The Manse Residential Care Home

The Manse Residential Care Home is a care home providing accommodation and personal care to up to 33 people. The service provides support to older people, people with disabilities and people living with dementia. At the time of our inspection there were 32 people using the service.

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

Risks to people were not always sufficiently assessed and plans to mitigate and manage risks were not always sufficiently detailed, instructive and up to date. Medicines management was not always safe and did not always follow guidelines. There was not always a sufficient number of suitably qualified staff deployed to meet all people’s needs in a timely and safe manner at all times. People’s privacy and dignity were not always respected. People’s care and support was not always designed and planned in a person-centred way. Maintenance checks and repairs were not always carried out appropriately and in a timely manner. The quality assurance systems and processes were not always effective and the provider had not identified the issues we found during our inspection. We found no evidence anyone had been harmed. However, these issues had put some people at risk of potential harm.

There were systems and processes in place to safeguard people from abuse and improper treatment and people and their relatives felt the service was safe. The recruitment of new staff followed safer recruitment procedures. Infection prevention and control was effective.

People were supported to eat and drink enough and participate in activities and exercise. People and their relatives were included in making decisions about their care and involved in the development of the service. Staff were friendly, caring, kind and supportive and managers were approachable.

The provider, managers and staff worked in partnership with other agencies and organisations to provide people with their care and support.

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 15 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to look at the key questions of safe and well-led.

We inspected and found there were potential concerns with the other key questions, so we widened the scope of the inspection to become a fully comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, premises and equipment, good governance, and staffing. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

• The registered manager had undertaken risk assessments to establish the individual risks from COVID 19 to each staff member and person using the service and how they could be supported.

• Staff received the necessary training in infection prevention and control, including how to put on and take off personal protective equipment (PPE) appropriately. Staff followed best practice in relation to good hand hygiene and using PPE.

• Domestic staff followed a suitable cleaning and disinfecting schedule, led by a suitable member of staff. All staff were involved in ensuring frequently touched surfaces such as door handles were disinfected every two hours.

• The service no longer employed staff who worked at other care services, to reduce the risk of staff spreading COVID19 infections. This is in line with Department of Health and Social Care guidance in the adult social care winter plan about minimising staff movement across services. The provider had offered all staff permanent contracts to provide them with more financial security, so they no longer needed to work elsewhere.

• The provider had reviewed visiting arrangements because of the recent change in government guidance and the change in London’s COVID 19 risk status to tier two, which is high risk. People on end of life care could still receive visits from their relatives, who were provided with full personal protective equipment (PPE). Relatives could still communicate with their family members through windows and video calls. The provider was installing a purpose-built pod in the front garden for families to visit their relatives when the COVID 19 risk status is reduced.

• We observed people were supported with social distancing when in communal areas and a range of activities were available to keep people stimulated and reduce social isolation.

Further information is in the detailed findings below.

At our previous inspection of 30 June 2015, the service was rated good. At this inspection the service remained good.

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.

Care records were not always updated and accurate to reflect people’s needs and circumstances. There were a range of systems in place to monitor and assess the quality of service provided but these had not identified issues with documentation and record keeping

People told us they were safe at the service. People and their relatives told us staff were caring and kind to them. Staff maintained their privacy and confidentiality. Staff knew them well and understood their communication needs.

Staff knew how to protect people from abuse. They knew the signs of abuse and how to report their concerns. There were sufficient staff recruited in a safe way to provide care and support to people. Staff administered and managed people’s medicines safely. People received their medicines as prescribed.

Risks to people’s health, safety and well-being were assessed and management plans devised to guide staff on how to protect them from harm. People’s needs were reviewed and evaluated regularly. Care records had guidance for staff on how to deliver care to people in a way that met their needs. People and their relatives were involved in planning for people’s care.

The registered manager and staff understood their responsivities and supported people in line with the principles of the Mental Capacity Act 2005. The registered manager ensured decisions were made in people’s ‘best interests’ if they were unable to do so. They involved people’s relatives and professionals as required in decision making process. The registered manager had obtained authorisation from appropriate authority as required under the Deprivation of Liberty Safeguards. The monitored the conditions to ensure the people’s rights were not violated.

People accessed health care services to maintain their health. The service worked in partnership with other services such as a local hospice to ensure people received appropriate care and treatment. People received appropriate end of life care in line with their wishes.

People had sufficient food and drink to meet their nutritional needs. People told us they enjoyed the meals provided at the service. They received the level of support needed to eat and drink well.

People took part in activities they enjoyed at the service and in the community. People were supported to follow their interests, maintain their cultural, religious and social values.

Staff received regular training, support and supervision that enabled them to deliver effective support to people. The registered manager held regular meetings with staff where they discussed concerns about people and reflected on their practices.

The registered manager sought the views of people and their relative’s about the service and used their feedback to make improvements if needed. People knew how to make a complaint. The service had investigated fully and resolved complaints received in line with provider’s procedures.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People were supported in promoting their independence and community involvement. People were given opportunities to express their choices and to make decisions in their daily lives. We observed that staff were aware of people's preferences and routines so they could support people in their daily lives. From our own observations we saw staff treated people using the service with dignity and respect.