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Archived: The Manor Care Homes Requires improvement

The provider of this service changed - see new profile

Reports


Inspection carried out on 23 January 2018

During a routine inspection

The inspection took place on 23 January 2018, and the visit was unannounced.

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

Inspection carried out on 28 March 2017

During a routine inspection

This inspection took place on 28 March 2017 and was unannounced.

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

Inspection carried out on 30 June 2016

During a routine inspection

This inspection visit took place on 30 June 2016 and was unannounced.

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.

Inspection carried out on 7 March 2016

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

We previously carried out an unannounced inspection of this service on the 2 and 3 November 2015. During this inspection we found that the provider was not meeting the standards we expected and there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the systems to assess and monitor the quality of the service were not effective. We also found that people were not consulted or involved in their care.

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

Inspection carried out on 2 & 3 November 2015

During a routine 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 adults 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.

The Manor Care Homes provides nursing and residential care for up to 67 people many of whom are living with dementia. At the time of our inspection there were 43 people in residence. Accommodation is divided into three units, referred to as Sovereign, Tudor and Windsor. Each unit has designated communal areas and bedroom facilities. Accommodation for Tudor and Windsor units is provided over two floors with access via a passenger lift. There is a garden which is accessible and provides areas of interest.

This inspection took place on 3 November 2015 and was unannounced. We returned on 4 November 2015.

The Manor Care Homes had a registered manager in post at the service 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 the last inspection of the 14 July 2014 we asked the provider to take action. We asked them to make improvements with regards to medicines. We received an action plan from the provider which outlined the action they were going to take. We found that the provider had made some improvements.

However we found the policy and procedure for the safe handling of medicine was not being followed. The system for recording medicine in and out of the service was not robust which had the potential to compromise the safety of people using the service. We found people’s plans of care did not contain sufficient guidance for staff to ensure people received their medicine in a safe and consistent manner. Nurses responsible for the administration of medicine had not had their competency assessed.

People were supported by staff that had received training and had an understanding as to their role and responsibilities in reporting concerns with regards to abuse. Posters were displayed throughout the service which provided information as to external agencies to which concerns about abuse could be reported.

People at the point of moving into the service had potential risks to their health, safety and welfare assessed. People’s plans of care provided information as to how potential risks to people were to be minimised, however in some instances the information was not consistent and the process and information used to review people’s needs was not clear.

We found instances where people’s safety was compromised as the deployment of staff was not managed well. We found staff in some instances providing care and support to people who had not received the training to enable them to care for people safely.

We found systems and equipment were mostly maintained to a good standard. However within two units the environment was not maintained sufficiently to keep people safe. The provider had a plan for the closure of Tudor unit to facilitate its refurbishment.

People were supported by staff whose induction was not robust as records about staff induction were not consistently completed. Our observations showed that staff recently employed by the service were not effectively supervised. Staff did not receive regular supervision or have their competency assessed or appraised, which meant people did not always receive effective care. We found that the deployment of staff around the service was not effectively managed which meant the quality and consistency of care people received was mixed.

The use of agency staff meant that not all staff were familiar with the needs of people and their safety and well-being was compromised as people’s records did not always contain up to date and accurate information as to their needs. We found some staff to have a good understanding of the needs of people. People we spoke with and their relatives in the main told us they were happy with the care they received from staff.

People’s records showed that their capacity to make informed decisions had not always been considered and documented. We found people’s relatives in some instances had been asked to given consent to aspects of people’s care, which was not always reflective of the Mental Capacity Act 2005. The provider in conjunction with the consultancy firm was in the process of reviewing people’s plans of care so they reflected people’s capacity to make informed decisions.

People’s records showed that health care professionals had been involved where a person’s dietary intake was a cause for concern. Specialist diets, which included ‘soft’ diets for people who were at risk of choking, were provided. People’s nutritional intake was recorded to ensure people ate sufficiently.

We observed that people’s dining experience was mixed; the factor which contributed to this was the deployment and knowledge of staff to be able to assist people with their meals in a timely and sensitive manner. During the inspection we brought to the attention of the deputy manager and representative of the consultancy firm our concerns during and after the lunchtime meal in one unit as people were not receiving support in a timely manner. We observed some people were supported to eat their meal by staff that had a good understanding as to people’s needs and who encouraged people to eat in a caring and sensitive manner.

People and their visitors in the main spoke positively about the care people received from staff. We observed staff spending time with people in conversation and activities; however our observations showed inconsistencies over both days of our inspection or with regards to the individual units. In some instances we found people were not encouraged to take part in meaningful activities and staff did not spend time talking with people.

People’s involvement and that of their relatives in the development and reviewing of their care needs was not consistent. Records in some instances detailed the involvement of people’s relatives which was confirmed by visitors we spoke with. However in some instances we found people’s involvement or that of their relatives was not documented. Others records did not reflect what were important to individuals, such as their preferred daily routine or information as to their likes and dislikes. This meant that people’s support and care provided by staff was often driven by their need to complete tasks to ensure the running of the service rather that reflective of the individual needs of people.

People were aware of how to raise a concern and were confident to do so. Records showed that complaints were recorded and investigated, however records did not in all instances identify the outcome of the complaint investigation and how this information had been shared with the complainant.

The provider did not have quality assurance and governance systems in order to effectively monitor the quality and safety of the service provided. There was no evidence of audits being undertaken to be used as lessons learnt, with regards to risk, incidents, accidents and complaints that would support the provider and staff to reduce the likelihood of events reoccurring and therefore improve care.

A limited number of recent audits had been undertaken by the deputy manager had been carried out, however shortfalls identified had not been acted upon.

We found that policies and procedures with regards to quality monitoring, the management of complaints and safe administration of medicine were not followed. This had a direct impact on the quality of care people received.

The provider did not have an overview as to the care people received and therefore could not commit resources and develop the service.

Local authorities for health and social care who fund people’s packages of care have identified concerns as to the service being provided at The Manor Care Homes. Representatives from these authorities have been visiting the service in order to look into specific concerns.

The provider having received feedback from funding authorities has entered into a contract with a consultancy firm to provide support and guidance to bring about improvements to the service. The provider and representatives of the consultancy firm were at the service during our inspection.

We found four 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 the full version of the report.

Inspection carried out on 14 July 2014

During a routine inspection

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, and to provide a rating for the service under the Care Act 2014.

Our inspection was unannounced which meant the provider and staff did not know we were visiting.

The Manor Care Homes provides care and support for up to 67 people, most of whom have a diagnosis of dementia. Care and support is provided over three separate units within the home that are each led by their own unit manager. On the day of our inspection 57 people were using the service.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that people were not consistently protected from the risks associated with their medicines. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were needed to ensure the information contained in people’s care records was up to date in response to changes to people’s needs or recommendations from visiting health care professionals. This would help staff to protect people from the risk of receiving unsuitable or unsafe care.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Some people who used the service did not have the ability to make decisions about some parts of their care and support. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

People who used the service received their care in accordance with their care preferences. The staff understood people’s care preferences because people’s care records recorded how people wanted to receive their care.

People’s health and wellbeing needs were met, monitored and reviewed. The registered manager had a training plan in place to ensure staff received the training they required to meet people’s individual needs.

People who used and visited the service were happy with the care provided and we observed staff treating people with care and compassion.

Feedback from people who used and visited the service was sought and the registered manager made improvements to the care provided in response to receiving feedback.

The registered manager regularly assessed and monitored the quality of the care at the home. Appropriate and prompt action was taken to make improvements to the care when required.

Inspection carried out on 9 May 2013

During a routine inspection

Many of the people that used this service had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had at the home we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in a service and helped us to record how people spent their time, the type of support they got and whether they have positive experiences. We found that staff were meeting people's needs, that they used various means of communication depending on the person they were interacting with, and that these interactions were, mostly, positive.

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.

Inspection carried out on 12 March 2013

During an inspection in response to concerns

We carried out this review due to concerns raised about the standard of record keeping and staffing at the home. In order to review these areas we visited the home and spoke with five members of staff, including the registered manager.

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.

Inspection carried out on 17 September 2012

During a routine inspection

As part of our inspection of this service we spoke with six people who used the service, five relatives of people using the service and 14 members of staff working at the service.

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.