The inspection took place on 13 and 14 March 2018 and it was unannounced. At the previous inspection in December 2016 we found breaches of legal requirements in relation to notifications of incidents, evidence of seeking consent to care appropriately, person centred care, professional development of staff and evidence to verify equipment maintained in line with manufacturers’ guidelines and governance systems.
Following our last inspection (December 2016), we asked the provider to complete an action plan, which they submitted in April 2017, to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well Led to at least good. At this inspection, we noted improvements had been made in relation to submitting notifications, staff development and providing person centred care. However at this inspection, we found continued breaches of the regulation regarding the need for consent, equipment maintenance and good governance and significant concerns relating to the safe management of medicines. Further information about these concerns can be found in the relevant key question sections of this report.
Manorhey Care Centre (Manorhey) 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.
Manorhey accommodates 83 people across three floors. The ground floor unit specialises in providing care to people living with dementia, the first floor specialises in providing nursing care and the second floor provides residential care. At the time of this inspection there were 80 people living at the care centre.
There was a manager in post who had been registered with the Care Quality Commission since May 2015. 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 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.
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. You can see what other action we have told the provider to take at the back of the full version of the report.
People told us they felt safe living at Manorhey. At this inspection, we found serious concerns relating to the safe management of medicines. For example, we found some people had not received their medicines as prescribed because these had run out and had not been re-ordered. Staff did not have sufficient information to help them administer medicines in a safe manner. This was a breach of the regulation in relation to the safe administration of medicines.
Lifting equipment used to transfer people was not serviced in line with legal requirements and was a breach of the regulation. This meant people were at risk of injury until this equipment was serviced. This concern was highlighted to the registered manager who immediately removed the equipment from use.
Governance systems continued to be ineffective as they failed to identify the concerns we found during our inspection such as the inadequate management of medicines and equipment that required servicing. The lack of thorough oversight by the provider and registered manager meant we found that concerns raised at the last inspection had not been remedied. This meant people were at risk of poor quality care because the provider and the registered manager did not provide suitable assurances they effectively monitored the service provided.
Staff employed at the home had undergone all appropriate pre-employment checks to help ensure they were suitable for the role. Staff we spoke with were aware of their safeguarding policy and procedures and knew what action to take if they suspected abuse was taking place.
The registered manager and staff demonstrated an awareness of the Mental Capacity Act 2005 (MCA). However, we found the service did not consistently follow the principles of the MCA and continued to be in breach of the regulation in this regard. This meant people’s rights were not correctly safeguarded.
Staff received an induction, mandatory training and shadowed experienced colleagues prior to working unsupervised. Improvements had been made in how staff supervisions and appraisals were scheduled. These interventions, training and professional development, helped to ensure staff were competent and well equipped to carry out their roles.
There was a suitable choice of nutritious food and drink on offer at Manorhey. People’s meals were prepared according to their preferences and specific needs, for example, texture-modified or halal. This helped to maintain people’s good health and wellbeing.
Staff’s approach was caring and empathetic though we found the service did not demonstrate the hallmarks of a caring organisation. This was evidenced by the serious concerns we found in the management of medicines and the manner in which the registered provider assessed and monitored the quality of the service.
People and their relatives gave us many examples of how staff supported with kindness and compassion. People said staff carried out their duties in a respectful manner and that they were supported by staff who knew them well.
People told us staff encouraged them to be independent according to their abilities. Staff we spoke with confirmed this. This helped to promote people’s general good health and wellbeing.
There was a variety of activities arranged within the home and in the community and suited to people’s individual preferences and abilities. Regular activities helped to stimulate people’s wellbeing and were facilitated by dedicated activity coordinators with the support of care staff.
People told us they knew how to make a complaint or raise concerns. There were systems in place to manage complaints and we saw these were investigated in line with the provider’s policy and procedures.
There was a registered manager in post and everyone we spoke with told us they and the entire staff team were approachable and helpful.
There were policies and procedures in place and regular staff meetings were held to help ensure staff were supported to undertake their role effectively.