Archived: Neva Manor Care Home

Neva Manor Care Home is a residential care home providing personal care for people aged 65 and over. The service can support up to 14 people. At the time of the inspection 12 people were living at the home. The home provides accommodation across two floors. The first floor is accessible by stairs and a stair lift where there are bedrooms and two communal bathrooms. To the ground floor there are bedrooms, a kitchen, communal lounge, lounge-diner and a communal bathroom. There is access to a rear garden and car parking to the front of the home.

People’s experience of using this service and what we found

People gave positive feedback about living at Neva Manor Care Home. Staff were kind, caring and knew people well.

We made a recommendation about the management of Legionella. The provider was working through requirements made by the fire service in relation to fire safety.

Governance systems had been developed to be effective in identifying and actioning improvements. The service was well led and managed. Staff received regular training and supervision.

The home was clean and tidy. People enjoyed their individual rooms and the outdoor space at the home. There was a friendly and relaxed atmosphere where people had good relationships with the managers and a small, consistent staff team.

People enjoyed the food provided and mealtimes were sociable. People were supported to maintain good health. The service had developed positive relationships with local health teams.

People’s feedback and opinions were sought through surveys and meetings. There were good systems of communications within the staff members and with relatives. Care plans explained how people preferred their care and support to be delivered.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 August 2021). The provider had completed an action plan to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 19 (Fit and Proper Persons Employed).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the previous inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Neva Manor Care Home on our website at www.cqc.org.uk.

Enforcement

We have made a recommendation in relation to the management of legionella.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Neva Manor Care Home is a residential care home for people aged 65 and over. The service can support up to 14 people. At the time of the inspection 10 people were living at the home.

Neva Manor Care Home is located in Weston-Super-Mare. The home provides accommodation across two floors. The first floor is accessible by stairs and a stair lift where there are bedrooms and two communal bathrooms. To the ground floor there are bedrooms, a kitchen, communal lounge, lounge-diner and a communal bathroom. There is level access to the garden and car parking to the front of the home.

People’s experience of using this service and what we found

Improvements had been made at the service to address previous shortfalls identified in areas such as safeguarding, accidents and incidents, medicines, infection prevention and control and risk assessments.

People were supported by caring staff who knew them well. There was a pleasant and welcoming atmosphere at the home.

Overall, governance systems had improved. We found improvements were needed in parts of the recruitment process and associated auditing of these systems. Further areas which were being improved such as staffing assessments needed to develop. Staff had received training they required for their roles. Further identified training was planned.

The provider had sought feedback from people, relatives and staff. Communication systems were in place and had been reviewed to be more effective. Positive feedback was received about the improvements made at the service. The provider was approachable and had engaged with making required changes to ensure people were safe and well supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 April 2021). Four breaches of regulation were found and a warning notice was issued. We followed up the warning notice in a targeted inspection (published 25 June 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 22 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 11 and 18 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Neva Manor Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to Regulation 19 (Fit and Proper Person Employed) at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Neva Manor Care Home is a residential care home for people aged 65 and over. The service can support up to 14 people. At the time of the inspection 11 people were living at the home.

Neva Manor Care Home is located in Weston-Super-Mare. The home provides accommodation across two floors. The first floor is accessible by stairs and a stair lift where there are bedrooms and two communal bathrooms. To the ground floor there are bedrooms, a kitchen, communal lounge, lounge-diner and a communal bathroom. There is level access to the garden and car parking to the front of the home.

People’s experience of using this service and what we found

The provider had made improvements to the service and had met the warning notice in relation to Regulation 12 (Safe care and treatment).

Risk assessments and care plans around moving and handling, skin integrity, catheter care and modified diets had been reviewed to ensure accuracy and consistency.

Staff had received additional training and competency assessments in relation to infection prevention and control (IPC) measures and medicines storage. We made a recommendation around protocols for as required medicine.

Systems were in place to check, identify and improve outcomes for people in areas such as accidents and incidents, skin integrity, medicine management and IPC.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 April 2021). Four breaches of regulation were identified at this inspection.

We served a warning notice in relation to Regulation 12 (Safe care and treatment). At this inspection we found improvements had been made.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Neva Manor Care Home is a residential care home providing personal and nursing care to 12 people aged 65 and over at the time of the inspection. The home can support up to 14 people.

Neva Manor Care Home is located in Weston-Super-Mare. The home provides accommodation across two floors. The first floor is accessible by stairs and a stair lift where there are bedrooms and two communal bathrooms. To the ground floor there are bedrooms, a kitchen, communal lounge, lounge-diner and a communal bathroom. The registered manager’s office is located adjacent to the lounge. There is level access to the garden and car parking to the front of the home.

People’s experience of using this service and what we found

People were at risk of avoidable harm. Risks were not always identified, and risk assessments did not always include correct and sufficient information to guide staff about how they should keep people safe. Medicines were not managed and stored safely, one person had their prescribed controlled drugs administered incorrectly over a prolonged period. People were not always protected from the spread of infection and the provider could not be assured that sufficient numbers of suitably qualified staff were deployed across the service. The provider was not analysing accidents and incidents as a way of preventing a recurrence. People were at risk of potential abuse because there was no oversight of safeguarding in the service and the provider failed to act when people sustained bruising.

The provider’s governance system was not robust and had not been used effectively to identify the shortfalls, errors and omissions we found during our inspection. The provider was not always open and honest with people in the home, telling them they had a cold when they had confirmed Covid-19. Staff, people and relatives were not always engaged with. The provider had not undertaken questionnaires since 2018. Staff, people and professionals said the registered manager was approachable. Staff we spoke with said there was a good team and spoke about people in a person centred way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations. The service has deteriorated to inadequate.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns identified during the infection prevention control checks, areas of concern identified included staffing levels and infection prevention and control. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Neva Manor Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to risk assessment and management, medicines storage and management and infection prevention and control. Further breaches were identified in relation to the lack of oversight of safeguarding and failure to identify potential safeguarding concerns. The provider’s systems were not robust or being used effectively to ensure errors, omissions and shortfalls were identified, resulting in a further breach.

Please see the action we have told the provider to take at the end of this report. 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Neva Manor Care Home is a residential care home providing personal care to 14 people aged 65 and over. At the time of the inspection there were 13 people living at the home.

The building is laid out over two floors, there are bedrooms, two communal lounges, a dining room, accessible garden and communal bathroom on the ground floor. Stairs and a star lift lead to the first floor where there are two communal bathrooms and further bedrooms. All bedrooms have hand washing facilities and a toilet. There is a separate building with laundry facilities and car parking is available at the front of the home.

People’s experience of using this service and what we found

The provider did not always protect people from the risk of harm and abuse. Not all safeguarding incidents had not been identified and reported to the local safeguarding team as required. Staff did not receive safeguarding training, however staff we spoke with were able to tell us what actions they would take if abuse was suspected or witnessed. Risks were not consistently identified and when they were, information was not available to guide staff about actions they could take to lower the environmental risks to people.

Medicines were not consistently managed safely, for example the provider did not use body maps to guide staff about where to apply which creams and there was no information available to guide staff about the application of creams in people’s care plans. Staff used personal protective equipment. However, soap bars were available for communal use and these posed a risk of cross-contamination and infection. The provider was not assessing and monitoring staffing arrangements to ensure there were appropriate levels of staff available to meet people’s needs.

Not all people’s needs were assessed, and guidance was not consistently available for staff about actions they should take to meet people’s needs. However, care plans did reflect people’s choices and preferences. Information was not always accessible to people with a visual impairment as it was not produced in larger font.

Staff did not always receive training in line with the provider’s training programme. Activities were discussed with people and the provider had identified people were not consistently participating in activities, the service had confirmed the activities coordinator was exploring new activities. The provider had also asked people to participate in the activities because it negatively impacted staff morale if they did not. There was a lack of consultation around people’s preferences and choices of activities. The service made timely referrals to healthcare professionals and worked with them when the need arose. The provider was not consistently consulting and working in line with best practice guidance.

There were no End of Life care plans available for us to review during the inspection, however we reviewed compliments from loved ones who had been supported by the service towards the end of their lives. The service had not received any recent formal complaints.

People told us they were supported by staff who were kind and caring, and we observed many caring interactions between people and staff during our inspection. Staff ensured people were treated with dignity, this included calling people by their chosen name and ensuring the doors were closed when people were receiving assistance with personal care and using the toilet.

Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

The inspection was prompted in part due to concerns about a lack of statutory notifications received from Neva Manor Care Home. Statutory notifications are important as they tell us about import events and incidents that occur at a service and help us to monitor services. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive, Effective and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Neva Manor Care Home on our website at www.cqc.org.uk.

Enforcement

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection found that people’s rights were being protected and there were sufficient competent staff to meet people’s needs. Recruitment practice was improved. However, checks on potential staff members were not comprehensive. Those checks were completed retrospectively following the inspection visits and the recruitment policy reviewed so practice would be more robust.

Neva Manor is registered to provide accommodation and personal care for older people. It is able to accommodate up to 14 people. There were 12 people using the service at the time of the inspection.

Neva Manor has 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.

Individual risks were understood and there were detailed plans in place where a risk was identified. However, although risks from pressure damage were understood and met, there was no formal risk assessment in place. We recommend the service review their policy on protecting people from the risk of pressure damage.

People received their medicines as prescribed, taking into account their individual needs. A community pharmacist advisory visit in August 2016 advised a small number of actions, which had been completed.

People’s care was planned with them and they received care which was centred on their needs and wishes.

People said they were very happy living at Neva Manor and that the care they received was how they wanted it to be. Their care needs were well met. Any health care support people needed was well provided because the staff worked closely with health care professionals.

There were sufficient numbers of staff for the number and needs of people using the service and staffing was flexible. Staff received training that equipped them for their work and they received regular supervision and a yearly appraisal. Staff felt well supported and said they could take any concern or question to the registered manager.

People were protected from abuse because the staff understood what to do if they saw anything which concerned them. People said they had no concerns and felt confident they could raise any complaint. A complaints procedure was available for their use and small issues had been addressed as complaints and dealt with to people’s satisfaction.

People were treated with kindness. People said the staff were kind and helpful one commenting “All very friendly and they take you as they find you. All very kind”. People said they were treated with respect and their privacy was upheld. Staff engagement with people was observed to be very respectful.

People's views were sought throughout the day, through their care plan reviews and through yearly

questionnaires about the service. Questionnaires were also sent to family members, staff and health care professionals. The results were followed up.

Comments about the food were positive. The menu was varied but flexible, in accordance with people’s preferences. People said they could have anything they wanted and they were asked on a daily basis. Specialist diets were managed very effectively.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service had sought appropriate advice and was meeting people's legal rights in relation to MCA and DoLS.

People spent their time as they preferred. People regularly helped with food preparation and baking. They had crafts, exercise, music and puzzles/games available to them. There were a lot of visitors and staff and people using the service had formed friendships and shared social time together.

The premises was in a safe state of repair and there were arrangements in place for unforeseen

emergencies.

People and their family members said the home was very well led by the registered manager, who led by example. There were quality monitoring procedures in place, which were under regular review.

At this inspection we found new arrangements had been put in place for the administration and management of medicines. These included improved management of stock and records relating to the administration of some medicines. We saw practice around administration of medicines had improved and people's medicines had been reviewed by their GP. We were satisfied the provider had addressed the areas of non compliance we had identified at our last inspection.

On entering Neva Manor care Home we found the atmosphere warm and welcoming. We spoke with people living at the home, family members and a visiting professional and observed staffs understanding of the care and support needed. The people who used the service we spoke with said that "I have all that I need here, nice bed, lovely food" and staff are "delightful." We saw that the rooms were tastefully decorated with their personal belongings.

We looked at people's individual files which incorporated their personal history, likes and dislikes, care plans and risk assessments and found they encompassed the safety and well-being of people who use the service and utilised the services of external agencies when required.

People who used the service and family members told us that they knew how to raise a concern or complaint and felt confident in doing. They said if they had any issues or concerns they could "talk to the manager." There were policies and procedures in place providing guidance and all staff had received training which was identified on the training schedule.

We reviewed the medication records and found shortfalls in the way daily recordings were completed which may have an impact on the people who use the service.