Philiphaugh Manor

Updated 10 March 2023

Inspection team

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors and an expert by experience.

Service and service type

Philiphaugh Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed information we held about the service including information included in the provider information return. This is information providers are required to send us annually with key details about their service, what they do well, and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We met and spoke with 7 people and sought feedback by telephone from relatives of 3 people. We also spoke with 5 staff, the manager, the providers head of care and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Feedback was also gathered from 3 health and social care professionals who were present in the service during the site visit.

We reviewed 4 people's care plans and risk assessments and a range of medicines records. We also reviewed 3 staff files in relation to recruitment processes and the service training and supervision records. We also reviewed other records relating to the management of the service, including complaints received.

We asked the manager to provide us with a variety of documents in relation to quality assurance and staff rotas. This information was reviewed in detail after the site visit. The site visit was completed on 10 January 2023 and inspection activity continued until 13 January.

Updated 10 March 2023

About the service

Philiphaugh Manor is a residential care home providing personal care to up to 32 people. The service provides residential care to older people who may have a physical disability. At the time of our inspection there were 21 people using the service.

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

At this inspection we found improvement had been made in relation to the management of fire risks. Automatic fire door release mechanisms had been recommissioned and no fire doors were propped open during this inspection. Additional fire doors had been installed and evacuation plans developed detailing the level of support each person would require in an emergency.

Risks were identified and mitigated, and staff supported people to safely mobilise. Pressure relieving mattresses were set correctly, and bath hoists had been repaired.

Staff had not consistently documented incidents that had occurred, and accident audits were not comprehensive. We have made a recommendation in relation to these issues.

There were now systems in place to provide staff with guidance on how and when to use ‘as required’ medicines and people had been appropriately supported with medicines in tablet and liquid forms. However, further improvements were required in relation to medicines systems and records. One person had run out of a prescribed cream and this issue had not been promptly resolved. In addition, notes had not been maintained on the effectiveness of PRN medicines and there was no system in place to record where patch-based medicines had been applied to people’s bodies.

Recruitment practices were safe and there were enough staff to meet people’s needs. The service had experienced some recruitment challenges and as a result was operating at reduced capacity to ensure people’s needs could be met by the available staff.

Staff training had not been regularly updated to ensure all staff had the skills necessary to meet people’s needs. In addition, staff new to the care sector had not been supported to complete the care certificate.

Staff understood how to report safety concerns within the service and records showed the manager had appropriately raised safeguarding issues with the local authority.

Water pressure issues had been resolved and the decor in bathrooms upgraded. However, both bathrooms were noticeably cold on the day of the inspection and there was no heating available in one bathroom. Records showed people had not been regularly offered opportunities to bathe or shower contrary to people’s identified needs and preferences.

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. Systems to record people’s consent for photographs had been introduced and there were systems in place to assess people’s capacity to make specific decisions.

Issues in relation to damaged carpets and malodourous furniture had been resolved and clutter in the manager’s office had been cleared. A new maintenance person had been employed and prompt action was taken to address a maintenance issue identified during the inspection.

People were well supported at mealtimes and told us they enjoyed the food provided. The oven was working correctly, and kitchen staff understood people’s needs and preferences.

People’s care plans had been updated since the last inspection. However, these documents lacked clear guidance on how to meet people’s specific and individual support needs. In addition, care plans for people who had moved in recently contained only limited life history and background information.

People were comfortable in the service and told us they were safe. Staff offered support promptly when required and people requested assistance without hesitation. Relatives and visiting professionals were also complimentary of the services performance.

People’s care plans were now stored securely in a locked room when not in use. However, some staff did not know how to access these records.

The service does not have a registered manager. The service’s manager was supported by 2 duty managers and the roles and responsibilities of each manager were now well defined.

The provider’s quality assurance systems were not effective as they had failed to ensure compliance with the regulations and identify that some management tools were being used incorrectly.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 6 December 2022). We found breaches of the regulations and issued 2 warning notices in relation to failures to provide safe care and treatment and good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, we found some improvements had been made and that the warning notice in relation to safe care and treatment had been complied with. Although the service’s governance systems had improved these issues had not yet been fully resolved. The breaches of the regulations in relation to consent and premises and equipment had been resolved. However, new failings were identified at this inspection, these were in relation to person centred care and staff training.

Why we inspected

We carried out this inspection to check that warning notices issued after the last inspection had been complied with.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified new breaches in relation to person-centred care, and staff training and support. There was an ongoing breach in relation to recording and quality assurance at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.