Mandale Care Home

Mandale Care Home is a residential care home providing personal care to up to 57 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 38 people using the service. People were supported in an adapted building across 2 floors.

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

People were not always safe and protected from the risk of avoidable harm and abuse. Staff had failed to take appropriate action following a number of safeguarding incidents. The provider commenced an investigation and put systems in place immediately following our feedback, to minimise the chance of reoccurrence. Risks to people were not always robustly assessed, monitored or managed. The provider addressed this following our feedback.

Staff had not escalated safeguarding concerns to the registered manager, and the registered manager did not have oversight of all serious incidents which occurred within the home. Not all appropriate actions had been taken when things went wrong. Not all important incidents had been reported to CQC.

Some staff required refresher training in some areas. The provider had identified this and put a training schedule in place. We have made a recommendation about training.

Health and safety checks were in place and up to date. There were enough staff to support people and recruitment was ongoing. Safe recruitment procedures were in place. Medicines were managed safely. Suitable infection control procedures were in place.

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.

Staff engaged well with other professionals and made timely referrals. The provider gathered feedback from people, relatives and staff. The registered manager was approachable and operated an open-door policy. Relatives spoke positively about the home and said they would recommend it to others.

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 19 July 2019).

Why we inspected

We received concerns in relation to the environment, staffing, record keeping and the quality of care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

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

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 and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following the inspection, the provider took action to mitigate the risks and issues identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mandale Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made a recommendation in relation to staff training.

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.

We found the following examples of good practice.

Due to the outbreak of COVID-19 the service was closed to visitors in accordance with Government guidelines. People maintained contact with family through telephone calls or 'face time,' which had enabled people to speak to each other and window visits. A new visiting pod was ready to be used when the home could open back up to visitors.

Isolation had been implemented effectively and people living in the service were monitored for symptoms of COVID-19. The home was part of the national testing programme. Additional monitoring such as temperature checks and oxygen levels were carried out so that people's changing needs could be quickly identified and responded to.

There was an up to date infection, prevention and control policy in place supported by COVID-19 specific protocols.

The care home was kept clean. Staff kept detailed records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. We also saw communal areas were kept uncluttered so cleaning could take place effectively. There were appropriate laundry processes in place.

The service had an adequate supply of personal protective equipment (PPE) to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe.

The well-being of people and staff was regularly monitored. It was a priority for the company and different methods of support were available to people and staff,

We found the following examples of good practice.

• The home had a dedicated infection prevention and control lead who ensured all staff adhered to current, national guidance. This lead monitored and assessed all areas of the home and staff practices ensuring high standards of infection prevention and control were delivered in all aspects of the home and that suitable supplies of personal protective equipment were available.

• The home had a dedicated wing to ensure people recently discharged from hospital, presenting with any symptoms or, those newly moving into the home were supported safely in accordance with national guidance. The home provided people and their relatives with information to support their understanding of the isolation processes.

• People at risk and those isolating were cared for by a dedicated staff team who provided a support bubble to meet all their needs and reduce any feelings of isolation and loneliness. This included a range of individual social activities and contact with friends and family.

• People were supported to have face to face or telephone contact with friends and relatives through an appointment system. National guidance was being followed to ensure visits took place at a safe social distance. Infection prevention and control measures were in place to avoid potential transmission with others.

• The home was following national guidance by ensuring all staff were tested weekly and people living at the service were tested monthly. The home included other professionals who worked closely with the service to be tested weekly as part of their testing programme.

Further information is in the detailed findings below.

Mandale Care Home is a care home which is registered to provide nursing and residential care for up to 57 older people, including some who may live with dementia. At the time of inspection nursing care was not being provided. At the time of inspection 42 people were using the service. Mandale Care Home is a detached purpose-built care home set out over two floors.

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

At our last inspection the provider had failed to fully assess and reduce risks to people. Medicine management was not safe. People did not have complete, up to date plans of care. Care plans did not document people’s choices and preferences. Quality assurance systems were not robust. At this inspection we found these issues had been addressed.

People told us they felt safe living at Mandale Care Home. Staff knew how to safeguard people from abuse. Staff were recruited using systems which reduced the risk of unsuitable candidates being employed. Risks to people and for tasks carried out by staff were identified and actions were taken to mitigate these. Medicines were managed safely. Staff gave us mixed feedback on staffing levels. People told us call bells were answered promptly.

Some improvements had been made to the building since the last inspection. Further work was needed and an improvement plan was in place to address this. Safety actions identified in a recent fire service visit were being carried out at the time of inspection.

Staff had the skills and knowledge to deliver care and support in a person-centred way. They were supported through induction, training and supervision. People’s care needs were thoroughly assessed. 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.

Staff and relatives told us staff were caring. A range of was available to people. People’s health needs were met. The service worked with other professionals to best meet people’s needs.

A complaints system was in place. The provider and registered manager carried out a range of audits to identify and address issues. Lessons were learnt from adverse incidents.

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 (published 3 July 2018). There were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Mandale Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides personal care for older people and older people living with dementia. The home is a detached 57 bed purpose built care home in Stockton. It is set out over two floors. At time of our inspection there were 41 people using the service.

When we inspected the service the manager was going through the process of becoming a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person’s'. 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.

During our last inspection in October 2016 we identified gaps in people’s records. At this inspection we found that there were still omissions in recordings. The new management team had started to complete regular audits, however quality assurance processes had not always highlighted the inconsistent record keeping and recording errors which meant some actions had not been addressed in a timely manner.

This is a breach of Regulation 17, Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Whilst general risk assessments covering areas such as manual handling were in place and regularly reviewed health based risks to people were not always clearly identified and evaluated in care records. Medicines were not always managed safely. There were some gaps in medicine records. There was no record available of staff having undertaken training to take people’s blood sugar readings safely.

This is a breach of Regulation 12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection we noted that some Mental Capacity Act Assessments were not decision specific. Since the last inspection some documentation had been completed in this area. 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. However further work was needed to ensure all decision specific mental capacity assessments and best interest’s decisions were in place when people lacked capacity. We have made a recommendation about the recording of decisions taken in people’s best interest.

The environment was maintained, however during our visit we identified some issues with the building including a fault with the fire panel which was addressed during our second visit. Equipment checks were undertaken to help ensure the environment was safe. Emergency contingency plans were in place. Infection prevention and control practices were followed.

Policies and procedures were in place to protect people from harm such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe.

There were suitable numbers of staff on duty to ensure people’s needs were met. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

The new manager had ensured that staff were scheduled to have or had received training to be able to carry out their role, including training in areas such as health and safety and food safety however further training for staff was required in the area of diabetes management.

Staff were supported through regular supervision. Staff felt they could approach the management team if they had any issues.

Learning took place following reviews of accidents and incidents where themes and trends were addressed.

People had access to a range of healthcare such as GPs, hospital departments and dentists.

People’s nutritional needs were met and they enjoyed a varied, nutritional diet that met their preferences. People told us they enjoyed the food.

The premises were spacious and tidy and were suitable for the people living within the home however some areas required updating.

People were supported by a regular team of staff who were knowledgeable about their likes, dislikes and preferences. Visitors were made welcome.

Staff members were kind and caring towards people. People’s privacy, dignity and independence were respected. The policies and practices of the home helped to ensure that everyone was treated equally. End of life care procedures were in place.

Staff encouraged people to access to a range of activities and to maintain personal relationships.

Meetings for staff and people took place regularly. This enabled people to be involved in decisions about how the service was run. The service worked with a range of health and social care professionals to ensure individual’s needs were being met. Feedback was sought to monitor and improve the service.

Staff were positive about the new management team. They confirmed they were able to raise concerns. A clear complaints policy and procedure process was in place.

This is the second time the service has been rated Requires Improvement.

We previously inspected the service on 13 and 14 November 2014 and found that the service was not meeting all of the regulations which we inspected. We found the service was not meeting the regulations for consent to care and treatment and good governance. This was because the service did not have suitable arrangements in place for obtaining consent. The service had not been following the principals of the Mental Capacity Act 2005 and this had not been picked up by the quality assurance measures in place at the time. There were also gaps in the quality assurance systems in place at the service. We noted that audits had regularly highlighted the same areas for improvement and actions plans had not been put in place following these audits. The registered manager was not given feedback following these audits which meant they had been unable to make the changes needed.

After the inspection on 13 and 14 November 2014, the registered provider supplied an action plan to show us the action they planned to take to improve the quality of the service.

Mandale care home is registered to provide accommodation for people who require personal care, treatment of disease, disorder and injury and diagnostics and screening for up to 57 older people including people living with a Dementia. At the time of inspection there were 46 people using the service who were supported by 39 staff, of which 28 were care staff. The service was located in a residential area within its own grounds and had on-site parking. The service was located close to local amenities and a short distance from the town centre.

The registered manager had been registered with the Commission since 13 January 2013. 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.

At this inspection, we could see that the service had listened to the feedback provided to them during the last inspection and had made improvements to the quality of the service.

Staff showed they understood the procedures which they needed to follow if they suspected someone was a risk of abuse. Staff were able to discuss the types of abuse which people could be at risk from and how they could help to minimise these risks. All staff spoken with told us they would not hesitate to whistle blow [tell someone such as the registered manager] if they needed to.

Risk assessments were in place regarding people's specific needs and for the day to day running of the service. These were fully completed and had been regularly reviewed. Staff understood the importance of these to keep themselves and people using the service safe.

Health and safety certificates were up to date and showed measures were in place to ensure the safety of people and staff.

All staff had a Disclosure and Barring Services check in place. DBS checks help employers make safer decisions and prevent unsuitable people from working with vulnerable client groups. People and staff told us there were enough staff on duty throughout the day and night to care for them safely. Two relatives thought staffing levels could be increased. We could see staffing levels were regularly monitored.

People received their prescribed medicines when they needed them. From our observations, we could see that people were supported to take them and people were given the time they needed with their medicines.

Staff told us they were supported during their induction period and records confirmed this. We saw staff shadowed more experienced staff whilst they became familiar with people who used the service and the requirements of their role.

All staff were supported to carry out their roles effectively. Staff received regular supervision, appraisal and training. These also included observations of practice.

Staff had increased their knowledge and understanding of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards (DoLS). Most staff were confident when we spoke with them and felt able to seek further support from the registered manager if they needed to. We noted that not all MCA were decision specific. The operations manager told us they were already aware of this and support was in place to address this and to support staff to increase their knowledge and understanding of MCA.

Staff understood the action they needed to follow to ensure people received adequate nutrition and hydration. Risk assessments and care plans were completed and updated when people became at risk of malnutrition or dehydration and worked alongside health professionalsHowever food and fluid balance records were not up to date. We informed the operations manager and registered manager about this and were assured that action would be taken to address this. .

People told us they had access to health professionals when they needed them. We found evidence of this during inspection from our discussions with people and staff, from our observation of visiting professionals and from the care records.

People and their relatives spoke positively about the care and support they received from staff and told us they enjoyed living at the service. People told us they felt well cared for.

When we spoke with people they were not sure if they were involved with developing and reviewing their own care. We noted that people had not routinely signed their care plans to show they consented to the information in them. People told us that staff always sought their consent before any care and supported was delivered and that they were happy with the care provided to them.

People told us their privacy and dignity was maintained at all times. We observed staff knocking on people’s doors and waiting to be invited in. People were also given the time and support needed at mealtimes and when medicines were dispensed. All of which was carried out in a dignified manner.

People had care plans in place which reflected their health and well-being needs and had been regularly reviewed. We identified some gaps in these records.

We heard mixed reviews about the quality of activities provided at the service. The operations manager and registered manager told us they were both aware of this and plans were already in place to address this.

People and their relatives told us they knew how to make a complaint and felt confident that action would be taken. We could see a small number of complaints had been made and records detailed the action taken to resolve the complaint and the outcome of the complaint.

All staff told us they enjoyed working at the service and felt supported by the registered manager. People and their relatives spoke highly of the registered manager too. During inspection we saw staff worked as a team and regularly communicated with one another.

The service had good links with the local community and people attended events within the community. The local community were also invited into the service for events; these included open days, fundraising activities and visits from local schools.

The service regularly reviewed all accidents and incidents. This meant the service could identify any patterns and trends and take the action needed to minimise the risk of reoccurrence and harm to people.

The registered provider regularly visited the service and carried out quality assurance monitoring. The registered manager also completed a range of audits and developed action plans were any improvements where needed. These were reviewed by the registered provider during their visits.

Staff and people told us they were kept up to date with any changes or events occurring at the service and minutes were available if they had not been able to attend any meetings. We could also see that people had access to regular newsletters and had been invited to participate in the latest survey.

We found staff understood the requirements of their role and worked under the guidance of the registered manager to ensure people received safe care and support. We observed the staff team worked well together and communicated well.

Notifications had been submitted to the Commission when required to do so.

We saw that meals provided were varied, well presented and the menu was discussed with people who lived in the home to ensure they had a choice of different foods. Specific nutritional requirements were catered for and people's weight was monitored.

The home was clean and well maintained. There were policies in place and training was provided to support people to manage and prevent infection throughout the home. Infection control 'champions' were appointed to ensure that policies were adhered to and to communicate any changes with staff.

Staff were supported to undertake training, had regular supervision, appraisals and staff meetings. Staffing levels were reviewed to ensure that the needs of people living in the home could be met.

There was a complaints procedure in place and people we spoke with including relatives and staff understood how they would make a complaint or support someone who lived at Mandale Care Home to make a complaint. Relatives said that they felt confident to approach staff if there was anything they were not happy with.

During our visit we found that people who used the service experienced care and support that met their needs and protected their rights. This care and support was delivered by suitably qualified, skilled and experienced staff who worked in co-operation with other healthcare providers and professionals.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People who lived at Mandale Care Home were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with one person who told us that they had visited three homes in the local area before deciding to move to Mandale. They said, "We were welcomed immediately and my gut instinct was that this was where I wanted to be, and it was right."

Another person told us that the staff were very attentive, they said, "They can't do enough for you, I never have to press my buzzer they are always around."