Manor House

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

Improvements had been made to quality assurance systems at the service. However, quality assurance checks were not all effective and had not identified some issues identified in our inspection, such as gaps in risk management plans and concerns medicine was not always stored safely.

The provider was taking action to make required improvements to fire safety within the service, including improvements to the fire alarm and fire doors to make them safe.

We were mostly assured infection prevention controls were being followed.

People felt safe using the service. Staff understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People were generally positive about the food provided and told us they received a choice. However, some people’s specialist diets were not accurately recorded.

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.

People spoke positively about the staff and the care they provided. Staff felt supported by the registered manager.

The registered manager was open and honest and worked in partnership with outside agencies. They were committed to making improvements to the service.

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 May 2019) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 April 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance systems.

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 remains 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 House on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

Follow up

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.

¿ Staff performed dances to reduce people’s potential anxieties regarding staff wearing additional Personal Protective Equipment (PPE), which brought some light hearted fun to the situation.

¿ People were supported to stay safe when they met their friends and/or family members by meeting socially distanced in the garden for a short period of time.

¿ Staff had adjusted their working hours to minimise the amount of different staff entering the building.

¿ Empty rooms had been used as changing rooms for staff to safely change their clothes upon entering and leaving the building. These rooms could also be used for staff to sleep in should there be an outbreak in the home.

People’s experience of using this service:

• Changes had been made to the quality assurance process, however, further improvements were required to ensure people received effective care.

• Some people's care plans had not been updated following changes to their care needs.

• Senior staff had limited understanding of some aspects of the Mental Capacity Act 2005 (MCA). It was not clear if some people’s legal rights had been upheld in accordance with the MCA.

• Some people's preferences and life style choices had not been recorded and there were limited ways people could be involved in making decisions about their care.

• People felt safe using the service.

• Staff recognised the risks to people’s health, safety and well-being and understood how to identify and report abuse.

• People had access to support from staff when needed.

• Staff recruitment processes included a check of their background to review their suitability to work at the service.

• People received support with the medicines. Regular checks were undertaken to ensure people received the correct medicines by staff who were competent to support them.

• Staff understood and practised infection control techniques and had access to protective equipment to promote this.

• People were supported to have enough to eat and drink to maintain their well-being.

• People were supported to obtain advice from healthcare professionals, which was incorporated into people’s care.

• Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

• People and their families understood how to complain if they wanted to.

• There had been staffing changes since our last inspection, including new senior management. People were positive about the changes and improvements to the service.

• The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

More information is in the full report.

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 8 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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

There was no registered manager in post. However a manager had been appointed in October 2017 and was in the process of applying to become the registered manager. The manager was on temporary leave from the service. 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 provider’s area manager and human resource manager were jointly supporting care staff at the home in the manager’s absence.

We last inspected this service in May 2017, when we rated the service as ‘Requires Improvement’ overall. Following the last inspection, we asked the provider to complete an action plan to show how they would improve the rating of the safe, responsive and well led key questions to at least good and how they would address the breach of regulation 17 HSCA 2008 (Regulated Activities) Regulations 2014 Good Governance in the well led key question. The provider had not ensured that effective systems or processes were established and operated effectively to assess, monitor and improve the quality of the service, to mitigate the risks relating to the health and safety of people who used the service, to maintain accurate and contemporaneous records in respect of service users and persons employed to carry on the regulated activity.

At this inspection we found the provider had taken steps to improve the service, they had met most of the requirements of their action plan and there was no longer a breach of regulation. However, there were still some improvements required in Safe and Well-led regarding medicine storage and management, assessing risks to people’s safety and checking the quality of the service. We have rated the service as ‘Good’ in Responsive, however the rating for Safe and Well-led continues to be ‘Requires Improvement’. Therefore we have rated the service ‘Requires Improvement’ overall. This is the second consecutive time the service has been rated ‘Requires Improvement’.

Improvements had been made since our last inspection. The provider checked staff’s suitability to deliver care and support during the recruitment process and there were enough staff to meet people’s needs safely. Important events were recorded and acted on by senior staff to keep people safe. Staff understood their responsibilities to protect people from the risk of harm. However, medicines were not always stored and managed safely, some risks to people’s safety had not been assessed and the quality monitoring system continued to not always be effective.

The manager had worked closely with commissioning authorities to make improvements to the service. Commissioners are people who work to find appropriate care and support services, which are paid for by the local authorities or health authorities. People were satisfied with the service and were positive about the leadership of the service and said there had been improvements.

Staff had the skill, experience and support to enable them to meet people’s needs effectively. Staff worked within the principles of the Mental Capacity Act 2005 (MCA) and supported people to have choice and control of their lives.

Staff monitored people’s health and referred them to other healthcare professionals to maintain and improve their health.

People told us staff were caring. People were encouraged to maintain important relationships. Staff knew people and understood their likes, dislikes and preferences for how they wanted to be cared for and supported. Staff respected people’s right to privacy and supported people to maintain their independence.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was not a registered manager in post at the time of our inspection visit. However, a manager was running the home and was applying to be the registered manager. They had been in post since 17 October 2016.

Staff understood their responsibility to keep people safe and understood the risks relating to people’s care. However not all events which called into question people’s safety had been consistently recorded and reported to senior managers for analysis, in order to reduce risks to people’s safety. Some identified risks had not been recorded and assessed in full on people’s care plans.

There were insufficient numbers of staff to meet people’s individual needs on the day of our inspection visit. People received their medicines as prescribed, however best practice was not always followed in relation to storing medicines.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the principles of the MCA, however it was not clear what support some people required to make decisions. Where people had capacity to make their own decisions, these were respected and consent was gained before staff provided personal care.

People's nutritional needs were taken into account and people were supported to make referrals to other healthcare professionals when their health needs changed.

People told us staff were kind and caring and had the right skills to provide the care and support they required. Most staff treated people in a way that respected their dignity and promoted their independence.

Staff had an understanding of people’s individual needs and preferences. However, there were some gaps in people’s care plans because they had not been reviewed and updated regularly. People were supported to maintain relationships that were important to them. People knew how to complain and were able to share their views and opinions about the service they received

Care staff told us they felt supported by their manager and they were encouraged to share ideas to make improvements to the service. However some senior staff did not always feel supported by the provider. Checks on the quality of the service were not always effective because senior staff had not carried out actions to make improvements.

We found breaches of the Health and social care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found.

Is the service safe?

We observed moving and handling practice in the home. Most moving and handling practice we observed was satisfactory. However not all moving and handling practice was delivered in a way that ensured people's dignity was maintained.

We found poor standards of hygiene and cleanliness in the home which increased the risk of infection for people living there.

We found there were not enough staff on duty to care for people and ensure their safety and well being.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told nobody who lived at the home was under a Deprivation of Liberty Safeguard.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staffing and cleanliness and infection control.

Is the service effective?

We spoke with people who lived at the home and asked them about the care they received. One person told us, 'Staff help me and they seem to know what they are doing.'

We saw most people's care records reflected their care needs. However we found some records contained inconsistent information.

We spoke with staff to find out if they felt supported by their employer. Care staff gave us a mixed response. Some staff told us they could raise any issues with their manager. But some staff told us they did not feel supported by the provider because they sometimes changed the manager's decisions.

Is the service caring?

People we spoke with were positive about the care they received. We observed some positive interactions between care staff and people who used the service on the day of our inspection.

Staff we spoke with were positive about their role as care workers and enjoyed supporting people.

Is the service responsive?

We found people were asked for their views about their care. We saw the provider's latest customer quality survey results. The manager told us if people had raised specific issues she had spoken with the person about it. We found the results of the survey had not been shared with people who used the service.

We saw there had been meetings for people who used the service and for people's relatives. A relative told us they had attended the last meeting and there had been an action plan produced from it but this had never been followed up to see what had been achieved. We found no evidence of further actions arising from the meeting. The manager told us there were no further meetings scheduled to take place.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

Is the service well led?

We saw the provider had a system to monitor the quality of care they provided. The system was called a 'perpetual planner', which was a list of checks to be carried out by the manager on a monthly basis. We looked at various audits and found they were not effective. For example the infection control audit had not recorded there had been no cleaning schedule completed since 02 June 2014.

We found there were no action plans with the audits. This meant that we could not identify if learning had taken place and if appropriate changes were made to the service.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to their quality assurance systems.

During our visit we saw people were taking part in a quiz in the main lounge. We observed other people in the music room being supported in crafting activities. One person we spoke with who lived in the home told us that, 'The staff are friendly and it is very pleasant here.'

We saw that people's care was planned according to their needs and dependencies. A relative we spoke with told us that staff understood their family member and that they knew how to communicate with her. They told us that staff, 'Always get a smile from X.' One person we spoke with who lived at the home told us that they felt safe there.

We found on people's records that they or their relatives, had signed to give consent to the care and treatment they received.

The manager had a system for monitoring the quality of the service, which included regular audits. The manager responded to people's feedback and took actions to improve the quality of the service.

The two care staff we spoke with told us they felt well supported by their manager and were receiving a comprehensive induction.