The Manor House

The Manor House is a residential care home providing personal care to 46 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

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

Staff were not adequately deployed during busy times, such as meal times. Risks relating to people’s individual care needs had been identified and planned for. Assessments and plans to mitigate environmental risks were also in place. Staff understood their responsibilities in relation to keeping people safe and had received training in safeguarding. There were safe recruitment practices in place for new staff. People received their medicines as prescribed by staff who had been trained to give people their medicines. The service was clean, and staff observed good practice around infection prevention and control. Accidents and incidents were recorded and reviewed to mitigate further incidents.

Assessments of people’s needs were carried out prior to them moving to the home. New staff attended an induction and completed training relevant to their role. Staff supported people to maintain a healthy nutritional intake. Timely referrals were made to healthcare professionals when people became unwell. 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.

People were cared for in a way which upheld their privacy and respected their dignity. Staff knew people’s care needs well and offered reassurance to people in times of unease.

People’s individual needs and preferences were planned for and was regularly reviewed. There was a lack of planning for people’s end of life care. Provisions were in place to ensure people received visits from relatives and maintain their interests. Complaints were responded to appropriately.

There was a positive culture within the service and people enjoyed living in the service. Staff were clear about their roles and the registered manager was a visible presence throughout the home. People, their relatives and staff were involved in developing the service. Staff worked with other organisations to promote positive outcomes for people.

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

Rating at last inspection

The rating at the last inspection was good (published 31 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

At the last inspection in March 2016 the service was rated Good. However, there had been a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because cleaning chemicals had not been stored securely. This July 2017 inspection found that this issue had been addressed. Consequently, the provider was no longer in breach of this regulation. This inspection found that the service remained Good and met all relevant fundamental standards.

People were safe living in the home. Risks to people’s welfare were identified, planned for and managed. Medicines were managed safely and people received them as intended and in accordance with directions from the prescriber.

There were enough staff to meet people’s physical, emotional and social needs. Robust recruitment processes were in place.

Staff were provided with appropriate training and ongoing support. People considered that the staff supporting them were competent and knowledgeable.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff ensured that people had enough to eat and drink. People were offered choices for each meal. Those who required direct assistance or encouragement to eat and drink received this.

Staff were kind, caring and respected people’s privacy. They enabled people to maintain as much independence as possible.

People received personalised care that met their individual needs and preferences. People and/or their relatives as appropriate were involved in planning the care that people received. People could participate in events happening in the home and were supported to follow their own interests.

People and their relatives felt confident that if they needed to make a complaint that it would be promptly and appropriately responded to.

The manager promoted an open and receptive culture in the home. The views of people living in the home, their relatives and staff were sought.

The provider had suitable quality assurance systems in place to identify shortfalls in the service, which were acted upon.

Further information is in the detailed findings below.

The Manor House provides residential care for up to 52 people, some of whom may be living with dementia. The home is set in extensive gardens and woodland. The period accommodation is over two floors and most rooms have en-suite facilities. Some of the downstairs rooms have French doors leading out onto a patio area. There are a number of communal areas including a conservatory, two dining rooms and a library. At the time of our inspection, 50 people were living at The Manor House.

There was 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.

The people who used the service were supported by staff that had been safely recruited following appropriate checks. Staff had been trained and inducted. During our inspection we saw that staff demonstrated the skills and knowledge associated with the training they had received.

Staff demonstrated good team working abilities and told us they were happy in their roles. They worked in a way that ensured the atmosphere within the home was one of calmness and warmth. Staff communicated well with each other, the people they supported and visitors to the service. They were professional, friendly and showed compassion. There were enough staff to meet people’s individual needs and the people they supported had confidence in them.

The people who used the service spoke highly of the caring nature of the staff that supported them. They told us they were helpful, kind and worked hard to meet their individual needs. People felt respected and listened to. Independence was encouraged and people had choice over their day to day living. Privacy was maintained. The people who used the service told us staff knew them well and responded to their needs promptly. Relatives felt their family members were well cared for.

People were protected from the risk of abuse. The service had processes in place to manage safeguarding concerns appropriately and promptly. Staff demonstrated they knew how to prevent, identify and report concerns that could be potential abuse. The staff felt confident in doing this. Past concerns had been reported correctly and in a timely manner. Where required, the service had investigated concerns and taken actions as a result.

The service had identified risks to the people they supported and applied measures to control the risk of harm. However, the risks had not been consistently reviewed within the care records. When we spoke with staff they demonstrated they knew people well and that they understood the risks people were exposed to. However, we could not be sure people were protected from the risk of harm due to some inaccurate risk assessments.

The risks associated with the environment and working practices had been identified and reviewed. However, we found that cleaning products were not consistently secured and posed a risk of harm to the people who used the service as well as others.

Medicines were stored, recorded and administered safely. However some stock counts of medicines were incorrect and we could not be sure those people had received them as the prescriber intended. The service took immediate and appropriate action to address this.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had adhered to the principles of the MCA and made applications to the supervisory body to potentially legally deprive people of their liberty. The service had made appropriate best interests decisions by liaising with others and had recorded these decisions. Although staff’s knowledge of the MCA DoLS was variable they understood the importance of consent. The people who used the service told us staff always respected their choice and asked for consent before they assisted them.

People, and their relatives, told us they had been involved in planning the care and support they received. They told us they received care in an individual manner. However, the care plans we viewed did not consistently demonstrate this. They were variable in their content and sometimes not fully completed. However, the service had identified that care records required improvement and was addressing those issues.

People’s social needs were met and they told us how important it was for them to be able to see their family and friends whenever they wished. Activities were provided by the service although people told us they wished for more trips away from the home.

People benefited from having regular access to a variety of healthcare professionals. They told us these services were prompt in being requested when required. The feedback we received from the healthcare professionals we spoke with showed the service worked well with them to maintain people’s wellbeing. They told us the staff followed their recommendations in order to support people with their physical and mental health.

People had confidence in the registered manager. They told us they saw them regularly and found them to be supportive, responsive and approachable. The people who used the service, their relatives and the staff told us they were encouraged to provide feedback on the service. They felt listened to and included in what was going on within the service.

A transparent, inclusive and honest culture was promoted within the home. During our inspection the registered manager had been open with us and demonstrated knowledge of the service. They were aware of the areas that required improvement and demonstrated they had plans in place to address these. Incidents were discussed openly as a team and used to improve the service.

Regular audits were completed to monitor the quality of the service. These had identified most of the issues highlighted in this report and actions were in place to improve and develop the service. The senior management team had oversight of the home and was supporting the registered manager to make changes.

All the people we spoke with were happy with the service provided by The Manor House. They told us they felt well cared for and safe. Their relatives agreed and told us they had no cause for concern in regards to how their family member was supported.

We found that people were cared for appropriately and the home and its staff acted to ensure that people's care and welfare was maintained. Care planning was generally accurate and responsive. We saw staff interacted positively with the people they were caring for.

We spoke with the relative of a person using this service and they expressed satisfaction with the service their loved one received. They told us that, 'It's like a family, I know my [relative] is happy. They are looked after very well.'

We observed lunch time during our inspection and found that staff offered encouragement and assisted people as necessary. People were provided with a lunch of their liking and staff offered choice. Staff were patient with the people they were assisting and allowed them to eat at their own pace.

There were effective procedures in place at the home which meant people were cared for by suitably skilled and qualified staff.

The service supported people to raise concerns where this was appropriate.

We told the provider to make improvements and during this follow up, desk-based inspection, we found that they had.

We spoke with six people living at The Manor House and each person expressed satisfaction with the service. One person told us 'I am very grateful to be living here' it's such a nice home' and that the staff were all 'very kind.' Another person commented 'The staff are very helpful and make sure everything is just right for me.' A third person told us that the home was a 'wonderful' place to live' and a fourth person commented 'Nothing could be improved; I couldn't find any fault with it [the home]'.

Our observations of the home demonstrated to us that it was clean, mostly free from unpleasant odours and that infection control practices were in place. For example, we observed staff using alcohol gel, wearing disposable gloves and aprons and saw cleaners undertaking their duties.

We found that required improvements to the home's medication systems had been implemented and that accurate records were maintained throughout the home.

However, whilst we found that staff received appropriate training relevant to their role, they were not receiving regular one to one supervision.