Manor Farm Care Home

Manor Farm Care Home is a care home which provides nursing and residential care for up to 81 older people who may be living with dementia. At the time of this inspection there were 68 people using the service. Manor Farm Care Home provides care in one building spread over three floors, each floor is accessible by a lift.

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

We found a number of issues with how medicines were managed. Quality audits did not pick up on the areas we identified with medicines.

People were safeguarded from the risk of harm or abuse. Staff were recruited safely and there were enough staff on duty to meet people’s needs. People had risk assessments to reduce the risk of harm they may face. People were protected from the risks associated from the spread of infection. The provider had a system in place to learn lessons from accidents, incidents and complaints.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff asked for consent before delivering care. People had their care needs assessed prior to admission.

Staff were supported with regular supervision and training opportunities. People were supported to access healthcare and to meet their nutritional and hydration needs. The building was adapted to meet people’s mobility needs. The service was undergoing a redecoration and refurbishment programme.

Staff were observed to interact with people in a caring manner. People’s cultural and religious needs were met. People and relatives were involved in decision making about the care. Staff promoted people’s privacy, dignity and independence.

Care records were detailed and personalised. There were a variety of activities offered to people and plans in place to enhance what was offered. People’s communication needs were met. The provider had a complaints procedure and complaints were dealt with appropriately. People’s end of life care wishes were documented.

People, relatives and staff spoke positively about the leadership in the service. The provider had regular meetings with people and staff where they could be updated on the service development. The provider worked jointly with healthcare professionals to improve outcomes for people.

We have made a recommendation about environmental safety.

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 14 November 2017).

Why we inspected

This inspection was prompted by concerns raised with us by the local authority about the general safety and care people received. A decision was made for us inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. Please see the safe and well-led key question sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management and quality audits at this inspection.

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

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.

We found the following examples of good practice.

The service did not use agency and staff absences were covered by permanent staff or regular bank staff. Staff worked in their designated area to reduce the risk of cross-contamination.

Visitors underwent a thorough pre-screening process before entering the care home. The service provided each visitor with a mask and hand gel on entry.

There were several doors into the building and after being screened in the foyer, the visitor would leave the building to re-enter through the door closest to their relative’s bedroom.

People using the service could choose to meet their visitors in the dedicated visitors room downstairs instead of in their bedroom. This room also had a screen where visitors could sit behind if they visited during an outbreak.

The home was clean and free from malodour. There were several hand gel stations fixed to the wall and areas for handwashing throughout the service.

People were also encouraged to maintain contact with family and friends through iPads provided by the local authority.

At the last inspection in May and June 2015, the service was rated Good overall but had one breach of the regulations because the provider had not had a registered manager for more than twelve months. 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 this issue had been rectified. There was a registered manager in post.

People and relatives thought the service was safe. Staff were knowledgeable about how to report concerns or abuse. The provider had a recruitment system in place to ensure the suitability of staff working at the service and there were enough staff on duty to meet people’s needs. Risk assessments were carried out with management plans in place to enable people to receive safe care. The provider was in the process of carrying out refurbishment of the premises. There were systems in place to maintain the cleanliness and safety of the premises. The provider had systems in place to ensure the safe administration of medicines.

Staff received appropriate support through supervisions and training opportunities. Appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been applied for and authorised. Staff were aware of the need to obtain consent before delivering care.

People were offered varied and nutritious menus of food, snacks and drinks. People also had access to healthcare professionals as required to meet their day to day health needs.

People and relatives thought staff were caring. Staff were knowledgeable about how to develop caring relationships with people who used the service. People’s privacy and dignity was respected. Staff had awareness of The Equality Act 2010 and delivering care in a non-discriminatory way. People were given choices and their independence was encouraged.

Staff were knowledgeable about providing a personalised care service. Care plans were detailed and showed people’s preferences. A variety of activities were offered which included trips outside the home and visiting entertainers. People and relatives knew how to complain and the provider dealt with complaints in accordance with their policy. The provider kept a record of compliments about the service.

People, relatives and staff spoke positively about the management of the home. Regular meetings were held for people who used the service and relatives to check they were happy with the service provided. The provider had held a themed day to obtain feedback about the service. The service was asked to provide dementia training to the local community. Staff had regular meetings to keep them updated on policy changes, service development and to encourage good working practices. The provider had quality assurance systems in place to identify areas for improvement.

We have made two recommendations around the storage of medicines and supporting people with specific health conditions. Further information around this can be found in the detailed findings.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

Staff we spoke with were able to demonstrate to us the actions they would take in the event of an emergency. For example, one staff member gave an example of an emergency situation they had recently dealt with and told us they 'made sure [person] was breathing, talked to [person], made sure hazards were out of the way, called the senior and called the ambulance.' We reviewed the staff training matrix and saw staff were up to date with first aid training.

Is the service effective?

People had their needs assessed before they entered the service. Staff we spoke with demonstrated their understanding of what people's care needs were. We saw people were given choices of food and drink and those that needed assistance to eat or drink were given support at their own pace. We saw there were bowls of fruit on offer but two staff members told us there were times when there was not enough fruit for people. Staff and family members told us there was not enough staff to meet people's needs and we were told, 'if there was more staff' this would make it better.

Is the service caring?

People and their family members who we spoke with told us that staff were caring. For example, one person told us, 'the staff are good with everything about me" and "they help me and say don't give up.' We observed that staff asked people how they wanted to receive their care. We noted from a quality assurance survey, one family member had written, 'all of the staff are very caring.'

Is the service responsive?

We saw there were systems in place to obtain the views of people who use the service and their representatives. For example, a meeting for family members had been held in July 2014 and one of the outcomes of this was the staffing levels were increased by one staff member in the mornings on two of the floors. However, we found there was not enough hoisting equipment to meet people's needs. We also found there was a backlog to the laundry due to inadequate laundry facilities.

Is the service well-led?

The service had a manager in post who was in the process of becoming registered and who was supported by a deputy manager to manage the home. We saw there were systems in place to monitor the quality of service. For example, we saw family members were sent a letter asking for their views about the service and there were regular residents meetings held to obtain the views of people using the service. However, we noted there was no system in place to monitor staff during the night or at weekends and there was also no system in place to monitor call-bell response times.

People we spoke with told us they had enough food and drink to meet their needs. One person told us the food was "very good, very nice." Another person told us "On the whole, it (the food) is not bad." and "I can choose to eat plain food." We found people were protected from the risks of inadequate nutrition and dehydration because the provider had taken appropriate steps to provide people with nutritious food and drink.

People we spoke with told us they had enough equipment to meet their individual needs. One person told us "I have my chair and I can get about." We found there were sufficient supplies of equipment available to meet the needs of people who used the service.

There were enough qualified, skilled and experienced staff to meet people's needs. People we spoke with told us they thought there were enough staff available to meet their needs. We found the service conducted a monthly dependency review sheet which assessed the number of residents and their dependency rating.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with told us they received good care. One relative we spoke with told us "she used to fall a lot at home; but they are very caring."

People we spoke with told us "yes" when we asked if they felt safe. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found appropriate arrangements were in place in relation to the recording of medicine. Staff we spoke with told us they recorded when they administered people's medication.

People we spoke with who used the service told us they had no complaints about the service. They also knew who they could speak to if they did. For example one relative told us "no complaints, you go to the head person."