff were familiar with these. Staff had received training and were able to describe what abuse may look like and felt confident to raise any concerns and thought these would be listened to.

People had their needs assessed before they moved into the home and this information was used to create individual care plans that included clear guidance for staff to meet people's needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

Staff had developed good relationships with people who lived at the home. People told us their privacy was respected and their independence was promoted. We observed positive interactions between staff and people living at the home throughout our inspection.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. The registered provider had medicines policies and procedures in place. Medicines records were accurately completed.

People's food and drinks needs were met and clear guidance was in place for staff to follow to meet people's specific dietary needs.

People living at the home had opportunities to engage in activities of their choice and the management team had developed relationships with organisations within the local community.

The home had dementia-friendly adaptations in place to stimulate the environments of people living with dementia. The home was clean and had all required health and safety checks and documentation in place. Equipment was regularly serviced and individual emergency evacuation plans are in place the people.

Audit systems were in place and were consistently completed. Where areas for development and improvement had been identified, action plans were created and completed. Accidents and incidents were analysed to identify trends and patterns within the home.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken training and demonstrated a basic understanding of this. The registered provider had made appropriate applications for the Deprivation of Liberty

We spoke with all the people who lived at Mount Pleasant as well as their family and friends who visited during the day. Comments included:

"I am very settled here"

"This is a very, very very good home"

"My relative always seems happy and well cared for"

"They get it right 90 per cent of the time"

"I love my job"

"The manager is experienced"

"The team is very well organised"

We were able to observe how the people living at Mount Pleasant were supported during our visit. People were assisted in a safe and dignified manner. Staff interactions with individuals were noted to be always courteous and friendly with an emphasis on determining what individuals wanted. We were able to look at activities within the service and noted that many individual activities had been determined as well as regular group outings to places of interest. There was an emphasis on the spiritual needs of people with representatives of a local church visiting on a regular basis.

We spoke to five people who lived at the home. They told us before any care or treatment was undertaken they were asked for their consent. We saw evidence that where a person lacked the capacity to make a decision, decisions were made with the involvement of people's relatives.

People said they were well looked after and staff treated them kindly and with respect. They said:

“its very, very good”

“staff are very good”

“such a nice place”

“very good, if I need anything”

We looked at three care records. Care plan and risk assessments were personalised to the individual and gave simple instructions to staff on how to care for each person who lived at the home. Daily records of people's care showed that people had received the care and support they needed.

People using the service were protected from abuse. Staff were able to identify signs of abuse and understood their personal responsibility to report it. Training in safeguarding was up to date.

Systems were in place for staff appraisal and supervision. We reviewed appraisal and supervision records and found not all staff had received regular supervision. Staff we spoke to however, said they had felt supported in their job role to deliver good quality care. Staff benefitted from an annual training programme based on the needs of the people who lived at the home.

Some care records and policies were incomplete or not up to date. This meant that there could be a risk of people's needs not being met.

When we visited Mount Pleasant nursing care home we had the opportunity to observe the care and support that was being given to people living at the home. We saw many examples of good communication and patience by staff who interacted with individuals in a positive manner. Staff were warm, friendly and respectful to the people they were supporting.

We spoke with seven people who were living in Mount Pleasant nursing care home and met other people throughout the day. They were all very positive about living at the home.

They all praised the activities organiser and felt lost when she wasn’t on duty as they really enjoyed the activities she put on. People told us that staff were very kind and caring and worked very hard. Some said they had been out on trips in the past and would like to go out a bit more.

People were very positive about the staff especially about the manager. They made various comments such as:

“I’m very happy here, the staff are lovely, very kind and the manager is very good, the food is lovely..”

“”The staff are ok, we can talk to the staff if needed..”

Two relatives were able to tell us that they were very happy with the care and that the standard of care was always very good whenever they visited. They felt that the home was always clean and tidy and never had any unpleasant smells.

When we visited we noted that everyone was well dressed and well groomed and a lot of people were engaged in the afternoon activities in the lounge playing bingo.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.

We carried out an unannounced inspection of Mount Pleasant Nursing Home on the 18th September 2015.

Mount Pleasant Nursing Home is a 42 bedded residential home situated in the rural community of Allostock, Knutsford.

The home supports older people who require personal and nursing care. The registered provider has plans to provide a further ten places for people living with dementia. This will be provided in a purpose built building which is currently under construction. This will be subject to registration by the Care Quality Commission.

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.

The last inspection of Mount Pleasant Nursing Home was carried out in July 2013 and we found that the service was meeting all the regulations that were assessed at that time.

People and their families who were able to told us that they were happy living at Mount Pleasant and felt safe living there. They told us that staff were well trained, knowledgeable and very good at their jobs. People felt cared for and believed that care and attention by staff had helped them to progress and remain healthy.

The registered provider had ensured that systems were in place to protect vulnerable adults form abuse. This was done through the training of staff and the availability of policies and procedures relating to abuse. Staff were knowledgeable about the types of abuse that could occur and demonstrated a commitment to prevent this.

People lived in an environment that was clean, hygienic, and well-maintained and designed to enable them to move independently. People received care that was personalised and met their needs effectively. People had care plans which were person centred. This included an acknowledgement of their health needs but also placed emphasis on their social history and interests. We saw that care practice matched the information included within care plans.

People were supported by well trained and supervised staff. The nutritional needs of people were met and the registered provider had set up an effective system for taking the capacity of people into account.

People received person centred care from a staff team who used a caring and attentive approach. The registered provider had set up an effective activities programme and information was available in all if they wished to raise concerns.

The registered manager adopted an open and transparent style of manager and sought the views of people about how the standards of care in Mount Pleasant could be maintained or enhanced.