Archived: Manor Rest Home

Manor Rest Home is a residential care home providing the regulated activity of accommodation and personal care to up to 19 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

Not all risks to people were identified and recorded. We have made a recommendation about the management of risk. Although staff felt supported and valued by the provider and manager, formal supervision arrangements for staff were still not in place. We have made a recommendation about staff supervision. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Improvements were still required to monitor the quality of the service provided to ensure effective oversight and to meet regulatory requirements.

Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these processes. Medicine arrangements ensured people received their prescribed medication and staff’s practice was safe. The service was appropriately staffed to meet people’s care and support needs. Recruitment procedures were followed to ensure the right staff were employed to care for vulnerable individuals with minor improvements still required. People were protected by the providers arrangements for the prevention and control of infection.

Staff received appropriate induction and training opportunities. The dining experience was positive, and people's nutritional and hydration needs were met. The service ensured people received appropriate healthcare support as and when needed from a variety of professional healthcare services. The service worked together with other organisations to ensure people received coordinated care and support.

People were treated with care and kindness. People received a good level of care and support that met their needs and preferences. Staff had a good knowledge and understanding of people's specific care and support needs. The rapport between staff and people using the service was positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement [Published 25 January 2023]

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulation.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection 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 the Key Questions of Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Rest Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, consent and the requirements of the Mental Capacity Act 2005 and the provider’s quality assurance and governance arrangements at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manor Rest Home is a residential care home providing the regulated activity of accommodation and personal care for up to 19 people in one adapted building. The service provides support to older people and older people living with dementia. At the time of our inspection there were 18 people using the service.

People’s experience of using this service and what we found

Not all risks to people’s safety and wellbeing were assessed or recorded and improvements were still required relating to safe medication practices and procedures. Robust arrangements were not in place relating to the provider’s recruitment practices. Findings from this inspection showed lessons were not learned and improvements made when things went wrong.

Staff training records showed not all staff employed at the service had received mandatory training in key topics. Not all staff had received an induction, regular supervision or an annual appraisal of their overall performance. The governance arrangements were not effective and demonstrated a lack of provider oversight.

People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff knew what to do to safeguard people. People were supported to access healthcare services and receive ongoing healthcare support. The dining experience for people was positive and they were complimentary about the meals provided. The service worked with other organisations. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, best interest assessments were not completed where bedrails and sensor alarms were in place. People and those acting on their behalf were complimentary and positive about the quality of care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good [published October 2018]

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the support of people living with dementia and staffs’ practices relating to moving and handling. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Rest Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff could demonstrate that they knew people well. Staff treated people with dignity and respect.

Records we reviewed showed people and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and when there was a change in care needs. People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The provider had a number of ways of gathering people’s views, they held regular meetings with people and their relatives and used questionnaires to gain feedback. The provider carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

Manor Rest Home provides accommodation and personal care without nursing for up to 19 persons some may be living with dementia. At the time of our inspection 18 people were living at the service.

The service had 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a GPs and district nurses.

Staff were attentive to people's needs and treated people with dignity and respect. Staff were able to demonstrate that they knew people well.

People were provided with the opportunity to participate in activities which interested them. People knew how to make a complaint; complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

This is a summary of what we found;

Is the service safe?

When we arrived at the service the staff asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. We saw records which showed that the health and safety in the service was regularly checked. This included regular checks on such areas as fire safety equipment, gas and electric appliances as well as checks on the environment. This told us people were looked after safely.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw that staff were recruited appropriately and employed after appropriate checks were completed. This meant people were cared for safely by people of suitable character and skills.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. People told us they were; 'Well looked after;' and that they were; 'Happy here.' One person told us; 'Staff are good they look after me.'

Is the service caring?

We saw that people were relaxed in the company of each other and staff. We saw that staff were attentive to people's needs. Staff we spoke with were able to demonstrate they knew people well. We saw staff treating people with dignity and respect. One person we spoke with said; 'Staff are very good, very helpful, cheerful, all nice girls.' Another person told us the service was:'Homely and friendly.'

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to. People's care records showed that where appropriate, support and guidance was sought from health care professionals, including a doctor, optician, chiropodist and district nurse. The service had recently taken part in a pilot study with their local general practitioner on avoiding unnecessary admissions to hospital. This told us that the service worked well with other professionals and that people's needs were met.

The service had its own minibus to help people access activities in the community.

Is the service well-led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed. As a result the quality of the service was maintained.

People and relatives told us that staff were caring and responsive to people's needs. We also spoke with a visiting professional who advised from their experience that, 'Everyone is very helpful'.

We found that the provider had reviewed their systems to make them more effective for gaining people's consent to their care.

We found that the provider had systems in place to ensure people's nutrition and hydration needs were met.

We reviewed three staff personnel files and found that systems still needed improvement. We spoke with seven staff and we were told that there was enough staff available.

We found that some improvements were needed regarding the management of medicines and the monitoring and assessing the quality of service provision.

We reviewed three people's care plan files and found that it was not clear that arrangements had been made to obtain people's consent for their care, or from others involved in their care.

We found that staff supported people to obtain appropriate health and social care support.

The provider had systems in place for people and others to raise any concerns or compliments and for the assessment and monitoring of the service.

We found systems in place for infection control however we had concerns regarding the safety and suitability of premises.

We found that whilst the provider had systems in place for recruitment they were not being consistently followed.

We spoke with five staff who told us they had support to undertake their work.