Manorfields Residential Care Home

Manorfields residential care home is a care home providing personal care for up to 40 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 35 people using the service.

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

Window restrictors had not been fitted to two smaller windows in people's bedrooms. However, the registered manager resolved this during our inspection. Further work was needed to ensure the application of topical creams was managed safely. Other aspects of medicines administration were managed safely, and people received their medicines when needed. Risk assessments and care plans were kept up to date to reduce risks to people's health and wellbeing. There were processes supporting the safe recruitment of staff. Lessons were learnt following incidents and accidents. There were systems to ensure the environment was safe and infection prevention control arrangements were effective. Systems were in place to minimise the risk of abuse. Staff received safeguarding training and knew how to whistle blow.

Improvements had been made since our last inspection. There were systems in place to maintain and improve the quality of service delivery. People, their relatives and staff had opportunities to give feedback on the service and this was used to improve care. Staff received supervision and training. There was a positive culture in the service.

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 and update

The last rating for this service was requires improvement (published 11 November 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This inspection was carried out to follow up action we told the provider to take at the last inspection.

We undertook this unannounced focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12, Safe care and treatment, and Regulation 17, Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We found there had been enough improvement and the warning notice had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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

Manorfields Residential Care Home is a residential home registered to provide care for up to 40 people. The service provides care to older people, some of whom are living with dementia. At the time of our inspection there were a total of 35 people using the service.

We found the following examples of good practice:

The layout and design of the premises could be used to effectively manage and reduce any onward transmission from infection should there be an outbreak.

Cleaning routines were followed and included frequent cleaning of regularly touched surfaces so that the cleanliness of the location was maintained.

Procedures were followed to ensure COVID-19 tests were conducted in line with the latest advice to the service.

Policies and risk assessments were in place to help manage and reduce the risks associated with COVID-19 for people and staff.

Staff had designated rooms for changing their uniform and putting on and taking off their personal protective equipment. (PPE). Adequate supplies of PPE and hand hygiene products and facilities were available throughout the premises for staff to use. The registered manager told us they would continue to complete checks on staffs’ use of PPE to ensure they used it in line with guidance.

Visiting arrangements were planned to reduce the risks from infection transmission. Checks were in place and carried out to reduce the risk of infection from any visitors to the location. The registered manager told us they would review the recording of these to ensure all checks were recorded. Visiting guidelines and policies were up to date with the latest government guidance.

Manorfields Residential Care Home is a residential care home providing personal and nursing care to 36 people at the time of the inspection. Manorfields accommodates up to 40 people in one adapted building over two floors. There are communal areas for people to relax on both floors and an accessible garden area.

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

Safeguarding training was not up to date and policies were not dated. Relatives told us that their family member’s clothing and property was not always protected, and items got lost. Families also told us that their loved ones did not always look well cared for and were observed wearing other people’s clothes.

Risk assessments did not always reflect people’s health care needs and were at times contradictory. Care plans were not always comprehensive enough to identify the support people required.

Most staff were up to date with training in infection prevention and control. Staff we observed were wearing personal protective equipment and appeared to be following current infection control guidelines, the home was clean and tidy.

Staffing levels did not appear sufficient, we observed people on one level of the home eating whilst unobserved by staff. Staff did not appear to have time to spend with people. Staff told us there were not always enough staff.

Staff training records were out of date for a wide range of care.

There was quality monitoring in place, but concerns we identified were not picked up. Staff reported incidents and there was analysis of themes when people had falls.

Lessons learnt were reflected on and improvements put in place. Staff felt supported by the registered manager.

Medicines were administered and managed safely, and staff had completed medicines training.

An external healthcare professional who visited the service on a weekly basis told us staff were kind and caring and always raised any concerns with them.

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 2 May 2019).

Why we inspected

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 inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The inspection was also prompted in part due to concerns received about people looking unkempt, unexplained injuries, management of falls, staffing levels and manual handling of people. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to Safe Care and Treatment and Good Governance at this inspection.

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 work alongside the provider and local authority to monitor progress and improvements. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People told us they felt safe living at Manorfields Residential Care Home. The risks to people had been assessed and where appropriate some relatives had been involved in compiling and reviewing care plans. Staff had an intimate knowledge about the range of people’s needs. People were supported with their medicines in a safe way. People accessed healthcare services when they needed them, and they were supported to eat and drink enough to remain healthy.

People were involved in making decisions about their care and support and their consent about the care and services offered was obtained. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.

Recruitment checks had been carried out to ensure staff were suitable to work at the service. Training relevant to people’s support needs had been undertaken by staff. The staff team felt involved in the running of the home and were supported by the registered manager and management team.

There were systems in place to monitor the quality and safety of the service being provided. People’s views of the service were sought through meetings, surveys and informal chats. A complaints procedure was in place and people knew what to do if they had a concern of any kind.

The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

More information can be found in the detailed findings below.

Rating at last inspection: The home was rated Good at the last inspection in December 2017.

The service met the characteristics for a rating of “good” in all the five key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

Follow up: We will continue to provide ongoing monitoring of this service.

We last inspected this service in September 2015 and found the service to be meeting the regulations, although there was no registered manager in post at the time of our inspection.

Manorfields Residential Care Home provides accommodation and care for up to 40 older adults, many of whom are living with dementia. At the time of our inspection there were 28 people using the service.

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.

People told us they felt safe with staff and relatives felt their family members were safe. There were enough staff on duty during our inspection visits to meet people's needs. However, staff and some relatives told us there were times when the service was short-staffed and staff were rushed. We asked the registered manager to review how staff were deployed and their response to short-notice staff absence to ensure there were always sufficient staff to meet people's needs.

The risks people were exposed to had been assessed and staff demonstrated they knew how to keep people safe. Some improvements were needed to risk assessments as records did not always reflect people's current needs or changes in risks. Some risk assessments were not personalised to the individual.

Staff were safety recruited to help ensure they were suitable to work in a care setting. They were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people using the service.

The provider had made improvements to the way in which people's medicines were managed to ensure people were supported to take their medicines safely. People received their medicines when they needed them.

Staff were well-trained and skilled in meeting the needs of people. They were knowledgeable about the people they supported. Staff felt they received good support, and guidance from managers to enable them to provide effective care.

Staff recognised their responsibilities to support people with decision making in line with Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff sought consent from people to their care and respected people's right to decline care. Records did not always support that staff were complying with conditions with DoLS.

The provider was in the process of undertaking an upgrade of the premises to improve the facilities and décor for people.

People were supported to have sufficient to eat and drink in line with their preferences and needs. Staff encouraged people to eat healthily whilst respecting people's right to choose what they ate.

People had their health needs assessed and care plans put in place to meet their needs. People were supported to access a range of health professionals to help them to maintain their wellbeing.

The staff were caring and kind and genuinely enjoyed their work. The atmosphere within the service was welcoming and calm, with staff spending time chatting with people, providing reassurance when needed and being attentive to people's needs.

Staff got to know people by being introduced to them, spending time with them, reading care plans and speaking with relatives. Staff knew people well and used the information they had about people's preferences to tailor their care and support. Some care records were not up to date and did not reflect changes in people's needs. The registered manager was in the process of reviewing and updating care plans and records.

People were supported to take part in one-to-one or group activities. People could choose how they wanted to spend their time and this was reflected in their care plans.

There was a complaints procedure in place and relatives told us they felt comfortable to raise concerns on behalf of their family member and were confident these would be listened to and acted upon.

The registered manager had made improvements in the service to provide safe, personalised care. Staff were clear about their roles and responsibilities and spoke about clear leadership and support which provided them with confidence in managers. The provider undertook a range of audits within the service to ensure people were receiving good care. The outcomes of internal and external audits, together with people's views were used to bring about improvements and develop the service. The registered manager was able to show how they had learnt from incidents in the service and had used the information to improve care. We saw that on-going improvements had been made as a result of this approach. This showed that the service was well-led.

Most relatives felt listened to and told us they were generally happy with the care and service. The provider had a system in place for relatives to use if they had any concerns.

We saw food charts were not always completed accurately and inconsistencies in the way people's weight had been recorded, from stones to kilograms. This meant that people could lose further weight before staff realised and acted on this.

We saw equipment was available to support people's mobility so that they could remain independent.

We saw the recruitment procedure for staff members had been followed and appropriate checks were undertaken before staff began work. This meant that people could be assured that they were cared for by suitable staff.

There were systems in place to review the quality of the service provided.

We found care records had been updated and rewritten, taking into account people's preferences and input from families, wherever possible. We saw efforts had been made to write care plans in a person centred way (this means written from the point of view of the person, stating support and assistance they need from care workers).

We saw people and their representatives had been asked for their views about the service in July 2012. The information from the completed surveys had been reviewed and an action plan developed to address any issues developed. We were told other systems to check the quality of the service, such as medication audits and care plan audits had been or were due to be introduced.