Archived: Manor House

We found the following examples of good practice.

We had received a concern that staff were not wearing surgical face masks while on duty during the Covid-19 pandemic. However, we found on this unannounced visit that all staff were wearing masks. We discussed with the registered manager that the guidance about staff wearing face masks, even when not in close contact with people, is to protect people living at the home from the risk of contracting Covid-19. The registered manager was aware of this guidance and assured us this has been followed throughout the pandemic.

The service was clean. Effective cleaning routines were implemented to ensure infection control risks were minimised and people were kept safe. Suitable cleaning routines were in place to help keep hygiene practices to a good standard.

During the summer months families had visited people in the garden. Recently the conservatory had been converted into a visitor’s room to enable people to see their families during the winter months. Designated family members visited by appointment and the room was deep cleaned after each visit. Visitors were required to wear masks and, as necessary, other Personal Protection Equipment (PPE). These were supplied by the home if needed.

Where families were unable to visit, or between visits, staff helped people to keep in touch with their family and friends via telephone and video calls.

Suitable testing routines had been arranged for staff and people who used the service. The registered manager said both staff and people who used the service had been happy to participate in regular testing.

Robust admission procedures were in place, for example, the service required documentary evidence of a negative Covid-19 test results before people moved in, followed by a period of self-isolation.

Staff had received suitable training and guidance regarding infection control, and how to respond to the Covid 19 pandemic. During the inspection we observed staff demonstrating suitable knowledge of good infection control practice. Additional staff training had also been maintained.

The service had comprehensive policies and procedures in respect of Covid 19 and its implications on the running of the service. From our discussions and observations these had been effectively implemented.

Further information is in the detailed findings below.

Manor House is a care home that provides personal care for up to 16 predominantly older people. At the time of the inspection 12 people were living at the service. Some of these people were living with dementia.

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

There was a relaxed and friendly atmosphere at the service. People made choices about where and how to spend their time. People told us they were happy with the care they received and believed the service was a safe place to live. People were positive about staff, and their caring attitude, and told us they were treated with kindness and compassion.

While we found people’s care needs were met people told us, and we observed, that there were times when there were delays in staff assisting people due to staffing levels. We have made a recommendation about how staffing levels are assessed.

The provider had acted on recommendations made at the last inspection about adapting the environment to support people with dementia, supporting people to access the local community and the effectiveness of quality assurance systems. Signage had been updated to identify shared areas, bathrooms and people’s bedrooms. People’s needs, in relation to their preferences about going out, had been assessed and action taken in line with those wishes. Audits were now being regularly completed and the accuracy of record keeping had been improved by the introduction of an electronic recording system.

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 supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and detailed their needs and preferences. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

The medicines system was well organised and staff received suitable training. People received their medicines on time.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. The environment was safe and people had access to equipment where needed.

Recruitment practices were robust and new staff completed a comprehensive induction. Staff had received appropriate training and support to enable them to carry out their role safely.

People and their families were given information about how to complain and details of the complaints procedure were displayed at the service. The registered manager/provider and staff knew people well and worked together to help ensure people received a good service. People and staff told us the registered manager/provider was approachable and listened when any concerns or ideas were raised.

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. (Report published on 5 March 2019). While there were not any breaches of regulations there were three recommendations. At this inspection we found improvements had been made and the rating had improved to Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Manor House 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 care home accommodates up to 16 people in one adapted building. On the day of the inspection 14 people lived in the home.

The registered manager was also the provider. 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.

Records did not always reflect all the information we were told was sought during the recruitment process. People were supported safely with their medicines; however at the beginning of the inspection, some staff training was not up to date in line with the provider’s policy. Checks and audits completed by the registered manager had not always been recorded. We have recommended the registered manager reviews their governance procedures.

People told us they felt safe using the service. Risk assessments were in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. When people became anxious or low in mood, staff used their in-depth knowledge of people to ensure they received the right support.

People, relatives and staff told us the found the service to be ‘homely’. However, we have made a recommendation about the environment as it did not currently reflect best practice in dementia care.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Staff knew who lacked the capacity to make decisions and care plans gave information for staff to use when making decisions in people’s best interests.

People had enough to eat and drink and had choice about what they ate. Staff were very responsive to any change in needs or health concerns.

People were provided with activities to engage them in the home. Staff told us these were based on their knowledge of people’s interests. However, people were not routinely asked if they would like to access the local community. We have made a recommendation about this.

There was a positive culture within the service. The registered manager led by example and the standards they expected were known by the staff team. Staff clearly cared about the people they supported and worked to maintain people’s wellbeing. Staff understood how to communicate with people effectively and offered choice wherever possible.

People and relatives told us they they found the registered manager and staff approachable and any changes or concerns were dealt with swiftly and efficiently. People had regular opportunity to share their views of the service and any required changes were made promptly.

Manor House is a care home that provides care for people who have dementia or mental health needs. The home can accommodate up to 16 people. At the time of the inspection there were 16 people living at the service. The home was arranged over two floors, with access to the upper

floor via stairs or a chair lift. Bedrooms had wash hand basins and vanity units. There were shared bathrooms, shower facilities and toilets. Communal areas included two lounges, a dining room, a well maintained garden and an outside seating area.

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.

We observed positive, compassionate and caring interactions between people and staff. Staff took the time to stop and chat with people and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection. One staff member said; “The best thing is being with the residents, to see a smile on their faces means everything to me”.

People’s care plans were detailed documents which contained information about their background, history, likes and dislikes. People’s care plans were linked to risk assessments and contained information for staff on how to reduce the likelihood of them coming to harm.

People told us they enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people had their medicines as prescribed and on time. People were supported to see a range of health and social care professionals including speech and language therapists, chiropodists, district nurses and doctors.

People were kept mentally and socially engaged through a range of activities inside the home. The service employed an activities coordinator who was developing a programme of personalised activities to suit people’s individual needs.

People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant that people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks.

There was a safeguarding adult’s policy in place and staff had received training on this subject. Staff confidently described how they would recognise and report any signs of abuse. There was a policy in place on whistleblowing which staff were aware of and applied to their practice. The registered manager promoted an ethos of openness and honesty which demonstrated the requirements of the duty of candour.

Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. People were involved in planning their care and staff sought their consent prior to providing them with assistance.

People, staff and relatives were encouraged to give feedback through a variety of forums including staff meetings, residents’ meetings and questionnaires. This feedback was used to drive improvements within the service. There was a system in place for receiving and managing complaints. There was a quality assurance system in place with a range of audits including medicines, maintenance, risk assessments and care plans.

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. We used our observations to determine how people were cared for and supported at Manor House. We spoke with the registered manager, four staff and two people who used the service.

We found people's views and experiences were taken into account in the way the service was provided.

People's care needs were assessed, care and treatment was planned and delivered in line with their individual care plans.

We found staff were supported to deliver care and treatment safely.

The provider notified us of incidents that occurred at Manor House, so that where needed, action could be taken.

We spoke with four people who lived at Manor House, the registered manager/registered provider, a senior carer, a carer, and the chef.

One person who lived at Manor House described one member of staff as 'he's a nice boy, I like him'. Another person told us, 'I wouldn't be any where else'.

We found, people needs were assessed, care and treatment was planned and delivered in line with their individual care plan.

People were cared for in a clean, hygienic environment.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received and had an effective system in place to identify, assess and manage risks to health, safety and welfare of people who use the service and others.

The provider notified us of deaths of people who lived in the home so that, where needed action could be taken.

During our inspection we found, people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care and people's privacy, dignity and independence were respected. We also found people's needs were assessed, however, care and treatment was not always planned and delivered in line with their individual care plan.

People were not always cared for in a clean, hygienic environment and people who use the service; staff and visitors were not protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were not supported to deliver care and treatment safely and to an appropriate standard.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive and the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.