Manor Farm Care Home provides care and support to a maximum of 25 older people, some of whom were living with dementia. At the time of our visit there were 21 people using the service. The inspection was unannounced and took place on 5 September 2017.
At our previous inspection on 3 and 7 February 2017, we identified widespread failings which put people at risk of harm. The service was found to be in breach of regulations 9, 11, 12, 17 and 18 of the Health and Social Care Act 2010 (Regulated Activities) Regulations 2014. We rated the service inadequate. At this inspection we found that the service continued to breach these regulations and remains inadequate.
The home had a manager in place who was in the process of registering with us. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.
Three weeks prior to our inspection the registered manager resigned from their role and a new manager began working at the service. The deputy manager had also stopped working for the service and a new deputy manager had started a week prior to our inspection. Whilst significant progress had been made in the three weeks since the new manager started at the service, there were still significant shortfalls in the care provided to people. This was linked to a lack of oversight from the previous registered manager, deputy manager and the provider. In our report when we refer to the failings of the ‘previous management team’, this includes the provider of the service.
People were put at the risk of significant harm in the absence of clear records and assessments which reflected all current areas of risk and how these should be managed to protect the person from harm. Whilst the new management team was prioritising writing new care plans, the documents in place at the time of our inspection were not fit for purpose.
People were supported by staff to have maximum choice and control of their lives. However, assessments of people’s capacity and Deprivation of Liberty Safeguards applications had not been completed appropriately.
People were not supported to maintain good nutrition, and action had not been taken by the service to reduce the risk of people becoming malnourished.
People were not supported to live full, active lives and to engage in meaningful activity within the service. We observed that some people were socially isolated and disengaged from their surroundings. The new management team had plans in place to address this shortfall, which included the recruitment of two new activities staff.
The care plans and assessments currently in place for people were generic and not person centred. Care planning did not include enough information about people’s past lives and experiences for staff to understand them. People and their representatives were not consistently involved in the planning of their care, and their views were not reflected in their care records. The new management team was rewriting all the care plans at the time of our visit and planned to involve people in this process.
The staffing level in the service had improved and the new manger had in place a system to ensure effective deployment of staff.
The previous management team had not made improvements to the training and knowledge of staff. Staff were not consistently supported to develop their skills within the caring role. There was no system in place to assess staff competency and performance. The new management team had implemented a supervision system and had identified shortfalls in staff training which were being addressed. Plans were in place to carry out staff appraisals.
There was a failure of the previous management team to ensure that systems in place to monitor the quality of the service were effective in identifying shortfalls and areas for improvement. Limited improvement had been made following our previous inspection and this had not been identified by the provider.
The new management team had made improvements to the culture of the service. Staff were positive about the new management team and were enthusiastic about the positive changes taking place in the service.
Staff recruitment was conducted in such a way that ensured prospective staff had the skills, background, experience and knowledge for the role.
Medicines were managed and administered safely by staff. Improvements were required to ensure protocols for the administration of ‘as and when’ (PRN) medicines were available to staff.
Throughout our inspection we fed back concerns and shortfalls to the new management team. They were proactive in ensuring that action was taken to mitigate risks and have provided us with an action plan which they update and send us weekly.
The overall rating for this service is 'Inadequate' and the service therefore continues to be 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.
You can see what action we told the provider to take at the back of the full version of the report.