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Archived: The Manor House Inadequate

We are carrying out a review of quality at The Manor House. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 12 October 2018

During a routine inspection

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 ca

Inspection carried out on 20 February 2018

During a routine inspection

This inspection visit was carried out on 20 February 2018 and was unannounced.

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. The

Inspection carried out on 4 May 2017

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 10 January 2017. A breach of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found.

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.

Inspection carried out on 10 January 2017

During a routine inspection

This inspection visit took place on 10 January 2017 and was unannounced.

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

Inspection carried out on 29 September 2016

During an inspection to make sure that the improvements required had been made

This inspection visit took place on 29 September 2016 and was unannounced.

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 mee

Inspection carried out on 29 February 2016

During a routine inspection

This inspection took place on 29 February 2016 and was unannounced.

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 pl

Inspection carried out on 8 November 2013

During a routine inspection

People told us they were happy with the support they received. One person told us “I like it here, the staff help you.” Another person said “I like living here, I like all my friends.” Another person told us about their holiday and the support they had received from a member of staff. People were involved in making decisions about their daily lives, and this was clearly recorded in their support plans.

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.

Inspection carried out on 25 April 2012

During a routine inspection

People's views and experiences were taken into account when planning and delivering people's care and support. People told us about the courses they were attending at college, and going to the day centre. One person told us about going to ‘The Green Gym’, a local gardening club and meeting their friends there. Another person told us about learning cookery at college, and going to Derby Dance every Monday. Another person told us they worked with Derby City Council as part of ‘Empower Derby’, which is a self advocacy group for adults in Derby who have a learning disability.

People told us they were asked their views about what was good at The Manor House and what they would like to change. They told us they felt able to raise any issues in these meetings, as well as at any other time.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with people who used the service and they told us they liked living at The Manor House.

People we spoke with told us they liked living at The Manor House. One person told us “Very nice here, they help me a lot.” Another person said “It’s alright, I can go out.” One person we spoke with said “I like the staff and I like living here. I didn’t like it to begin with, but I have got used to it.”

People we spoke with knew about their care plans and told us they were kept in the office. People knew they had a key worker (a named person responsible for updating the care plans with the person). They told us their key worker talked to them about their care plans. All the people we spoke with said they would feel comfortable telling a member of staff if they were unhappy.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted upon. People who used the service had the opportunity to attend ‘residents meetings’ and comment on the running of the service.

Reports under our old system of regulation (including those from before CQC was created)