Archived: The Manor Care Homes

The Manor provides residential and nursing care for older people. The Manor is registered to provide care for up to 67 people, over three units in the home. At the time of our inspection there were 15 people living at the home in Windsor unit, and Sovereign and Tudor units are currently closed. The Manor Care Homes 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.

At the last inspection of the service on 16 and 19 September 2017 we found there was an absence of the provider managing risks. This was a breach of Regulation 12 and 17 of the Health and Social Care Act 2008, and a breach of Regulation 18 (Registration) Regulations 2009, Notification of incidents.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well Led to at least good. We did not receive an action plan from the provider which should have outlined the action they were going to take. At this inspection we found that the provider had made improvements in all three areas where there was a breach. This followed the involvement of a consultant who brought their own staff team into the home to support the provider.

There was no registered manager in post. The provider confirmed the acting manager had begun the application process. 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 Manor Care Homes 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 provider has formulated an action plan and has commenced improvements in the home. There is an extensive plan of refurbishment where improvements to the fire safety have been highlighted. Decoration of areas has commenced and these are being planned with people’s dementia and failing sight in mind so areas will be highlighted in vivid colours.

At the last inspection of the service we found there was a lack of oversight by the provider to check quality monitoring had been carried out effectively. At this inspection, we found that the provider had commenced a wide range of quality monitoring checks. We will return to ensure these are embedded and protect people in the home.

The provider carried out quality monitoring checks in the home supported by the acting manager and home’s staff. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an emergency arose, or an equipment repair was necessary. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance diary to manage any emergency repairs.

We found that applications had been made to the local authority to legally deprive people of their liberty. The acting manager and care staff had been trained in the Mental Capacity Act (MCA) 2005. They were also aware of best interests meetings to ensure peoples treatment was in line with the MCA and Deprivation of Liberty Safeguards. People were asked for their written consent to care following their admission to the home. This was in addition to staff agreeing their actions prior to each caring intervention.

Staff had received training for their specific job role, and staff had begun to be enrolled on more formalised training which would increase their overall knowledge and provide them with a nationally recognised qualification in care. Staff were able to explain how they kept people safe from abuse, and were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse. Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home.

People were provided with a choice of meals that met their dietary and cultural needs. The catering staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices to meet their individual dietary needs and preferences. A range of activities tailored to people’s interests were provided by staff on a regular basis. Staff had had access to information and a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the acting manager and staff, and the care offered to their relations. People were involved in the review of their care plan, and when appropriate their relative’s views were included. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans were being re-written to ensure they were easy to read and described the care and assistance people required. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks, with health professionals both in the home and externally.

We observed staff positively interacted with people throughout the inspection, where people were offered choices and their decisions were respected.

We received positive feedback from the local authority with regard to the improved care and services offered to people at The Manor Care Homes.

The Manor Care Homes is a care home that provides residential and nursing care for up to 67 people, many of whom are living with dementia. The accommodation is provided over three units, accessible by using the lift and stairs. At the time of our inspection there were 31 people using the service.

The registered manager of the service had left in March 2017. 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. An acting care manager, who had previously worked as registered manager in the service, was overseeing the day-to-day management.

We last inspected The Manor Care Homes in March 2017. At this time we found the registered provider was not compliant with the regulations. This was because the provider failed to have effective systems in place to ensure the quality of care was regularly assessed, monitored and improved to ensure people received good care.

At this inspection we found the provider continued to breach the regulations relating to good governance and did not have systems in place to keep people safe. In addition, we found further breaches of regulations at this inspection.

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.

People were supported by staff who did not all have the knowledge and skills to provide safe and appropriate care and support. The provider had systems for ensuring there were adequate numbers of staff but systems were not effective in ensuring staff had the right skills and experience to keep people safe.

People were not always protected from the risk of harm or actual risk because the provider had not consistently notified authorities, including CQC and the local authority, of significant accidents and incidents within the service. This included expected and unexpected deaths of people using the service. This meant authorities were unable to take timely action in order to assure themselves that people protected from the risk of avoidable harm.

The provider did not have established systems or processes in place to enable them to assess, monitor and improve the quality and safety of the service provided. They were unable to demonstrate how they assured themselves that they were providing good care and people were safe in the service.

The provider's safeguarding and staff recruitment procedures helped to protect people from the risk of harm and abuse. The provider had not followed their safeguarding procedure. Although staff raised concerns with managers, concerns had not been escalated to external authorities to ensure action was taken to keep people safe.

Risks to people's health, safety and wellbeing had been assessed and were included in people's care plans. Records included guidance for staff to follow to protect people from the risk of harm.

People were supported to received their prescribed medicines safely.

Experienced staff completed training relevant to their roles. They told us they felt supported to perform their role and responsibilities. Agency staff did not consistently complete induction to enable them to provide effective care. The care manager agreed to review induction training for staff who were new to the service to ensure all staff were able to provide effective care that was personalised.

Staff felt supported by the care manager and the clinical lead and were able to approach them for advice and guidance when they needed to.

Staff ensured people's rights and best interest by working within the principles of the Mental Capacity Act (MCA) 2005. People were supported to make choices and decisions about their care.

People were supported to maintain and improve their health, nutrition and wellbeing. People were supported to access external health professionals when they needed to.

Records to monitor people's nutrition and health were not always completed accurately to demonstrate staff were following guidance from health professionals.

People and relatives had positive relationships with most staff. Some staff demonstrated they were not familiar with people's needs. Staff treated people with kindness, compassion and respect. Staff promoted people's dignity, privacy and rights when they provided care. People and relatives were involved in the development of their care plans.

People's care was reviewed and care plans updated to ensure they reflected people's current needs.

People were supported to pursue their hobbies and interests and people were involved in developing activities in the service. We found at times there was not consistent stimulation to prevent people feeling bored or frustrated.

The provider had a complaints procedures, however people and relatives were not assured that their complaints would be resolved to their satisfactions. This was because although people felt listened to, they felt any improvements made were not sustained.

People, relatives and staff had confidence in the day-to-day management of the service by the care manager. Some people and relatives felt the provider was not in touch with people's needs.

We issued a Notice of Decision to suspend admissions to the service. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Manor Care Homes is a care home that provides residential and nursing care for up to 67 people, many of whom are living with dementia. The accommodation is provided over three units, accessible by using the lift and stairs. At the time of our inspection there were 45 people using the service.

The service had a registered manager in place 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.

People and relatives were supported to share their views about the service. However, changes were not always made and improvements were not sustained when people requested them. The provider had systems in place to monitor the quality of the service. Quality assurance audits and checks were not effective in developing the service and driving improvements.

People told us they felt safe at the service and with the staff that looked after them. However, some relatives had concerns about their family member's safety due to the large turnover of staff. The provider had systems for ensuring there were adequate numbers of staff with the right skills and experience to provide safe care and support. Staff were recruited in accordance with the provider's recruitment procedures.

Staff demonstrated they understood the provider's safeguarding procedure (protecting people from abuse) and knew how to keep people safe.

People received their medicines as prescribed. However, further improvements were needed to ensure medicine records were completed accurately.

People's care needs were assessed including risks to their health and safety when they started to use the service. However, improvements were needed in relation to how risks to people's health and well-being were reviewed to ensure assessments were reflective of people's current needs.

Staff received an induction when they commenced work and on-going training to support people safely. We saw staff used equipment to support people correctly. Staff received support through regular supervision.

We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had been followed. Mental capacity assessments reflected the choices and decisions they were able to make and the support they needed to make more complex decisions. Staff demonstrated they sought people's consent before providing care and support.

People were provided with sufficient meals and drinks that met their nutritional needs. People were supported to have access to health care appointments and referrals were made to health care professionals for additional support or guidance if people's health changed. However, records to monitor people's health and well-being were not consistently completed or accurate. This meant people's needs were not always effectively monitored to ensure people received appropriate care.

People told us they were treated with care and that staff were kind. We observed staff were respectful and kind when they spoke with people. Staff recognised and responded to people's distress or discomfort and people were supported to maintain their dignity.

People received care that was personalised and care plan reflected people's wishes and preferences. Staff had some knowledge of people's life history and things that were of interest to them, despite staff turnover. Further action was needed to ensure people's care plans reflected people's current needs and evidenced that people had been involved in reviews of their care.

People were supported to take part in activities and to go out into the community but it was clear there was a lack of meaningful for people to follow their hobbies and interests.

People and relatives were confident to raise any issues, concerns or to make complaints. People told us the registered manager was available and approachable. However, people and relatives felt that concerns raised were not always addressed or resolved in the long-term.

At our last inspection on 8 March 2016 we asked the provider to take action to make improvements and this action has now been completed.

The Manor Care Homes provides nursing and personal care for up 67 people. At the time of our inspection there were 32 people using the service. A number of people accommodated at the service were living with dementia and some people had complex physical needs. The service is located in Leicester and accommodation is provided over two floors with a lift for access.

The Manor Care Homes 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.

Following our inspection in November 2015 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there. The commission placed the service in special measures and the provider agreed not to admit any new people until they had improved the care provided. At the time of this inspection we found that although there were some areas where further improvement was needed, significant progress had been made in the way that the service operated and in relation to the way in which care was being provided. Therefore the service has been taken out of special measures.

People using the service told us they felt safe and relatives felt their family members were safe. We found there was not always enough staff available to deliver people's planned care. The registered manager took immediate action to ensure staff were deployed more effectively to meet people's needs. Staff were safely recruited to help ensure they were safe to work in the service. Staff were trained in safeguarding people and knew what to do if they had concerns about the well-being of any of the people using the service.

Potential risks to people had been assessed, such as risks associated with the person's health condition and environment. Risk assessments were not always updated to reflect changes in people's needs and abilities.

The provider had ensured that effective systems were in place to ensure medicines were stored, administered and managed in a consistent and safe manner.

Staff received training and support that provided them with the knowledge and skills required to work at the service. We observed staff were confident and skilful in their interactions with people and talked with people as they supported them and put them at ease.

The provider had implemented a revised staff training and competency framework and nurses and care staff said they were satisfied with the amount and quality of training they received. People were well supported with their healthcare needs and records showed they were seen routinely and when required by a range of health and social care professionals.

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

We found the requirements to protect people under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been followed. Appropriate paperwork was in place, including care plans, to demonstrate any restrictions on people's liberty were being lawfully applied.

People told us the staff were respectful and caring and supported them to maintain their privacy and dignity. People were offered choices and involved in their own care. We saw staff supported people to maintain their independence.

Staff were knowledgeable about the people they supported and demonstrated that they knew their likes, dislikes and interests. Care plans had been developed to focus on people as individuals and described their choices and how they wanted their care to be provided.

Staff had introduced a new programme of one-to-one and group activities. Records showed and we saw that these were well attended and people told us enjoyed having more to do.

All the people using the service, relatives and staff we spoke with during our inspection said the service had improved. The provider's quality assurance system had identified where some developments were needed to the service, although we saw that improvements were not always identified or completed within timescales. Further improvements were needed to record-keeping and to ensure audits were consistently applied.

We carried out a focussed inspection of this service on 7 March 2016. The inspection was unannounced.

We undertook this focussed inspection to check upon the enforcement action we had taken against the provider and whether the provider now met the legal requirements. This report only covers our findings in relation to the requirement and information gathered as part of this inspection. You can read the report from our last comprehensive inspection, by selecting 'all reports' link for The Manor Care Homes on our website at www.cqc.org.uk

The Manor Care Homes provides nursing and residential care for up to 67 people many of who are living with dementia. At the time of our inspection there were 39 people in residence. Accommodation is divided into three units, referred to as Sovereign, Tudor and Windsor. The provider has temporarily closed the unit known as Tudor to carry out upgrade works to the environment and enable the service make the improvements required.

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.

During our inspection we found the provider had made improvements in the specific areas we had identified.

The provider had introduced a new format to care plans which had improved person-centred care. Staff spoke positively about the new care plans and felt that plans were more informative and easier to use. Plans took into account people's preferences, likes and dislikes and routines.

It was not always evident that people and their relatives had been involved and consulted in the reviewing of their care needs. We found that in some instances people's involvement or that of their family was not documented. Not all care plans and records had been updated to reflect changes in people's care as a result of care reviews.

People were aware of how to raise a concern and were confident to do so. The provider was more pro-active in responding to concerns about the service in order to minimise the risk of complaints.

We found that the provider had made implemented arrangements to monitor the quality of the service in order to keep improving the quality of care people received. Robust audits were in place to check the work being completed by staff. These checks were more effective in identifying and quickly responding to issues they identified at an earlier stage. However, audits had not always identified inconsistencies in care plan records.

Audits included gaining feedback from people who used the service and their relatives each month. People who we spoke with and their relatives told us that they felt involved in their care and had opportunities to be involved in the development of the service through resident and family meetings

We also spoke with two people who used the service, five staff members working at the service and five relatives of people who used the service. The relatives we spoke with were all happy with the care provided at the home. One relative told us: "She's looked after brilliantly as far as I can see." Some of the staff we spoke with expressed concern that staffing levels were just manageable and said that they would be unhappy if these were reduced.

We looked at people's care records and the activities available to them. We found that people were involved in the planning of their care, wherever possible, and that people were engaging with the local community.

We looked at nutrition within the home and found this to be of an acceptable standard.

We spoke with staff working at the home who told us that they felt happy in their work and that they believed themselves to be adequately trained and qualified to carry out their roles. They told us that there was continuous training offered by the home and that they felt they could approach the manager of the home should they need to.

We reviewed the staff numbers at the home at the time of our visit and found these to be sufficient. Staff told us they felt there were enough staff on duty at the home.

We looked at how the home recorded people's care and how they stored these records. We found this to be satisfactory.

People using the service were positive about it. One person told us, "It is a nice place, like home really." Another person commented that, "I like it here, they (the staff) do look after me and I have made some nice friends here." Nobody using the service was critical of the staff and they all told us that they enjoyed living at the home.

The relatives we spoke to were complimentary about the home itself, the staff working there and the quality of life their relative experienced there. One relative told us "It is all very good. I have no complaints at all. I don't think she'd be alive if they didn't look after her as well as they do." Another relative of someone who was new to the home told us, "I think the home is lovely and clean and, quite honestly, I couldn't wish for her to be anywhere else."

Staff working at the service did tell us that they felt that, at times, they needed additional members of staff on duty. One staff member said, "There are not enough staff on a daily basis." We observed staff to be very busy whilst on shift. The provider was in the process of recruiting additional staff members at the time of our visit. We did not see any evidence that staffing levels were having a negative impact on people using the service.