Archived: The Manor House

This inspection took place on 12, 22 and 30 October 2018. The first day was unannounced, the second day was announced to ensure the nominated individual who represented the limited company was in the home. The final day was spent telephoning people’s relatives.

At the last comprehensive inspection in February 2018 the service was rated, 'Requires Improvement.' We found the service was not meeting regulations with regard to good governance. The provider had failed to bring about sufficient, sustainable improvements to improve the quality of the service. We issued a warning notice against the provider.

Following the last inspection, we asked the provider to complete an action plan to tell us what they would do, and by when to improve the service. We agreed the providers date for them to make improvements in the management of the service; and the provider told us they would have completed their actions in relation to the other breach of the regulations by the end of May 2018.

The Manor 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.

The Manor House accommodates up to 16 people in one adapted building. At the time of our inspection there were 16 people living at the home.

The care service should be developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At this inspection we did not see the service provided to people met these values.

There was no registered manager in post. Since the last inspection the registered manager had left the role and cancelled their registration with us. 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 had appointed an acting manager in the service.

Health and safety checks were not regularly completed or evidenced to ensure risks to people’s safety were minimised. We identified some health and safety issues to the acting manager on the first day of our inspection visit where we had immediate concerns to people’s safety. These had not been followed up by the acting manager and fully reported onto other interested parties.

We found there was an absence of supervision by the provider to check quality monitoring had been carried out effectively. There was no evidence that quality monitoring had been undertaken since July 2018. The areas not covered included care plans and checks on medicines management.

There were no adequate infection control checks in place, staff were unsure which coloured mops and buckets were used consistently by staff in each area of the home. Staff were also unsure what temperature soiled clothing was washed at. These resulted in a heightened potential for cross infection and cross contamination of infection in the home. Improvements are required for the access to policies and procedures which would give staff the information to operate systems effectively and protect people in the home.

The audit systems in place were not reviewed by the previous registered manager to ensure people received a quality service. The nominated individual did not audit any systems in view of no registered manager being employed. Incidents were recorded but information was not always sent to CQC. Improvements are required in assessing risk to people.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. There was no system in place that allowed the acting manager to consistently supervise the staff to ensure people were safe in the home.

Care plans provided limited information for staff that identified some people’s support needs, however there was little information about people’s associated risks. There was enough staff on duty to respond to people’s health and care needs, however, social care and pastimes were not seen as a priority and people were not supported with these because staff did not have enough time. Staff recruitment procedures were adequate which ensured people were cared for by staff who had been assessed as safe to work with them. Staffing levels were adequate to provide basic levels of care. People’s health and welfare was placed at risk from a poorly maintained environment.

The environment was in need of decoration, there was no plan of refurbishment of equipment or replacement of items or floor coverings. There were carpeted, corridor and store room areas in need of cleaning or replacement due to malodour.

People were supported in line with the requirements of the Deprivation of Liberty Safeguards (DoLS). People’s capacity had been assessed and six people had a DoLS in place for the restriction placed on them. Staff were not knowledgeable about the Mental Capacity Act 2005 (MCA) which could allow staff to unknowingly abuse people’s human rights.

People were cared for by a caring and compassionate staff group who. Staff demonstrated some knowledge about how to care for people. However, some staff training courses and training records were out of date. That meant that we could not be assured staff were in receipt of the necessary information.

Care reflected most of people’s needs, however care and support plans lacked detail and depth of detail to fully inform staff and protect people from harm. People had not been referred to health professionals to maintain or improve their health; Information about people’s dietary and cultural requirements were not updated.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last comprehensive inspection in January 2017 the service was rated, 'Requires Improvement.' We found the service was not meeting regulations with regard to providing care in line with the Mental Capacity Act 2005 and having systems in place to ensure quality services. We issued a warning notice against the provider. We followed up these issues in a focussed inspection in May 2017 and found improvements had been made, though further improvements were needed to ensure people were always supplied with a good, quality service. The service remains rated as, 'Requires Improvement.' The service has been rated as 'Requires Improvement' for over two consecutive comprehensive inspections.

At this inspection, we found the provider had continued to make improvements to the care provided. The provider had made improvements to systems and processes for monitoring and evaluating the quality of care but this area required further development. Some shortfalls identified during this inspection had not been identified though audits and checks. The provider had failed to make sufficient, sustainable improvements to the quality of the service. The overall rating for this service remained 'Requires Improvement.'

The Manor House is a 'care home' without nursing. 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.

The Manor House accommodates up to 16 people across two floors and is situated in the Littleover area of Derby. The service primarily supports people living with a learning disability and mental health needs. At the time of our inspection, there were 16 people using the service, including one person who regularly used the service for respite.

The service had 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 2008 and associated Regulations about how the service is run.

The registered manager was promoting a positive culture in the service that was focussed upon achieving good outcomes for people. They had identified where improvements were required and had taken steps to make some changes and develop the service. Further improvements were needed to ensure people were provided with good care as a minimum standard.

Staff demonstrated a good understanding of actions they needed to take to keep people safe. Records showed potential risks to people had been assessed, but did not always include the detail and guidance regarding the measures staff needed to take to reduce risks or reflect people's current needs. People received the support they needed if they became distressed or were placing themselves and others at risk of harm.

People were supported to have sufficient to eat and drink. Care records did not include detailed information and guidance for staff to support people to manage their health conditions. However, staff demonstrated they were knowledgeable about people's needs and supported people to access a range of health services to maintain their health and well-being.

People's care plans did not always include the information staff needed to provide personalised care. There were limited records to demonstrate how people had been involved in the review of their care. However, staff demonstrated they had good knowledge about people's life histories, likes, dislikes and preferences.

Staff had completed training to enable them to recognise signs and symptoms of abuse and felt confident in how to report concerns.

Staff were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.

People were supported to take their medicines safely and as prescribed. Systems were in place to support staff to follow safe infection control procedures to prevent the risk of infection when providing care.

The provider reviewed accidents and incidents and took action to ensure lessons were learnt to avoid future harm.

Staff completed an induction process when they first started working in the service. They received on-going development training and supervision for their role. The registered manager reviewed and evaluated training to ensure it was effective. They had planned further training to ensure staff skills and knowledge were based on current best practice.

People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 (MCA), sought consent before providing care and respected people's right to decline care and support.

The provider was in the process of upgrading the premises to improve the facilities for people using the service.

People were treated with kindness, respect and compassion and they were given emotional support when needed. Staff demonstrated they understood the importance of upholding people's right to privacy and dignity.

Staff supported people to express their views and be involved in making decisions about their care as far as possible. This included consulting relatives and access to independent advocates if necessary.

People were supported to engage in a range of activities and provided with opportunities to be involved in the local community.

People and relatives told us they felt comfortable in raising concerns and complaints and had confidence in the registered manager to take action to resolve them.

You can see what action we told the provider to take at the back of the full report. Full information about CQC's regulatory response to the concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out a focused inspection of this service on 4 May 2017 which was unannounced. We checked whether they now met the legal requirement. This report only covers our findings in relation to ‘Well-Led’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Manor House on our website at www.cqc.org.uk

A registered manager was not in post. The provider had appointed a manager. The provider told us the manager was in the process of applying to the Care Quality Commission to be the next 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 2008 and associated Regulations about how the service is run.

The provider had appointed a management consultant and a quality lead to support them and the manager to make the required improvement.

The people we met appeared content and relaxed. Those who were able to give their views verbally said they were happy at the service. One person told us they liked their room and the staff.

During our inspection visit we saw people take part in some activities. In the afternoon they went into the garden and played ball games on the lawn. Those who did not want to go outside did individual activities indoors including colouring and listening to music. Staff told us the provider had purchased new games and other activity resources for people and they enjoyed using these.

The people’s care plans we looked at had been reviewed and re-written so that staff had improved guidance about the support people required. Further action was needed to ensure all the information was accurate so they could support people to stay safe and well.

People received their medicines in a safe way. We found medicines were stored, administered and managed safely. Staff had clear information and guidance to follow to ensure people’s health needs were met.

Staff told us they felt supported by the manager and the quality lead. Records showed staff had received some training and were supported in their roles through individual supervision and meetings. Further training dates had been planned.

We found improvements to the premises were ongoing with regards to the repairs, re-decoration and heating to improve the living environment.

The manager had introduced an interim system of audits and checks whilst the provider’s management consultant developed a comprehensive audit system. Some audits had been completed for the month of March 2017 on the premises, management of medicines and care plans. However, further action was needed ensure that the audits were robust and completed in a timely manner and that any shortfalls identified would be addressed promptly.

The Manor House is a care home that provides residential care for up to 16 people and specialises in caring for people living with a learning disability or people who have mental health needs. The accommodation is over two floors. At the time of our inspection there were 13 people using the service.

Although it is required to have one, the service did not have a registered manager in post at the time of our inspection. 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.

At our last inspection of the service in September 2016 we found the provider's arrangements to assess people's mental capacity and obtain people's consent to care and arrangements for the effective governance of the service were not sufficient to ensure that people received effective care from a service that was well led. These were respective breaches of Regulations 11 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection the provider told us about the action they were taking to rectify the breaches. At this inspection, we found that some improvements were made sufficient to rectify the breach in Regulation 11 but further improvements were needed to ensure quality assurance systems were robust and effective in ensuring people received quality care.

The provider had introduced a new system of audits and checks to assure themselves that people were receiving good care. However, we found the governance and quality assurance systems were not sufficiently robust or effective in where improvements were required and how these were to be made. There was no evidence that the provider reviewed, identified shortfalls and took steps to make improvements in a timely manner. This meant the provider was unable to demonstrate their ability to sustain continuous service improvements and ensure people were receiving quality care.

The deputy manager oversaw the day-to-day running of the service. She got on well with people and relatives who felt happy to approach her whenever they wanted to. Staff told us they had confidence in her support but had little confidence in the leadership and governance of the provider.

People, staff and relatives were encouraged to share their views and be involved in the running of the service.

People told us they felt safe at the service and with the staff that looked after them. Staff understood the safeguarding procedure (protecting people from abuse) and knew how to keep people safe.

People's care needs were assessed including risks to their safety and well-being. However, further improvements were needed to enable staff to monitor accidents and incidents and reduce the risk of further occurrences.

Staff were recruited in accordance with the provider's recruitment procedures. There were sufficient staff available to meet people's needs safely and reliably.

People's medicines were mostly managed safely but medicine records were not always accurate. Improvements were required to ensure that systems were in place to ensure medicines were stored safely.

Staff were knowledgeable about the needs of people and had completed a range of training to enable them to provide effective care. Training records were not kept up to date and the provider had not assessed staff individual training and development needs. This meant that staff may not receive the training they need or have access to updated training to enable them to continue to provide effective care.

Staff told us that the deputy manager provided staff with support and guidance within their roles. Staff did not have confidence in the support of leadership of the provider.

The service ensure people's rights and best interests by working within the principles of the Mental Capacity Act 2005 (MCA) to obtain people's consent or appropriate authorisation for their care. This meant people had been given the opportunity to make their own decisions or those acted on their behalf made decisions in people's best interests.

People were positive about the food provided and were given sufficient to eat and drink in order to meet their nutritional needs.

People had their health care needs assessed and care plans were put in place to meet their needs. However, we found care plans did not always include sufficient information and detail to provide staff with the information they needed to keep people healthy. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people's health.

Staff were caring, compassionate and attentive in their approach to meeting people's needs. Staff treated people with respect and promoted their dignity when they provided care. Staff supported people to gain independence and respected their preferences as to how they liked their care to be provided.

Staff knew people well and used the information they had about people's interests to tailor their support. Care plans reflected people's wishes and preferences and supported staff to provide care that was person-centred. People and, where appropriate, their relatives were actively involved in deciding how they wanted their care and support to be delivered.

People were supported to access a range of activities. These included one-to-one and group activities such as arts and crafts, pampering sessions, gardening, meals out and day trips.

The provider had a clear complaints procedure which provided people and their relatives with clear information about how to raise concerns and how they would be managed. People's ability to raise complaints had been assessed and where they lacked mental capacity to raise concerns, a copy of the complaints procedure had been provided to the person's advocate. People and their relatives told us they felt comfortable to raise any concerns and were confident these would be listened to and acted upon.

During this inspection we found one breach 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 this report.

We carried out an unannounced comprehensive inspection of this service on 29 February 2016. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach of Regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because we found the provider's arrangements to obtain consent for people's care and ensure people's freedom was not being unlawfully restricted were not sufficient to ensure people received effective care. We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Manor House on our website at www.cqc.org.uk.

The Manor House provides accommodation and personal care for up to 16 people living with a learning disability. At the time of our visit there were 13 people using the service. The service is required to have a registered manager. At the time of our visit, there was no 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. A manager was in the process of applying for registration with the us.

We found the requirements to protect people from having their freedom unlawfully restricted under the Deprivation of Liberty Safeguards had been followed. Applications had been made for people and the provider had systems in place to monitor authorisations and alert staff when they needed to be reviewed. Where people had mental capacity, we saw that staff supported them to make choices about their care. However, where people may not have mental capacity to make decisions or consent to care, assessments were not always completed accurately and failed to consider that people may still be able to make some decisions for themselves.

There was no registered manager in post. At the time of our inspection the service had been without a registered manager for over 430 days. We were told that a manager was in the process of making an application for registration with the Care Quality Commission.

The provider's quality governance and assurance systems did not always assure the delivery of high-quality care for people. Audits and checks were carried out but these were not effective in monitoring the quality of the service, identifying where improvements were required and ensuring improvements were made in a timely way. The provider was not able to meet targets stated in their own action plan. There was no evidence to demonstrate that the provider used the outcomes of audits and checks to bring about improvements within the service.

People were provided with a choice of meals that met their cultural and dietary needs. Meals were chosen in advance and people were supported to choose from two main meals through picture menus. People had limited opportunities to make their own drinks and snacks. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people's health.

Staff received training and support that provided them with the knowledge and skills required to work at the service. The provider was in the process of improving the way they monitored training staff had undertaken to enable them to monitor when refresher training was due and plan training accordingly.

People and staff told us they had opportunities to share their views about the service through meetings and by speaking directly with managers and the provider.

We found two 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 this report.

We previously carried out an unannounced inspection of this service on 8 November 2013. Three breaches of legal requirements were found. This was because the provider had not maintained the environment and carried out suitable repairs and refurbishment, the provider had not completed mental capacity assessments or held bet interest assessments for people who lacked mental capacity. The provider had also not ensured that medicine records were completed accurately.

We undertook this inspection to check if the provider had implemented their action plan and to confirm that they now met legal requirements.

The Manor House is a care home that provides residential care for up to 16 people with a learning disability. The accommodation is over two floors, accessible by using the lift and stairs. At the time of our inspection there were 14 people using the service and one person was in hospital.

The Manor House is required to 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 2008 and associated Regulations about how the service is run. At the time of our inspection, a registered manager was not employed at the service. The provider told us they were in the process of actively recruiting for a registered manager.

As part of this inspection we looked at the improvements made by the provider and to confirm that they now met the legal requirements.

People told us they felt safe at the service and with the staff that looked after them. Staff understood the safeguarding procedure and knew how to protect people from abuse and keep them safe.

People's care needs were assessed including risks to their health and safety. However, improvements were needed in relation to how risks to people's health and well-being were assessed and the guidance available for staff to provide safe and appropriate care.

People were supported to receive their medicines safely. However further improvements were needed to the storage and recording of medicines to reduce the risk of errors during the administering of people's medicines.

Staff were safely recruited to help ensure they were suitable to work in a care setting. Staff received an induction when they commenced work and on-going training to support people safely. We observed that sufficient numbers of staff were deployed within the service at the time of our inspection.

We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had not been followed. Further action was needed to ensure a mental capacity assessment was carried out so that people's wishes were known and kept under review. Where a person lacks capacity to make decisions or are unable to do so, then the provider must act in accordance with their legal responsibilities to ensure that any decisions made are in the person's best interests.

People were supported to have sufficient to eat, drink and maintain a balanced diet. Meals were served individually and staff provided assistance to people who required it.

People using the service said the staff were well-trained and provided effective care and support. We observed staff were confident and skilful in their interactions with people and always talked to people as they supported them and put them at their ease. Staff told us they were satisfied with the amount and quality of the training they received.

People were well supported with their health care needs and records showed they were seen routinely and when required by a range of health and social care professionals.

People told us the staff were caring and encouraged them to be independent. People were offered choices and involved in their own care. Care plans were not always updated to reflect changes in people's needs.

People were supported to access the wider community and engage in one-to-one and group activities within the service. Activities included college courses, arts and crafts, shopping, trips to local facilities and pub visits.

The provider's quality assurance system was not applied consistently. There were limited audits carried out and those that were saw were ineffective. There was no recent recorded evidence that people in the service had opportunity to feedback on the running of the service. However people did confirm that they had attended meetings where they had been consulted and involved and felt able to give their opinion on proposed changes within the service. There was no evidence to demonstrate that the provider reviews, identifies where improvement is required and takes the necessary action to make improvements.

We found one breach 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 this report.

Staff had clear guidance on how to support people in the way that they wished. People's health care needs were met, with support from a range of health care professionals.

People received their medication as prescribed. Staff assisted people to take their medication if they were unable to manage themselves.

People told us their bedrooms were being redecorated and they were involved in choosing what wallpaper and paint that they would like. However, the building required repairs, refurbishment and better maintenance.

People said there were sufficient staff on duty to meet their needs.

Improvements needed to be made in record keeping. Medication administration records were not accurate, as staff had not always signed when they had administered medication. Although detailed support plans were in place, best interest assessments had not been completed for people who lacked capacity to make important decisions about their life, health or welfare.