Archived: Manor House

We inspected Manor House on 3 and 14 December 2015, we found two breaches of regulations relating to the management of risks to people’s health and safety and support and supervision for staff.

We then undertook a focused inspection on 17 May 2016 in relation to the breaches of regulation we identified at our previous inspection of December 2015. We found that the service had followed their action plan and had met our requirements. At this inspection on 4 April 2018 the service continued to meet standards and we have therefore rated the service as Good overall.

The service had a registered manager who had worked at the service for several years. 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 this inspection we found that people’s medicines were administered in a safe way. Records for the management of medicines were maintained and these were correctly completed. Medicines were stored in a locked trolley but the trolley was not secured to ensure it was not easily moved. We spoke to provider about this and they agreed to take immediate action to improve this.

People were protected from avoidable harm. Management plans provided guidance to staff to help them mitigate risks to people. The provider maintained health and safety systems, and carried out regular checks to ensure the environment continued to be safe. The service was clean. Staff were trained in infection control and knew how implement the procedures to reduce risks of infection and contamination. Staff reported incidents and concerns as they should. Records of incidents and accidents were maintained, and the registered manager reviewed them. Actions were put in place to reduce the likelihood of incidents repeating again.

Staff were trained on safeguarding adults from abuse. They understood signs of abuse and how to report it in order to protect people. There were sufficient staff available and well deployed to meet people’s needs. Recruitment checks were conducted before new staff were employed. Staff received training, support and supervision to carry out their duties effectively.

People’s needs were assessed and individualised care plans in place that sets out how people’s needs and requirements would be met. People and their relatives told us they were involved in planning and reviewing their care. Care plans were kept updated.

People’s nutritional needs and dietary requirements were met. Staff supported people to eat and drink enough. People had to access to healthcare services they needed to maintain good health. The provider had arrangements and systems in place to enable people receive consistent care when they moved between services and departments.

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 consent from people before they delivered care and support to them. The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

People told us that staff were kind and compassionate to them. Staff treated people with respect and dignity. Staff encouraged people’s independence and choices. Staff were trained in end-of-life care. People’s end-of-life wishes were noted in their care plans. People were engaged and occupied in activities they enjoyed. The service respected and supported people’s protected characteristics such as heir disabilities, culture and religion.

The service obtained the views of people and their relatives and used them to drive improvement. People told us they were listened to, and their views acted upon. People and relatives knew how to raise their concerns. The provider regularly checked and monitored the quality of service provided to people. The provider worked jointly with other organisations and services to deliver effective care to people.

Additionally, the provider did not have in place a formal programme of one to one meetings (supervision) with staff to ensure they were supported to fulfil their roles and responsibilities.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches described above.

We undertook a focused unannounced inspection on the 17 May 2016 to check they had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Manor House on our website at www.cqc.org.uk

Manor House provides accommodation for up to 23 people who require personal care and support on a daily basis. People using the service have a wide range of healthcare needs and many are living with dementia. At the time of our inspection there were 18 people living at the home.

The service is required to have a registered manager in post. 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. At the time of this inspection the registered manager was on extended leave and the acting manager had submitted their application to the CQC to become the registered manager of the service.

During our focused inspection we found the provider had followed their action plan. Assessments were in place to manage the risk to people from the use of bedrails. Additionally, the provider had a system in place to ensure staff received one to one sessions with their manager to consider work issues and their professional development.

Sufficient action has been taken to meet the legal requirements that were breached at the last inspection. We have changed the ratings of ‘safe’ and ‘effective’ from ‘requires improvement’ to ‘good’. This means that the overall rating for this service has been changed to ‘good’.

Manor House provides accommodation for up to 23 people who require personal care and support on a daily basis. People using the service have a wide range of healthcare needs and many are living with dementia. At the time of our inspection there were 17 people living at the home.

The service is required to have a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The service is required to have a registered manager in post. At the time of this inspection the current registered manager was on leave from the service until June 2016. The provider had appointed an acting manager, to assume the registered manager’s responsibilities during the period of their absence.

Prior to our inspection of Manor House we received information from the service notifying us of a serious injury that had occurred to one of the people living at the home. We are carrying out a separate investigation in to the circumstances surrounding this incident. Once we have concluded our investigation we will notify the provider of what action we intend to take, if any, as a result of our findings.

During this inspection we found the provider in breach of their legal requirement with regard safe care and treatment. For example the provider had not assessed the risk to people from bedrails where these were in use. This meant there was no information or guidance for staff working in the home to make them aware of the risks posed by bed rails to ensure people were sufficiently protected from these.

We also found the provider in breach of their legal requirement with regard staffing. They did not have in place a formal programme of one to one meetings (supervision) with staff to ensure they were supported to fulfil their roles and responsibilities.

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

We were not assured the systems the provider had in place to audit and check the service were entirely effective. Issues we identified during our inspection around lack of formal staff supervision, the accuracy of care records and the management of risks to people had not been picked up by the provider or acting manager.

Despite these issues people and relatives said people were safe at Manor House. Staff had been trained to identify signs that could indicate people may be at risk of abuse or harm. They knew what action to take to ensure people at risk were protected. They had also been trained to ensure people were not harmed by discriminatory behaviour or practices.

The provider had systems in place to identify and assess risks to people’s health, safety and welfare. Staff were instructed on the actions to take to ensure people were protected from injury or harm from identified risks. The provider had arrangements in place to ensure there was regular service and maintenance of equipment and the premises. The home was clean and hygienic. Staff kept the home free from obstacles and trip hazards so people could move around safely. There were enough staff on duty to support people in the home and to meet their needs. The provider had carried out appropriate checks to ensure they were suitable and fit to support people using the service.

Staff received training that was appropriate to their role. They had a good understanding of people’s needs and how these should be met. People and relatives said staff looked after people in a way which was kind, caring and respectful. Staff knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. Staff supported people, where appropriate, to retain as much control and independence as possible, when carrying out activities and tasks.

Staff encouraged people to stay healthy and well. Relatives told us they were kept informed and updated about any changes to their family member’s health and wellbeing. People were supported to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. Staff regularly monitored people’s general health and wellbeing. Where there were any issues or concerns about a person’s health, staff ensured they received prompt care and attention from appropriate healthcare professionals such as the GP. People received their medicines as prescribed and these were stored safely in the home.

People were appropriately supported by staff to make decisions about their care and support needs. Care plans had been developed which reflected people’s needs and their individual choices and preferences for how they received care. People’s care and support needs were reviewed with them regularly.

Staff were welcoming to visitors and relatives and encouraged people to maintain relationships that were important to them. People were supported to undertake activities and outings of their choosing. The provider had developed good links with organisations and charities in the community to increase the range of activities people could participate in.

People and relatives said the service was well managed. People and relatives were satisfied with the way the provider dealt with their concerns or issues and said senior staff were approachable and willing to listen. The provider sought people's views about how the care and support people received could be improved. They made improvements and changes when these were needed.

The provider had procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had received training to understand when an application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Applications made to deprive people of their liberty had been properly made and authorised by the appropriate body. The provider was complying with the conditions applied to the authorisation.

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with six people using the service, a visiting relative, a visiting healthcare professional and the staff supporting them.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We asked people using the service and a visiting relative if they thought the service was safe. People told us they felt safe. One person said, 'I'm fine and being looked after well.' A visiting relative told us, 'It is safe here and you can see it in the way they look after and handle people.'

Potential risks to people's health, safety and welfare within the home and in the community were regularly assessed by senior staff. There was appropriate guidance for staff on how to take action to minimise these risks to keep people safe from harm or injury when they received care and support.

People were cared for in an environment that was kept clean and hygienic. Staff knew how to maintain good standards of cleanliness and personal hygiene to reduce the risk of cross infection.

Senior staff ensured equipment used in the home was serviced and maintained regularly so that it was safe to use. Regular housekeeping checks were undertaken each week to ensure the home was kept in a good state of repair and order. The home was free from clutter and obstacles which meant people were able to move freely around the home.

Senior staff carried out appropriate checks on people employed to work at the home. This included carrying out security checks to ensure people were not barred from working with vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant people were safeguarded as required.

Is the service effective?

People using the service were asked for their consent to plan and review their care and support needs. Where people were unable to make complex decisions about their care and support, their representatives and other healthcare professionals had been involved in making decisions on their behalf which were in their best interests.

People's care plans were reviewed weekly by staff to check these were up to date and people had received the care and support planned for them.

There were appropriate mechanisms in place to monitor people's general health and wellbeing. Regular checks of people's weights and blood pressures were undertaken by staff. These were documented and reviewed by senior staff to identify any potential underlying issues or concerns. Staff also regularly checked people were eating and drinking enough.

Is the service caring?

People were cared for by friendly and attentive staff. A relative said about staff, 'They're very caring.' During our inspection we saw many examples of warm and kind interaction between staff and people using the service. Staff spoke with people respectfully and took time to listen and chat with them. People that needed extra help and support moving around the home or with eating and drinking were not rush or hurried by staff and could do so at their own pace.

Is the service responsive?

Staff were responsive to any changes and deterioration in people's general health and wellbeing. They took appropriate action to ensure relevant healthcare professionals were kept informed about any changes so that people got the appropriate care and attention they needed.

Is the service well-led?

The views and experiences of people using the service and their relatives were sought by the service. Changes and improvements to the service were made when people wanted or needed these.

Senior staff understood the importance of robust quality assurance and carried out regular checks to assess and monitor the quality of service provided.

The provider sent us an action plan on 29 August 2013 setting out the actions they would take to achieve compliance with these regulations.

During this visit we checked these actions had been completed.

We looked at people's individual medication records. We saw these had been completed and maintained appropriately by staff to show that people had received their medicines, as prescribed by healthcare professionals. We observed medicines were kept safely.

We also saw senior staff carried out regular checks of people's records including their medical records to ensure these were accurate, fit for purpose and appropriately reflected people's current care and support needs.

People received appropriate support to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of food and drink. There was also sufficient numbers of staff to meet the needs of people using the service.

People were provided with information about how to make a complaint if they were not happy with the service. We saw the provider took appropriate action to resolve any issues or concerns raised.

We saw from people's records their individual care and support needs had been assessed and plans were in place to meet these needs. However not all of the records we looked at showed information was promptly reviewed and updated which meant staff did not have up to date information about people's current care and support needs.

We also identified concerns with the management of medicines within the home. We found medicines were not kept safely. We also had no assurance that medicines were given to people appropriately, as prescribed.