Archived: The Manor House

Updated 28 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

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 with people’s relatives. On the first day of the inspection the team consisted of one inspector and an assistant inspector whose area of expertise was in the care of people with a learning disability. On the second day the team consisted of two inspectors, and calls were completed by the lead inspector. On the third day we contacted people’s relatives for their opinion of the care provided to their relations.

Before our inspection visit, we reviewed the information we held about the home and information from the local authority commissioners. The commissioners for health and social care, responsible for funding some of the people that lived at the home told us they had some concerns about how the home was being managed. We took this into account during our inspection.

We looked at the notifications from the provider; a notification is information about important events which the service is required to send us by law.

We spent time observing the care and support being provided throughout the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four people who lived in the home and four relatives, the nominated individual. This home is owned by a limited company, the nominated individual is appointed by the director(s) of the company to act on their behalf. We also spoke with the acting manager, the head senior carer, one team leader and one care worker.

We looked at the care records for four of the people who lived in the service. We also looked at records that related to how the service was managed including staffing rotas, recruitment, training and quality assurance.

We asked the nominated individual to send us documents to clarify the use of a temporary member of night staff. This was not sent for 2 weeks after the date requested. We also requested documents from the acting manager which included copies of the training records, the staff rota and minutes of meetings for the people who used the home and staff meetings. These were supplied following the inspection.

Updated 28 November 2018

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.