Background to this inspection
Updated
16 April 2019
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: The inspection team consisted of one inspector and one expert by experience on the first inspection visit and two inspectors on the second inspection visit. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type: Manton 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 can accommodate up to 21 people and has three double rooms and ground floor and first floor accommodation. On the day of our inspection there were 16 people using the service.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection: The inspection was unannounced on the first day of our inspection visit.
The Inspection site visit activity started on 20 February 2019 and ended on 25 February 2019.
What we did: Before our inspection visit we reviewed information already known about the service which included: The Provider Information Return. (PIR) This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications which are important events the service is required to tell us about. We also reviewed all other information sent to us from other stakeholders for example the Local Authority and members of the public.
During our first day of our inspection we spoke with five people living in the home and three relatives. We spoke with three support staff, the cook, domestic, an activity member of staff, the registered manager and a second registered manager who manages a service nearby which is associated with the provider.
We carried out observations across the day to observe how staff interacted with people and met their needs as not everyone could tell us about their experiences. We reviewed records including: two care and support plans, staff files, rotas, medication records and other records relating to the management of the business.
Following the inspection, we requested additional information to help us from our judgements. This was received when requested.
Updated
16 April 2019
About the service: Manton House is a residential care home providing personal care and accommodation for up to 21 people; several rooms were for double occupancy. There were 16 people using the service at the time of our inspection.
People’s experience of using this service: Since the last inspection the previous manager had left and there was a new registered manager in post. They have worked at the service previously as a deputy manager so were familiar with the service. They had started to make some improvements in the short time they have been the registered manager. At the last inspection we rated the service requires improvement in responsive and well led. During our most recent inspection despite improvements noted we found further improvements were required in each key question.
¿The service required financial investment to ensure in remained in a good state of repair and décor and was suitable for the needs of people using the service. There was no clear refurbishment plan and the environment had not been sufficiently updated since our last inspection.
¿Hazards identified on the first day of inspection had not been identified by the provider which increased the risks to people using the service.
¿We were encouraged by the immediate actions taken by the registered manager on our feedback and their willingness and genuine efforts to improve the service. They however need to reach a point where they are able to identify their own priorities and there needs to be clearer provider oversight and robust quality assurance processes.
¿Individual risks were identified and appropriate actions taken but risk assessments and care plans were not always updated in a timely way and information was not easily accessible to all staff. Staff were confident they could recognise abuse and knew what actions to take to promote people’s safety
¿Staffing levels were appropriate to meet people’s needs and there was an assessment tool in place to determine the number of staffing hours necessary according to people’s needs. The tool
was not very explicit and did not take account of the environment.
¿Staff recruitment processes were adequate and helped ensure only suitable staff were employed.
¿Staff audited medicines to help ensure people had their medicines in stock and administered when needed. We have made a recommendation about medicine audits to help ensure all areas of medicine management are identified as part of the audit.
¿People were supported to eat and drink enough for their needs but staff practices did not demonstrate a sufficiently individualised approach to meeting people’s dietary needs. We have made a recommendation about this.
¿The environment was not sufficiently personalised. However, the registered manager took some immediate actions to rectify this.
¿Staff knew people well but without consistent leadership the staff team had delivered the service as they thought best. This led to inconsistencies in how people were supported. Staff were kind but some had outdated practices.
¿Staff training was mostly up to date and there were plans to update it.
¿Most people were settled at the service and staff responded to people in a timely way. Some people were regularly engaged and staff took their time when delivering personal care and support. People were supported to stay active but this was an area for development as activities were limited in scope and not suitable for everyone. Community engagement was improving. We have made a recommendation about activities.
¿Care plans described people’s needs but care staff did not access care plans regularly or contribute in reviewing them. We have made recommendations about care planning and recording of people’s care needs.
¿Staff consulted with people about their care needs but capacity to make decisions had not always been clearly established.
Rating at last inspection: The rating at the last inspection on 26 September 2017 was requires improvement in responsive and well led with no breaches to the Health and Social Care Act Regulations.
Why we inspected: Previously we had rated this service as requires improvement and therefore have been back to ensure it had improved to good. We had received an action plan telling us what the service managers would do to improve provision and we checked this action had been taken.
Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve the rating of the service to at least Good. We will require them to provide an action plan detailing how this will be achieved. We will revisit the service in the future to check if improvements have been made.