Manor House is a residential care home for up to 30 older people, most of whom live with a degree of dementia. Nursing care can be provided through the local community nursing services if appropriate. 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. Manor House is an old Georgian building set over various floors and extensions with a range of communal spaces leading onto a secure garden and outdoor spaces in Plymouth. South West Care Homes Limited also operates 10 other services in the South West from a head office. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. There had been a recent safeguarding concern resulting in the dismissal of three night care workers but this had been managed well and in partnership with the local authority safeguarding team.
We made a recommendation to ensure that despite audits identifying improvements were required that timely actions were taken to maintain a comfortable and pleasant environment for people.
We carried out an unannounced inspection of Manor House on 3 and 4 July 2018. At the time of the inspection 27 people were living at Manor House. The registered manager was on sick leave during our inspection. The service was being managed by a deputy manager with the support of another registered manager from the provider’s other service locally and a regional manager based at Manor House. They were supported by team leaders and care workers and ancilliary staff. The provider oversaw the running of the service from a head office and completed regular visits and audits. 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.
On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, most of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the communal areas or in their rooms.
People were encouraged and supported to maintain their independence, emphasised by some people being supported to return home to the community. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or went outside. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance.
People were provided with good opportunities for activities, engagement and sometimes trips out. These were well thought out in an individual way and the regional manager was looking at developing a more robust way of ensuring all individuals had their social needs met with the help of a new activity co-ordinator in the near future. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them.
People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and staff support and the service worked in partnership with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns and issues would be addressed and people seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. They used chatting and distraction techniques as they knew people well, showing patience and understanding. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally.
People were well cared for and relatives were involved in planning and reviewing their care as most people were not able to be involved due to living with dementia. The computerised person centred care planning system enabled relatives to safely access care records and share information and photographs from afar. Care plans showed that people were enabled to make smaller day to day choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people's repeated stories.
There were regular reviews of people's health, and staff responded promptly to changes in need. For example, care records showed many examples of staff identifying changes in need and appropriate and timely referrals to health professionals with positive results for people.
People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. Staff knew when people did not appear ‘right’ and acted as advocates to ensure they received the right health care.
Medicines were well managed and stored in line with national guidance. Records were completed with no gaps and there were regular audits of medication records and administration and to ensure the correct medication stock levels were in place.
Staff had good knowledge of people, including their needs and preferences. Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively. Handover and communication between staff shifts was good so there was consistent care.
Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The care staff team was stable and many care staff had worked at the home for some years. Training was inclusive, each staff member attended, for example the maintenance person had been trained in specialist dementia care. Staff felt well supported through recent changes in management provision whilst the registered manager was on sick leave.
People's privacy was respected. Staff ensured people kept in touch with family and friends, inviting friends and family to events regularly. Relatives told us they were always made welcome and were able to visit at any time, use the quieter lounges and make hot drinks. People were able to see their visitors in communal areas or in private. 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.
The staff and managers showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. They identified staff skills and matched staff to people’s personalities. Staff gave examples of particularly rewarding work with people. Staff showed a caring ethos and this showed in the way they cared for people in individualised ways. During the inspection staff had a lovely sing song and dance with people and knew and respected how people living with dementia viewed their world.
Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom, often taking their meal with people too. Nutritional assessments were in place and special dietary needs were catered for as well as specialist crockery and cutlery and finger foods to aid
independence for people living with dementia.
There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider audits. There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. All responses were positive from the recent quality assurance questionnaire. People's views were acted upon where possible and practical, and included those living with dementia. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them. A monthly newsletter and notice board kept people up to date with regular ‘tea and chat’ with the manager. encouraged families and children to attend, with face painting and a bouncy castle.
Further information is in the detailed findings below.