Archived: The Old Manor House

There were two other breaches of the regulations found at the March and April 2016 inspection. One of these related to risk assessments not always being regularly reviewed. For example, medicine self administration and nutritional risk assessments following recorded weight loss. The provider had not followed their own action plan issued to CQC following the previous inspection. For example, the monitoring and regular provision of training for staff. Other concerns related to the lack of regular and effective review of care plans and errors in the recording of people’s money managed by the service. The action taken by the provider to address these concerns will be checked at our next comprehensive inspection.

After the last comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

This report only covers our findings in relation to the question “Is the service Effective.” You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Manor on our website at www.cqc.org.uk

The Old Manor House is a care home for up to 14 older people, some of whom were living with dementia. At the time of this focused inspection there were nine people living at the service.

At this focused inspection we found the registered provider had taken effective action to address the requirements of the warning notice and this had been met. However, the overall rating for this service has not been changed following this focused inspection. CQC require a period of time to elapse before we can judge that the service has sustained any improvements made in the way the service is run. We will review the outstanding breaches and the overall rating of the service at our next comprehensive inspection.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 previously carried out a comprehensive inspection of The Old Manor in November 2015. At that inspection we identified one breach of the legal requirements. This related to how the service was supporting staff to receive training, supervision and appraisal to enable them to carry out their work. We subsequently issued one requirement and told the provider to take action to address the breach of the regulations. The provider sent the Care Quality Commission an action plan following the publication of the report to state they were taking suitable action to address the concerns we raised.

We carried out this inspection to check if the service had made the required improvements identified at that comprehensive inspection.

Before this inspection we also received a number of concerns from an anonymous source. The allegations included that staff were not trained to administer medicines; not trained to help people with moving and handling; staff were rude to people living at the service; and did not assist people to use the commode when they needed it. At this inspection we checked to see if there was any evidence to support these allegations.

At this inspection we assessed what training staff received. We judged that opportunities for training for staff members was not satisfactory. Records demonstrated staff had not had suitable training in several areas, which were legally required. This included manual handling, safeguarding and first aid. The organisation provided staff with a corporate induction. However we judged this was not of sufficient length and depth to provide staff with enough skills and knowledge so they could do their jobs safely. Staff did receive an induction, but records to evidence this were not satisfactory for us to be certain it was delivered appropriately. The majority of staff had received supervision, and as appropriate an annual appraisal. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Suitable arrangements were in place to assess if people had capacity to make decisions, and the registered manager knew what action to take if people lacked capacity. However care staff had limited knowledge about mental capacity, and staff training arrangements in this area were not sufficient.

People had access to doctors and other external medical support. This included chiropodists, dentists and opticians.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. People told us they felt well cared for by staff who worked with them. People said staff were caring and attentive. Comments received included, “I have no complaints everything is excellent,” “I am fine here, everyone is doing a good job,” and “They (the staff) could not do more than what they are doing.”

People told us they liked the food at the service. Comments we received by people included, “Meals are very good,” “On the whole food is good,” and meals were, “Brilliant.”

We also spoke with the staff on duty. The staff had no concerns about the practice of team members. Comments included, staff “Get on well with the residents.” Staff said if they had any concerns about staff practice they would report it to management. Staff members we spoke with said they were certain management would deal with any concerns appropriately.

Risks in relation to people’s daily lives were assessed, identified and planned for to help ensure risk of harm was reduced. However, such assessments were not always reviewed regularly. For example changes in a person, such as loss of weight, were not reflected in their current nutritional risk assessment held in their care plan. This meant that staff were not always provided with accurate information to help them meet people’s care needs.

The registered manager told us that care plans should be reviewed every few months. Three out of the four care plans we reviewed had not been regularly reviewed. Five of the nine people who lived at the service permanently had care plans that required review. People’s care plans were held in files which did not securely hold the pages which fell out when the file was opened. This meant that pages easily became detached or lost. People and, where appropriate, their relatives were able to review care plans.

One person looked after their own medicines and had responsibility for storing and taking their prescribed medicines. Their medicines were not stored securely. A competency assessment, in their care plan, had not been reviewed since January 2016. There was no assessment with their medicine administration record, which showed they were competent and safe to do this. Regular medicines audits were carried out but had not identified this concern.

The service held personal money for two people. This money was held in securely in separate zip pouches with running accounts recorded. One person’s money was incorrect by £4. This error had been signed for and witnessed by two different staff and not identified until raised by the inspector.

People were supported by staff who knew how to recognise abuse and how to respond to any concerns. The service held a policy which was available to all staff to refer to as needed. Staff were confident that any concerns raised would be responded to appropriately by the registered manager.

Accidents and incidents that took place at the service were reported, recorded and audited. This meant the risk of re-occurrence was reduced.

People were provided with information on how to raise any concerns they may have. The service held a suitable complaints policy and had responded to concerns raised appropriately.

There were regular maintenance checks carried out at the service such as water, fire systems, wheelchairs, windows, and equipment such as the passenger lift. There was a maintenance person who addressed any repairs required in a timely manner.

People had access to some activities. Activities were provided by the care staff. Some external musicians visited to entertain people.

People and their families views of the service provided had been sought and recorded.

Staff felt well supported by an approachable and supportive registered manager. Staff told us the manager was “Very approachable,” and “Easy to talk to,” so staff felt they could approach the manager for help and advice when they needed this.

The registered manager was also the registered manager for another service in the Anson group. This meant they spent up to one day a week at this other service. The registered manager was supported day to day by a deputy manager. The provider and the operations manager also supported the registered manager. The registered manager had not previously identified the concerns found at this inspection.

We had concerns about quality assurance systems in place for example the ability of the registered persons' systems to detect and make improvements where problems at the service exist.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Old Manor House is a care home which offers care and support for up to 14 predominantly older people. At the time of this inspection 12 people were living at the service. The service occupies an older style detached house with accommodation over four levels.

The service had 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 walked around the service which was comfortable and personalised to reflect people's individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was possible to establish if people had received their medicines as prescribed. However, handwritten entries made by staff and management on the medicine administration records (MAR) were not always signed and witnessed. This meant there was a risk of errors and people may not always receive their prescribed medicines safely. The registered manager assured us this would be addressed immediately.

There were sufficient numbers of staff to meet people's needs. People told us staff responded quickly when they required assistance. Staff were supported by a system of induction and supervision. Staff meetings were held to allow staff to voice their views. Staff did not receive appraisals annually. Staff were not always supported to receive necessary training and updates to enable them to carry out their roles effectively.

Meals were a sociable event, with staff and people living at the service eating together and enjoying each others company. People were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

People's care records were held in files which did not hold information securely. Each time the files were opened all the pages fell out and there was a risk information could become lost. Care plans contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. People and where appropriate, their relatives were involved in care plan reviews.

The management and the people who lived at the service told us they did not enjoy group activities. Events had been arranged such as film nights, outside entertainers and bingo nights but people preferred to spend their time reading and chatting with others. Residents meetings also did not meet people's needs, with people requesting that their views be sought on a one to one basis in their rooms as they felt more able to speak freely in this environment. People's views were respected and this suggestion was accepted by the registered manager who was making arrangements to speak with people individually.

There was a programme of renovation and re decoration in process throughout the service. There were systems in place to monitor the quality of the service provided. Responses to surveys had been positive. There were records that showed manual handling equipment had been serviced. Fire alarms and evacuation procedures were checked by staff, the fire authority and external contractors, to ensure they were in good working order. There was a record of regular fire drills. This meant the service was well maintained and any defects were identified and addressed in a timely manner.

We identified a breach of the Regulations. You can see the action we have told the provider to take at the end of this report.

As part of our inspection we spoke with the registered manager and inspected the premises.

Following our inspection, we found people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw staff provided care to people in an efficient and kindly manner and they demonstrated empathy for and an understanding of the care needs of people who used the service.

We saw people had a choice of sitting area and that individuals chose where they wanted to spend their time.

The home had a garden at the front of the home where people could spend time outside.

The care records we saw provided guidance for staff on the care people needed and were regularly reviewed.

Medication administration systems in place were robust and complied with legislation.

A robust recruitment system was followed to ensure people were cared for by suitable staff.

Improvements to the environment were required including the provision of window restrictors, attention to the locking facilities to doors and the delivery temperature of the hot water.