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Manor House Residential Home Requires improvement

Reports


Inspection carried out on 7 January 2020

During a routine inspection

About the service

Manor House Residential Home is a residential care home for up to 22 older people living with dementia. At the time of inspection there were 21 people living at the home.

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

There was a registered manager who had been the manager of the service since it registered with CQC in October 2010.

The provider did not have adequate systems in place to assess and monitor the safety and quality of people’s care. Their policies were outdated and did not reflect current practice. The provider had not carried out regular audits to maintain the safety of the environment, fire safety procedures, decoration or repairs. Immediately following the inspection, the provider implemented systems to monitor and improve the safety of the home; these systems needed to be shared with staff and embedded into practice.

Staff did not always understand how to safeguard people from the risk of harm. Following the inspection, the provider updated their policy and put in systems to identify when incidents occurred and when to report to safeguarding. These systems require embedding to be effective.

Staff were recruited using safe recruitment practices, however, the provider did not have systems in place to ensure staff remained safe to work.

There were enough staff deployed to meet people’s needs. People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care that mitigated these known risks. People were supported to access relevant health and social care professionals.

People received care from staff they knew. Staff had a good understanding of people's needs, choices and preferences. People and their representatives were encouraged to be involved in planning how their care was provided. Staff gained people's consent before providing personal care and ensured their privacy and dignity were maintained.

Staff received training to enable them to meet people’s needs and were supported to carry out their roles.

There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

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

The last rating for this service was Good (published 22 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified three breaches of regulation in relation to safety of the environment; safeguarding and management oversight. 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.

Inspection carried out on 4 July 2017

During a routine inspection

Manor House Residential Home provides care for up to 22 people living with dementia some of who experience behaviours that may challenge others. The home consists of two floors, communal areas and gardens in the village of Middleton in Northamptonshire.

At the last inspection, the service was rated Good; at this inspection we found the service remained Good.

The service continued to provide safe care to people living with dementia. Staff understood their responsibilities for safeguarding people from harm and followed the provider’s policies to provide people’s prescribed medicines safely. There were enough suitably skilled staff to meet people’s needs. Staff had been recruited using safe recruitment practices.

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.

People received care from staff that had received training to meet people’s specific needs around their dementia. Staff were compassionate and helped to develop positive relationships with people which helped to manage behaviours which may challenge others.

People received a balanced diet from staff that understood their dietary needs. People were helped to maintain their independence and dignity by the use of suitable crockery and support from staff.

People were treated with respect and helped to maintain their dignity.

People were supported to access healthcare professionals and staff were prompt in referring people to health services when required.

People’s risks were assessed and staff had person-centred care plans they followed to mitigate these risks. Care plans were updated regularly and people and their relatives were involved in their care planning where possible.

Staff sought people’s consent before providing care and people’s mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguarding.

The provider and registered manager continually assessed, monitored and evaluated the quality of the service to identify areas for improvement, and implement change where required.

Inspection carried out on 25 June 2015

During a routine inspection

This unannounced inspection took place on 25 June 2015. The home provides support for up to 22 people living with dementia. At the time of the inspection there were 19 people living at the home. The home has an Enhanced Dementia Classification (EDC) which enables people to be supported with advanced dementia through to end of life care.

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.

People told us that they felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. We observed that on the day of our inspection there were sufficient staff on duty. The recruitment practice protected people from being cared for by staff that were unsuitable to work at the home.

Care records contained risk assessments to protect people from identified risks and help to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decision about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People felt safe and there were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about safeguarding adults.

Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did. Pictorial formats of upcoming events and signage around the home to support with daily living was in place.

Staff had good relationships with the people who lived at the home. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. The registered manager was visible and accessible. Staff and people living in the home were confident that issues would be addressed and that any concerns they had would be listened to.

Inspection carried out on 27 November 2013

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

Our inspection of 6 June 2013 found that risk assessments for the building and premises had not been completed for some time. During this inspection we saw that risk assessments were being carried out on at least a weekly basis. The action taken when risk was identified was also recorded.

We were unable to speak with people who used the service about the safety and suitability of the premises. We spoke with a relative of a person who had recently moved in. They told us they were satisfied with the care and support their relative received. They said "the staff are very caring and spend a lot of time with people".

Inspection carried out on 6 June 2013

During a routine inspection

We spoke with two people who used the service. Both said they liked the staff who supported them. We observed staff interacting with people who used the service. Staff were respectful, kind and helpful. We saw that people who used the service were occupied and engaged in activities that were meaningful to them.

We looked at the safety and accessibility of the premises. The provider had carried out some refurbishment since our last visit in January 2013. We saw that risk assessments of the premises had not been carried out for some time.

Inspection carried out on 11, 15 January 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed that people who used the service were treated with respect and dignity. People had their privacy respected and were able to maintain as much independence as possible.

Inspection carried out on 5 April 2011

During a routine inspection

We spoke with several people using the service who told us they were happy with the quality of care and support provided. They found staff were confident and trained to provide the care that they needed, respectfully and in the manner that suited them.

People said they had opportunities to take part in activities organised by the home and receive visitors at any time. People are supported to continue their interests and hobbies, such as gardening, reading the newspaper and singing.

Staff were observed interacting with people well and providing encouragement, support and the care that they needed. Some of the comments we received from people using the service included:

�I find the staff do respect me�

�I choose what I want to do and when�

�I don�t need much help but I know staff do have to help others�

�Nothing�s too much for the staff�

�Am quite happy and safe here�

�I�ve got nothing to complain about�

�It�s very good here, as you can see, there�s always something happening here�

�We do get on with life, everyday is different and we do different things. I have to say we do enjoy a good sing-song�

�Have nothing to complain about, quite happy and if there was a problem you just tell them�

The local authority who commission services and carry out contract monitoring visits at the home. They gave us positive feedback about the quality of care provided at the home, especially in relation to maintaining the wellbeing of people with dementia, thus preventing them having to move into a nursing home.

The Local Involvement Networks (LINks) members were consulted on this issue. We received one response, commenting positively about the provision of care, health and medication support, choice of meals, respecting people�s privacy and dignity, trained staff supporting people and cleanliness of the home.

Reports under our old system of regulation (including those from before CQC was created)