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Inspection Summary


Overall summary & rating

Good

Updated 31 July 2018

Manchester House 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. Manchester House is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability. There were 65 people accommodated at the time of the inspection.

This was an unannounced inspection which took place over two days on 25 and 26 June 2018.

The last comprehensive inspection was carried out in May 2017 when we found some breaches of regulations relating to safe care and treatment and Governance of the service. We followed up in November 2017 and found improvements had been made and the breaches of regulations were met. We rated the services as ‘Requires improvement’ because we needed to ensure the service could maintain consistent standards over a more prolonged period of time.

At this inspection we found improvements had been sustained. The service accommodates people with a wide range of diverse and complex care needs. Although we highlighted some areas for improvement we found that people living at Manchester House were receiving safe care which also enhanced their quality of life. The management and leadership of the service was more established and consistent.

There was a registered manager in post. 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.

We found the management structure supported the service with clear lines of accountability and responsibility. The auditing and monitoring systems in place had been developed over a period of time and were now fully embedded. This level of monitoring helped identify and reduce risks around safe care and treatment.

At the last inspection in November 2017 we made a recommendation for improvement because we found people were not always being supported in good time with their personal care needs; people told us they had to wait for extended periods of time when using their call bells to call for support. At this inspection we found some improvements had been made but feedback from people remained mixed and we saw that some people continued to present challenges for staff with respect to supporting their personal care needs.

We found people’s risks regarding their health was assessed and monitored. There was improved clinical leadership in the service and there was evidence of effective referral and liaison with supporting health care professionals. Feedback from a visiting health care professional was positive about staff approach and competence in relation to wound care and pressure ulcer monitoring.

We found people were protected against the risks associated with medicines because the provider’s arrangements to manage medicines were consistently followed.

We found the home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). People were being supported to make key decisions regarding their care and treatment. The supporting care plans and assessments evidenced people being consulted and involved in their care. Care plans we saw were clearly written, agreed by people and were being regularly reviewed.

There were ten people who were being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom and ensures that any restrictions are appropriate and in the person’s best interests. We found these were being monitored by the registered manager of the home.

P

Inspection areas

Safe

Good

Updated 31 July 2018

The service was safe.

People’s risks regarding their health care were assessed and monitored.

Medicines were administered safely. The provider’s policies and procedures were followed.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

There were enough staff on duty to help ensure people’s care needs were met.

Staff had been checked when they were recruited to ensure they were suitable to work with vulnerable adults.

There was good monitoring of the environment to ensure it was safe and well maintained.

Effective

Good

Updated 31 July 2018

The service was effective.

We saw people’s dietary needs were managed with reference to people’s individual preferences and choice.

When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed.

We found the home supported people to access support for their health care needs.

Staff said they were supported through induction, appraisal and the home’s training programme.

Caring

Good

Updated 31 July 2018

The service was caring.

When interacting with people staff showed a caring nature with appropriate interventions to support people.

People told us their privacy and dignity was respected.

There were opportunities for people to provide feedback and get involved in their care and the running of the home.

Responsive

Requires improvement

Updated 31 July 2018

Some people and their relatives told us there were long waiting times for staff to respond to people when they asked for help and assistance. This had potential to affect some people’s well-being.

Peoples care plans showed good detail and evidenced they had been regularly reviewed. For two people the care plan goals regarding personal care needed further review.

There were activities planned and agreed for people living in the home. These continued to be developed.

A process for managing complaints was in place and people we spoke with and relatives knew how to complain. Complaints made had been addressed.

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Well-led

Good

Updated 31 July 2018

The service was well led.

There was a registered manager in post to provide a lead for the home. There was a consistency of management and leadership which had provided improved stability for the service.

We found the senior management structure was now clearly defined and provided better support for the home. The provider had clear lines of accountability and responsibility.

The systems for auditing the quality of the service had been embedded and were consistently carried out.

There were some systems in place to get feedback from people so that the service could be developed with respect to their needs and wishes.