Archived: The Manor Care Home

The Manor Care Home is a residential care home providing care and accommodation for up to 21 older people who live with a learning disability and autistic people. Some of whom have physical disabilities, and/or are living frailties of old age and dementia. On the day of our inspection, there were 19 people living at the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People were mostly 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 did not always support people to have a range of opportunities and experiences to maintain their skills for as long as possible and have greater control over some areas of their own lives. Staff carried out daily tasks such as cooking and cleaning without actively supporting people to take part. The provider was seeking additional training for staff to understand how to be more focused on people’s strengths and promote what they could do, so people had a fulfilling and meaningful everyday life. Each person had their own room, which was personalised to meet their needs and preferences.

People lived in one large house and shared spaces, at busy times such as mealtimes the environment was noisy. Consideration had not been given to creating a dementia friendly setting such as supporting people to recognise their surroundings and move independently around the service.

The provider was aware of and were committed to providing resources to make any necessary improvements as quickly as possible. Staff equality and diversity was respected and promoted at the service and within the provider’s organisation.

Right Care:

People and their relatives told us they received kind and compassionate care. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so.

People received good quality health care, support, and treatment because staff and specialists could meet their needs. Most staff knew and understood people well.

People were supported to eat and drink safely.

Right Culture:

People were not supported by managers and staff who fully understood current good practice in relation to learning disability and autism people, some of whom were living with dementia.

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to maintain and develop the safety and quality of care were not always operating effectively.

Staff equality and diversity was respected and promoted at the service and within the provider’s organisation.

People we spoke with and their relatives told us, they liked living at the Manor care home and liked the managers and staff.

The provider had reflected on feedback from the inspection and had started to make changes.

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 3 July 2019)

Why we inspected.

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement

We have identified 2 breaches of regulation in relation to staff training and governance 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for the manor care home on our website at www.cqc.org.uk.

The Manor Care Home is a residential care home providing care and accommodation for up to 21 people. The home provides support to older people who have learning disabilities, some of whom have physical disabilities. Some people may also be living with dementia. On the days of our inspection, there were 20 people living at the home.

The home is a large property situated in Selsey, West Sussex. There are two communal lounges, two dining rooms, a separate activity building on the grounds and a garden.

The service has been developed and designed in line with 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 service was a large home, bigger than most domestic style properties. It was registered for the support of up to 21 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

People’s experience of using the service:

People using the service benefitted from caring, dedicated staff. Not all people living at The Manor Care Home were able to verbally express their views to us, but we observed they looked comfortable and at ease with staff. Their non-verbal language, body language, facial expressions and laughter indicated they were happy.

People and their families were placed at the heart of the service and involved in decisions as far as possible. 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’s care was provided safely. The staff team were consistent, staff knew people well and supported them to move safely around the service if needed, and when they were out of the home.

People’s medicines were well managed.

People’s risks were known and managed well, promoting independence as far as possible. Positive behavioural support plans were in place where required for staff to follow to support people’s care.

People were protected from discrimination because staff knew how to safeguard people. Staff knowledge of people meant they were alert to signs of change which may indicate someone was not happy.

People lived in a service which had a positive culture and was led by a committed registered manager and staff team.

The Manor Care Home had worked hard to develop good relationships with local professionals supporting people’s care for example the local authority, commissioners, primary care and the local learning disability service. Feedback we received was positive about the care people received.

Rating at last inspection:

At the last inspection the service was rated as Good (The last report was published 9 December 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained Good.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns, we may bring our inspection forward.

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

The Manor Care Home is a residential care home providing accommodation for up to 21 people. The home provides support to older people who have learning disabilities, some of whom also have physical disabilities and may also be living with dementia and therefore may require support with their personal care needs. On the day of our inspection there were 21 people living at the home. The home is a large property situated in Selsey, West Sussex. It has two communal lounges, two dining rooms, a separate activities building and a garden.

The home was a family run home and was the only home owned by the two providers. The management team consisted of one provider, a registered manager and a team leader. A registered manager is a ‘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 home is run.

People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. When asked what they would do if they suspected abuse, one member of staff told us, “I’d speak to my manager or CQC”. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented.

People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the storage, administration and disposal of medicines.

People were asked their consent before being supported and the registered manager had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. Records showed that best interest decision meetings had taken place with external professionals and that the registered manager had sought advice from the local authority to ensure that any decisions that were made were in people’s best interests.

People and their relatives, if appropriate, were fully involved in the planning, review and delivery of care and people were able to make their wishes and preferences known through regular meetings with their key-workers or residents’ meetings. Care plans documented people’s individual needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current.

Staff worked in accordance with people’s wishes and people were treated with respect and dignity. It was apparent that staff knew people’s specific needs and preferences well. Positive relationships had developed amongst people and staff. A comment within one person’s key-worker meeting, stated, ‘I am pleased with the staff that are working here, especially my key-worker’.

People’s health needs were assessed and met and they had access to medicines and healthcare professionals when required. One visiting healthcare professional explained that if people were unwell then healthcare professionals were contacted promptly, they told us “Some people here struggle to communicate their needs but I don’t have any concerns, I feel comfortable that they are okay. We’ve made a plan today for a couple of people and I’m confident they’ll carry it out”. Another visiting healthcare professional told us, “I enjoy coming here, people are really well looked after. When I ask them to do something for someone, for example, obtain a urine sample, it is done”.

People’s privacy and dignity was respected and maintained, when offering assistance staff did so in a respectful way by knocking on people’s doors before entering and using privacy screens when assisting people with moving and positioning. People had a positive dining experience and told us that they were happy with the food. One person told us, “I really enjoyed it today”.

The registered manager welcomed feedback and used this to drive improvement and change. There were quality assurance processes in place to enable the registered manager and provider to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect. People, a relative, staff and visiting healthcare professionals were complimentary about the leadership and management of the home. The home had a warm, friendly and homely feel and this was echoed in the comment made by the registered manager, who told us, “We try to work to it being ‘our residents’ home’ rather than just a home. They can say whatever they want, when they want. We try our best to ensure that they have the same life here as they would choose to have in their own homes”.

This inspection was carried out by one inspector. We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were treated with respect and dignity by the staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told there were no applications made under DoLS that were currently in force. The manager confirmed they understood when an application should be made to deprive someone of their liberty and how to submit one.

The home had proper policies and procedures in relation to the Mental Capacity Act. Relevant staff had been trained to understand how it should be implemented to ensure people's rights had been maintained. This meant that people would be safeguarded as required.

Is the service effective?

Where possible, people's health and care needs were assessed with them, and they were involved in writing their plans of care.

When necessary best interest decisions had been made to ensure the health and well-being of individuals who lacked capacity to make decisions for themselves

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People's relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The activities provided have been in response to requests made by people who lived at the care home.

A visiting health care professional informed us that the service has responded well to advice and guidance, and implemented any changes that have been required in a timely manner.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

All staff received one to one supervision from the manager or from a member of staff in a more senior role. Staff we spoke with confirmed they felt well supported and well led by the manager. One member of staff told us, "In supervision, we can discuss any problems there may be in the house. We can get advice about any changes that are needed or what needs to be improved."