Archived: Mantley Chase Residential Care

Mantley Chase is a care home operated by Holmleigh Care Homes Limited. The service provides support, personal care and accommodation for up to 12 people. It provides care to adults living with a learning disability, autism and behaviours that may challenge. Eight people were living at Mantley Chase at the time of our inspection.

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

At the last inspection we told the provider they needed to improve the oversight and governance of the service. Systems had not been effective in identifying and responding to maintenance issues and ensuring the home was clean with infection control measures adhered to. At this inspection we found the provider had made the improvements necessary to meet legal requirements.

During this inspection we found that the provider had made changes to the environment at Mantley Chase. For example, the carpets in people’s bedrooms and on the main staircase had been replaced and items that had required fixing had been repaired or replaced.

Changes had been made to the systems in place to assess the quality of the service and plan improvements. The management team were making regular checks of all aspects of the service. This was used to develop a comprehensive service improvement plan, which was regularly reviewed. Further time was needed to ensure that systems in place routinely identified areas for development and encouraged continuous improvement.

Medicines were safely managed. People were supported to take the medicines they had been prescribed. Staff had received training and managers regularly checked to ensure the systems were working well.

Risks people faced had been assessed and there were clear plans setting out the support they needed to stay safe. Staff had a good understanding of the risks and support people needed to stay safe.

More time was needed to fully imbed the quality assurance systems the provider had implemented. This was to ensure they were fully effective in identifying and responding to issues identified through these audits.

Rating at last inspection

The last rating for this service was requires improvement (published 24 April 2019) and there were breaches of regulations. 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 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 20 March 2019. Two breaches of regulations were found and we served a warning notice against the provider in relation to Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance of the service.

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 ‘Is the service Safe?’ and ‘Is the service Well-led?’ which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. 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 Mantley Chase on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mantley Chase is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement.

Mantley Chase was a care home for nine people with an annexe for three people. The service supports adults living with a learning disability or with complex behavioural needs.

To ensure this felt like people’s own home there were no deliberate signs to indicate Mantley Chase was a care home and staff wore their own clothes when working with people in the home and community. The home is in a rural area, away from any major roads. Two ladies and six gentlemen were living at Mantley Chase at the time of our inspection.

People’s experience of using this service:

The service did not always reflect the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support in the following ways.

• People could not be assured that their home environment was safe, well maintained and appropriately cleaned. People told us improvements were not being made to their environment, such as the additional kitchen which impacted on their wellbeing.

The outcomes for people using the service reflect the principles and values of Registering the Right Support in the following ways:

• Staff understood how to communicate with people effectively to ascertain and respect their wishes.

• Health and social care professionals guided staff to support people with their behaviour in accordance with national best practice guidelines.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

• People were protected from abuse and discrimination.

• People were supported to access their local community and transport was provided when needed.

• The provider did not operate effective systems and processes to assess, monitor and improve the quality and safety of the service provided. They had identified maintenance concerns prior to our inspection but had failed to make the required improvements to people’s home environment.

• Risks to people had been assessed and plans were in place and followed by staff to keep people safe.

• Safe recruitment practices were followed to protect people from unsuitable staff.

• The registered manager and deputy manager promoted consistency in staff, including block booked agency staff.

• Systems were in place to ensure people received appropriate support to take their medicines safely.

• Staff received the training they needed to support people’s needs. However, staff also told us they did not feel morale was very high at this time.

• Staff attitudes and behaviours were responsive, respectful and caring.

• There were processes in place to manage adverse incidents and complaints. There was evidence that learning from incidents was shared across the service.

Rating at last inspection: We last inspected Mantley Chase on 17 February 2016 and the service was rated Good (this report was published on 16 March 2016). At this inspection the service did not meet the characteristics of ‘Good’ in in relation to the environment/premises and the quality assurance systems, therefore we have rated the service as ‘Requires Improvement’ overall.

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous ‘Good’ rating. Previous CQC ratings and the time since the last inspection were also taken into consideration.

Action we told provider to take:

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the back of the full version 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 asked and received from the provider and registered manager a written plan of the action they told us, during the inspection, they will be taking to address the environmental concerns at Mantley Chase. We have asked them to provide us with an update of progress made against this action plan every two weeks. We will meet with the provider following this report being published to discuss how they will make changes to ensure the legal requirements are met and the rating of the service is increased to at least Good.

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme.

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

A registered manager was in place as required by the service’s conditions of registration. 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.

People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had been trained to recognise signs of abuse and report any concerns to their managers and other relevant authorities. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Occasionally people became upset, anxious or emotional. Staff were knowledgeable about the triggers which caused people to become upset and how to support them. Any incidents were investigated to understand if a situation could have been managed better by staff. There were clear audit trails of people’s daily financial transactions to prevent the risk of financial abuse. A system was in place to ensure the home was clean. However, not all chemicals cleaners used to clean to the coach house were securely stored. The registered manager immediately addressed this and requested a locked cabinet to secure and store the cleaning fluids.

People’s privacy, dignity and decisions were respected and valued by staff. People who were able to make decisions for themselves were involved in the planning of their care and consented to the care and support being provided. They were encouraged to express their choices and preferences about their daily activities. Their care and support plans were personalised and reflected their needs and choices. People’s needs were reviewed regularly. Where necessary, staff had appropriately referred people to health and social care services. People's dietary needs and preferences were catered for, documented and known by the staff and their medicines were managed and administered safely in accordance to their assessed needs.

Safe recruitment and the monitoring of staff levels ensured that people were supported by suitable numbers of staff with the appropriate experience and character. Records showed staff were supported and trained to meet people’s diverse physical and emotional needs.

Relatives told us their concerns were always listened and responded to. Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This inspection was completed by one inspector. We visited the home and also spoke to people in receipt of personal care and their relatives. This is a summary of what we found based on our observations, speaking with a person who used the service, talking with three staff and looking at records.

Is the service safe?

People told us they felt safe and happy at this home. Staff were trained and knowledgeable in safeguarding the people they supported. Systems were in place to monitor and evaluate situations where more complex support was needed. Each person had a risk assessment and behavioural plan of their individual needs. Staffing levels were monitored which ensured suitably qualified staff were available for each shift.

Is the service effective?

People told us they were happy with the care and support they received. The care plans were focused on the person and gave clear direction on how an individual should be supported. We observed good practices of appropriate interaction with people with limited communication and understanding. People carried out appropriate activities in the home and out in community. Families also told us they felt their relatives were happy living at the home.

Is the service caring?

We saw that people were comfortable around the staff. People at the home had a wide range of complex needs. We saw staff had a caring and positive manner and were able to adapt the needs of individuals. People at the home were encouraged to take part in activities and become independent. People told us they liked the staff. Families told us they felt the staff were very caring and trained well.

Is the service responsive?

We observed that staff responded timely and effectively to the needs of individuals. People had been involved in the decisions on redecorating the home especially their own rooms. Some of the bedrooms had been adapted to meet individual sensory needs and preferences. People's individual needs or requests about their bedrooms were considered and acted on. People were supported to make informed decisions about their day to day choices or activities. We heard from relatives who said their concerns had been dealt with in a timely and effective way.

Is the service well led?

People told us they could always speak to senior staff about any issues or concerns. New systems had been put into place to ensure that people were supported in an appropriate and proportionate manner. This was monitored and evaluated by the provider. We saw that the senior staff and carers carried out good caring and communication practises. The service had worked with health care professional and had implemented any recommended changes for individuals.

The staff had worked hard to review and update peoples care files. We found these to be fit for purpose and reflected people's needs. Staff were able to complete additional training as necessary. Staff were training to administer medicines. This training was updated every six months. The provider is also part way through a refurbishment plan for the whole home. The newly decorated rooms were a big improvement from our previous visit. New furniture and carpets had been ordered and plans put in place for the grounds. People were involved in developing their care plans. They were also supported by the staff to maintain as much of their independence as possible. People looked well presented and well cared for. Staff knew each person very well. We observed interactions and communication between staff and people who used the service to be respectful and friendly.

At our previous inspection on the 2 May 2012, we found the provider to be non-compliant with several essential standards. This was a follow-up unannounced inspection to assess the providers compliance since our last visit. The provider had developed an improvement plan following this visit and then confirmed with us that they were compliant.

The provider had made changes since our last inspection and we were able to find them compliant in all but one of the essential standards. We still had concerns regarding the record keeping and this standard remains non-compliant.