The inspection took place on the 13 August 2018 and was unannounced.

Mount Pleasant Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 24 people in one adapted building. At the time of the inspection there were 21 people using the service.

There was a registered manager in post who had been registered with the CQC since August 2016. 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.

At the last inspection we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because information in people’s care records was not always up-to-date and audit processes were not robust enough. At this inspection we found that improvements had been made, but identified issues with training that had not been managed appropriately. This meant there was a continued breach of Regulation 17.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. At this inspection we identified that improvements had been made to safe and responsive, but further improvements were needed in effective and well led.

During this inspection we identified that staff training was not being kept up-to-date. It is important that staff maintain their skills and knowledge to ensure this stays in line with current best practice. This had already been identified as an issue by the registered manger and the registered provider, however effective measures had not been put in place to ensure this was rectified. Following the inspection we contacted the registered manager who confirmed that training remained an issue. This showed that quality monitoring systems still needed improvement.

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

Whilst audit systems had failed to ensure that training had been kept up-to-date, other aspects of the quality monitoring process was more robust. For example, monitoring of care records, infection control procedures and the environment were being undertaken and where issues had been identified, these had been addressed. This showed that some improvements had been made in this area.

At the last inspection we identified issues around staff following appropriate moving and handling procedures. During the inspection we identified that improvements had been made in relation to this. Other risk assessments were also in place to maintain people’s safety and well-being.

We previously identified issues with the safe storage of medication as this was being stored in people’s bedrooms without appropriate risk assessments. At this inspection we identified that this had been rectified. People were receiving their medication as prescribed and appropriate paperwork was being completed to show that this had been given.

At the last inspection we made a recommendation that the registered provider implement appropriate procedures to become compliant with the Mental Capacity Act 2005 (MCA). At this inspection we found that appropriate action had been taken to ensure the registered provider was discharging their duties as required by the MCA. We observed that people’s rights were being protected and decisions made in their best interests where required.

At the last inspection we found that care records were not always being kept up-to-date. At this inspection we identified that thi

This inspection took place on the 25 July 2017 and was unannounced.

Mount Pleasant is a residential care home that is privately run and close to the rural village of Norley. The service has two floors and is registered to provide care and accommodation for up to 24 people. At the time of the inspection, 19 people were living there.

The service 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on the 5 and 6 January 2017 we found that there were a number of improvements needed in relation to the safety of care and treatment, safe recruitment and governance of the service. These were breaches of Regulations 12, 19 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was rated Inadequate and placed into special measures.

On this inspection, we found that whilst some improvements had been made the registered provider did not demonstrate full compliance with the Health and Social Care Act 2008. You can see what action we took at the end of this report.

The registered manager ensured that there was a regular review of people's care to identify changes to care needs. However, care plans and supporting documentation did not always accurately reflect the health or care needs of the people who used the service. This meant that people were at risk of not receiving the right level of support from staff less familiar with their needs. It was evident from our observations and discussions that staff knew people well and understood their requirements.

The registered manager had put in place a series of audits (checks) to monitor aspects of a person’s care and treatment. This included audits of the premises, medication, daily records and care plans. Some of these tasks had been delegated to senior members of staff. However, although completed on a regular basis, we found that these audits were not robust as they had failed to highlight and address some of the concerns found on this inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff obtained people's consent prior to providing care and support. However, staff did not evidence where they had made a decision in a persons’ best interest’ and not all staff could not relate their practice to the Mental Capacity Act 2005. We made a recommendation in regards to this.

The registered provider had made improvements to monitor the overall safety of the service and to mitigate risks. Remedial action had been taken to make the environment safer and to reduce the risk of harm to people who used the service. The service was accessible, clean and safe. Staff were able to describe their responsibilities for ensuring people were protected against any environmental hazards.

The registered provider demonstrated safe recruitment. Pre-employment checks had been undertaken prior to new staff starting work at the service. A Disclosure and Barring Service (DBS) check was in place. An applicant's employment history was available and verified. This meant that that ‘fit and proper’ persons were employed.

Staff had a good understanding of safeguarding adults and what they needed to do to keep people safe. Accidents and incidents were monitored effectively and action taken to minimise the risk of further harm. The management of medication and associated records was safe. People received their medication on time by staff who had received the appropriate training and competency checks.

People were treated with dignity and there was genuine warmth and affection displayed by

This inspection took place on the 5 and 6 January 2017 and the first day unannounced.

Mount Pleasant is a residential care home that is privately run and close to the rural village of Norley. The service has two floors and is registered to provide care and accommodation to up to 24 people. At the time of the inspection, 22 people were living there.

At the last inspection on 23 May 2016 we found that there were a number of improvements needed in relation to the management of medicines, record keeping and the overall governance of the service. We issued requirement actions in regards to Regulations 12 and 17 of the Health and Social Care Act 2008.

On this inspection, we found that whilst some improvements had been made the registered provider did not demonstrate full compliance with the Health and Social Care Act 2008. A number of breaches were identified. You can see what action we took at the end of this report.

The service 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 of the Health and Social care Act 2008 and associated regulations about how the service is run.

Risks to people’s health, welfare and safety were not always identified and planned for. Accidents and incidents were not monitored effectively. The registered manager did not ensure that regular reviews of people’s care were undertaken to identify risks, patterns or changes to care needs. There were no actions identified to keep people safe from harm.

Care plans and supporting documentation did not always accurately reflect the care needs of the people who used the service. This meant that people were at risk of not receiving the right care and support from staff that were less familiar with their needs. However, it was evident from our observations and discussions that staff on duty did know and understand their needs. People were treated with dignity and there was genuine warmth and affection displayed by staff towards them

The required pre-employment checks had not been undertaken prior to new staff starting work at the service. A Disclosure and Barring Service (DBS) check was in place but applicant’s employment history or previous conduct had not been explored or verified. This meant that there was a risk that fit and proper persons were not always employed.

The registered provider did not have robust systems in place to monitor the overall safety and effectiveness of the service and to mitigate risks. Many of our findings during this inspection had not been identified by the registered provider or registered manager as a cause for concern. Other matters had been noted but swift action had not been taken to resolve the issues and to minimise the risk to people and others.

People were supported where possible to have maximum choice and control over their own lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. However, care plans did not reflect how people’s consent was determined; their ability to make specific decisions and how best interest decisions were considered.

Staff were offered training, guidance and supervision for their role. Not all staff had completed the training required. This meant that people could not be assured that they received care and support from staff with the right knowledge and skills.

Improvements had been made to the administration of medication so that people received their prescribed medication safely. An assessment of staff competency was carried out and reviewed to ensure that this task was safely completed.

The registered provider has a statutory obligation to inform the CQC about a range of occurrences that may affect people who used the service. The registered provider had reported such events. This meant that we

This inspection took place on the 23 May 2016 and was unannounced.

Mount Pleasant is a residential home that is privately run and close to the rural village of Norley. The service is based over two floors and is registered to provide care and accommodation to up to 24 people. At the time of the inspection, 20 people were living at the service.

At the last inspection on 1 December 2015 we found that there were a number of improvements needed in relation to the management of medicines, staff support and training, record-keeping and quality management. We issued the provider with three warning notices because they had failed to meet the relevant requirements and improvements noted following the previous inspection carried out on 3 June 2015. We instructed the registered provider to meet all relevant legal requirements by 7 May 2016.

We also placed the service into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures.

Whilst we found a number of improvements in most areas, the registered provider had not demonstrated full compliance with the Health and Social care Act 2008 (regulated activities) 2014. You can see what action we have told the provider to take at the end of this 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 of the health and social care act 2008 and associated regulations about how the service is run. Since the last inspection a new manager has been appointed. An application an application to become registered with the Care Quality Commission has been submitted.

People received support with their medication. There were errors in the recording on people's medication administration records so we did not know whether people had received their medication as prescribed. Care plans relating to PRN (as required) medication were not in place for staff guidance. This issue had not been addressed following the last inspection. This meant that there was a risk that people could be administered more medication than required.

People told us that staff knew them well and that they care was "Just as they liked it". Care plans and risk assessments were in place but they were not personalised to reflect people's individual preferences. The manager had started to review the documentation. Supplementary records including food and fluid charts contained more detail than on the last inspection. However, they were not always completed on a regular basis and therefore did not accurately reflect a person's care on that day.

Staff sought the consent of people prior to support being provided. Care plans indicated a person's ability to consent around specific areas of their care. However, there was no assessment of people’s mental capacity to make a decision and how decisions made in their best interests were considered. None of the staff had received training in the mental capacity act or deprivation liberty standards (DoLS). We made a recommendation that staff received training as a matter of priority.

The manager and the registered provider were working with staff each day to observe and monitor practice. They had already identified a number of issues and were taking remedial action. They also spoke with people and families to seek their opinions. However, the formal quality assurance system at the service needs further improvement to ensure that people who use the service are protected from harm or unsafe care.

Staff felt that they were not always able to respond to people as quickly as they would like. They also gave examples of where they had to leave someone in order to assist another member of staff.

People said that staff tried to respond to their requests and were only delayed if they

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.

We undertook this inspection on 3 June 2015 and it was unannounced. This meant that the registered provider did not know we were coming.

We last inspected this location on 19 October 2013 and found that the service met the regulations.

Mount Pleasant Residential home is a two storey building which is registered to provide accommodation and care for up to 24 older people who live there. It is in the rural village of Norley and is close to the village facilities. At the time of inspection there were 22 people using the service.

There was no registered manager or nominated individual for the location and the registered provider had failed to notify us of this. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There was a manager who had been at the service for approximately nine months. She told us she was considering taking the role on a permanent basis.

People used the service told us that it was like “Home from home” and they felt “Safe and Secure”. Staff were able to tell us how they safeguarded people that they cared for and were confident in how to report concerns.

People lived in an environment that was clean, homely and welcoming. It met the needs of the people that lived there although some people expressed a wish to have better use of the garden. People told us that it was the “Next best thing to home.” People were served meals that had been freshly cooked and enjoyed this together in a pleasant dining area

However, we found that there were a number of breaches of the Health and Social Care Act 2008 (Regulated activities 2014.)

We found that the service was not safe because the registered provider had not taken the appropriate steps to ensure that staff who looked after people had received the appropriate on-going training and support required. They had also failed to ensure that they carried out the required employment checks to satisfy themselves that staff were of appropriate character to work at the service.

People received care from staff that had worked the service for many years and knew and understood their needs. This was clearly evident from our observations. We saw that people were treated with dignity and respect and there was genuine warmth and affection displayed. However, care plans and supporting documentation, did not accurately reflect the care needs of those people and so there was a risk that if staff were less familiar with the person they would not be able to deliver care required

We found that the management of medicines was not safe. We found that this was not stored securely and potential concerns with administration had not been highlighted by the staff. This meant that people were not protected from the risks associated with unsafe practice in regards to medicines.

The registered provider has statutory obligation to inform the CQC about a range of occurrences that may affect the health, safety and welfare of people who use the service. This is so that CQC can take follow-up action to safeguard the interests of people if required. The registered provider had failed, since November 2012, to report such events. CQC was, therefore, not able to monitor the events that affect the health, safety and welfare of people who used the service.

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

We spoke to four people who used the service, four staff, two relatives and one volunteer who assisted with activities at the home. The volunteer we spoke to said “the care is second to none”. Two people we spoke to who use the service said the staff were “very friendly and kind”. One person said she felt “very free” as she felt she was able to come and go as she pleased. Although both relatives we spoke to said it would be nice to see service user’s involved in more activities.

All four service users we spoke to and both relatives commented that the food was very good. On a tour of the home it was seen to be odour free and immaculately clean. Three service users also supported this observation and said the home was always very clean.

Staff were observed dispensing medication safely. Where appropriate they asked people whether they wanted pain relief. The three senior care assistants were all able to say what they would do in an event of a medication error.

We reviewed three care plans which were updated regularly with personalised daily reports. Personal records were held securely and remained confidential. The two relatives we spoke to contributed to the service user’s care plan.

The provider had a policy and procedure for receiving and dealing with complaints. They kept a clear log of all the complaints and how they dealt with them. We asked the two relatives if they ever had to complain which they said they had not but said they would be comfortable in doing so. Staff had also said they had not received any complaints from any of the service users or relatives in the past year.

We spoke with five people who used the service. They told us that staff were kind and caring and they were given support to be as independent as possible. Comments from people who used the service included

"There is nothing I can find fault with"

" The girls(staff) are very caring and helpful"

"The girls encourage you to do as much as you can"

We spoke with five members of staff who told us that their relationships with other colleagues and people who use the service was like being part of a big family. They told us that staff turnover was low and that a lot of the staff had worker here for many years. Some of the comments from staff included

"I love working here"

"Getting to know about them(people who used the service) and caring for them gives me a real sense of achievement"

We found that the manager and deputy manager made sure that training for staff was refreshed every year so that people who used the service were safeguarded from abuse and were protected from any potential hazards.

We observed staff caring for the people who used the service in a respectful way and interacting with them in a positively.

We found that the manager always looks to improve the service and takes into account the views of the people who use the service and their relatives in order to do so.

We spoke to 18 people who live at the home. They were all very positive about living there and they all said that the staff were very good and kind and caring. They told us that they know all the staff as they had been there for a long time and that they were all very respectful and always knocked on their bedroom door, called them by their preferred name and appeared to know how everyone wanted to be cared for.

Some comments made included for example,

"I love it here, it’s a lovely place.”

“The staff are lovely they never let me down, they will do anything for you, and we can totally rely on them”.

“I get three good meals a day and am looked after by the kind people who work here”.

“I enjoy being here. I get plenty of food, a most comfortable room and the constant attention of very kind staff, what more could I ask”?.

“We get a book about the home when we come to stay and it gives full information about the services on hand and how we can complain and who to tell if we don’t like things”.

People told us they had a care plan and they knew what was in it. They said that the plans were looked at each month to see if anything needed changing.

One person said their needs had recently changed due to mobility difficulties. However the care plan had been amended accordingly, with more assistance being noted on the plan and a new risk assessment in place.

People told us they felt well cared for by the staff that supported them.

Comments from people living in the home included

“I am very settled here. I enjoy watching television in my room and in the lounge and join in with the activities such as card games, quizzes and bingo.”

“Staff know what my care needs are and look after me well. I can do as I please. I sit outdoors in the good weather and I like looking at the Hen’s. The grounds here are beautiful”.

“Staff enable me to make my own decisions and choices in life. They assist me to stay in control wherever possible”.

We spoke to people living in the home and asked their views about safeguarding and general concerns.

They told us that they feel safe and have no concerns about the care and support they receive from staff.

People said they were treated well by staff that had been trained to look after them in a kind and caring manner. They said if they had concerns they would tell the manager or any staff member as they knew they would sort things out.

People told us that the staff were very good and they had no problems with them.

They said the same staff had been working in the home for a long time and really knew what they were doing.

People said they were happy with the staff and services provided and told us that they were included in decision making about how the home is run.

Everyone spoken with said they knew about the complaints procedure and of how to complain if they did not like anything.