Manor Farm Residential Home

The people who use the service that we met and talked with were very positive about the staff and the way they were supported by them. We asked one person if they thought that there were enough staff on duty including at weekends. They told us that they thought there were sufficient staff. One person told us "The staff are really nice girls".

People said that they appreciate having their own rooms, and being able to choose how

they are decorated. One person told us "I choose the things I like to have in my room".

People told us that they liked living at the home. One person said "I'm really happy here it's my home".

When discussing personal choice, one person told us "I can get up when I like. If I don't

feel very well I go back to bed ". Another person told us "It's lovely. There is nothing

wrong with the place. I've got lots of freedom".

Four people who use the service told us that they felt safe at the home and that staff are "kind and considerate".

People told us that the food was "lovely" and that there was plenty to eat at times that

suited them. One person said "I can't fault the food".

Staff members we spoke with told us that knew about the whistle blowing policy. One

person said "There is a lot of whistle blowing going on at the moment. It's caused a lot of tensions in the staff team ".

From December 2011 to February 2012 we attended three safeguarding meetings

regarding concerns raised about the care of people living in the home. The subsequent

investigations and actions taken to discipline staff showed us that people had not always received safe care. As a result of the safeguarding concerns, in December 2011, the local authority stopped the placements of people into the home.

The issues, raised at the safeguarding meetings, included concerns about the manual

handling assessments and risk assessments for the use of specialist equipment such as a slide sheets or rotunda. Risk assessments did not provide enough information to support staff members in assisting people with safe movement and transfers. We read in one persons care file that they were concerned about the way staff had transferred them onto their bed. During our visit we saw a staff member transfer a service user in a wheelchair. We saw that they did not put the wheelchair foot plates down for this person. This person was put at risk of injuring their feet during the wheel chair manoeuvre.

There were also issue about unsafe staff practices in relation to the administration of

medication. We looked in the manager's personal file and did not see any evidence that

the manager had undertaken additional training in the administration of medication to

ensure they understood safe practice.

Members of the safeguarding meeting were concerned that the manager and the provider did not always inform the appropriate agencies about safeguarding incidents.

Following our visit a health professional told us they had visited the home and had been

concerned about aspects of medication safety, as they had seen that the keys to the

mobile medicine cabinet were in the lock of the cabinet. They were concerned that the

cabinet was unattended by staff members.

At our visit we saw that staff members were not properly trained or supervised. Some staff members have not received an induction when starting work at the home. The manger had not received any supervision, appraisal or induction. Staff members did not receive additional training after poor practice has been identified.

We have issued a Warning Notice about Regulation 23 (1) (Outcome 14) which requires

the registered provider to take action by 16 April 2012 to meet the regulatory requirements. If this is not achieved further enforcement action may be taken.

Service users told us that they felt safe at the home and that staff were 'very kind'. One person said 'I was lonely at my home and I am lonely here'.

People told us that the food was 'lovely, especially the puddings' and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

We noticed unpleasant odours in the lounge and in the main entrance.

Since our last site visit there have been some improvements. The manager has worked hard to meet the compliance and improvement actions from our previous report dated December 2010. She has started a new programme of staff training. People moving to the home now have their needs properly assessed and we found that care plan records have started to adequately address the needs of people living at the home.

Although people had positive comments to make about the home we were concerned about some of the things we noticed when we visited. We were told, both by people living and working at the home, that there had been a problem with staffing levels. At the time of our visit the manager told us that she had assessed the need for three staff to be on duty so that people can be cared for safely. We saw that these staffing levels were not consistently maintained. The manager told us she will ensure these staffing levels will be in place in the future.

People whose health needs change whilst they are living at the home do not always received sufficient care from the staff team.

Staff do not always know the staffing structure in the home and are unclear about who is in charge when the manager is not on duty. We found that peoples' care has been compromised at times when the manager was absent from the home. The provider has taken charge of the home in these circumstances, but she has demonstrated that she does not always have the appropriate skills to do so safely. This means that people cannot be assured that their needs will be met at all times.

The provider failed to provide correct information for a person moving to hospital and failed to ensure their medication was available at the home in a timely manner. This resulted in their medical treatment being compromised.

Staff had not followed correct infection control procedures to minimise cross infection risks in the home.

Service users told us that they felt safe at the home and that staff were 'lovely girls'. Two people told us staff were sometimes rushed and looked tired.

People told us that the food was usually 'lovely' and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

We noticed unpleasant odours in the lounge and in one of the bedrooms.

Although people had positive comments to make about the home we were concerned about some of the things we noticed when we visited. We were told both by people living and working at the home that there had been a problem with staffing for a while. At the time of the site visit the home was without a manager and we were told that often there was not enough staff. We found this was having a negative impact for people living at the home were in a number of ways. There had been incidents of aggression between some service users, who needed a lot of staff time to support their needs. People moving to the home often do not have their needs properly assessed and we found care plan records did not adequately address the needs of people living at the home. Staff did not always have the appropriate knowledge and skills to support the needs of people in their care. For example, failure to provide correct information for a person moving to a new home had been resulted in their medical treatment being compromised. Staff had not followed correct infection control procedures to minimise cross infection risks in the home. We found that the visiting district nurses were having visit frequently to educate and support the care staff in meeting the needs of people.