Manor Lodge

Manor Lodge is a residential care home that supports people aged 65 or over, some of whom have dementia care or mental health needs. It is registered to accommodate and support up to 15 people. At the time of the inspection, 11 people were living at the home. The home has two floors with adapted facilities and ensuite rooms.

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

The provider had made some improvements in the home following our last inspection. However, there were some ongoing issues with quality assurance systems that needed further work to ensure the home was safe. Medicines for people were not always managed safely because we found they were not being recorded accurately against the dates they were administered.

Staffing levels for the home were assessed but the registered manager told us they needed to recruit additional staff for the home. We have made a recommendation about assessing suitable staffing levels.

Lessons were learned following accidents and incidents in the home. Systems to prevent and control infections were in place. Care plans and risks to people’s health were regularly assessed and reviewed.

Staff were trained to carry out their roles and received support with their continuous development. People were supported to maintain a balanced diet and their nutritional needs were monitored. People were supported to attend health appointments with professionals to help maintain their health.

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.

People received personalised care. Staff treated people with dignity and respect. People pursued their interests and were supported to avoid social isolation. Staff understood people's communication needs and were aware of promoting equality and diversity. Systems were in place to manage complaints about the home. Feedback was sought from people to help make continuous improvements to the home.

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 the service was Requires Improvement, (published on 13 October 2021) and there were breaches of regulation.

We issued requirement notices to the provider for breaches of Regulation 12 (premises and equipment), Regulation 9 (person-centred care), Regulation 10 (dignity and respect) and Regulation 11 (need for consent).

We issued a warning notice for breach of Regulation 17 (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 but the provider was still in breach of regulation 17 but no longer in breach of other regulations.

The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected

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

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 and recommendations

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 have identified a continued breach in relation to good governance at this inspection.

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

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.

Manor Lodge is a residential care home, providing personal care to people with mental health needs and physical disabilities. The home can support up to 15 people in one adapted building. At the time of the inspection, 12 people were using the service.

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

The provider was not always assessing, monitoring and improving the quality and safety of the service. We found risks to people were not being mitigated against effectively which could lead to people being harmed. For example, windows were not fitted with restrictors to prevent people climbing out of them and putting themselves at risk.

People did not always receive care that was personalised according to their needs and wishes and staff did not always treat people with dignity and respect. Records in respect of the decisions taken about people’s care and treatment did not contain evidence of people’s consent.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People's equality and diversity needs were not always covered with them and we have made a recommendation in this area.

People received their medicines but quality checks on medicines were not being recorded. We have made a recommendation for the provider to make additional training available on controlled drugs.

People maintained their health and nutrition with food and drink but we have made a recommendation about improving the meal time experience of people in the home.

People were protected from the risk of abuse. There were suitable numbers of staff available to provide support to people. The provider ensured infection control procedures were in place. Incidents and accidents in the service were reviewed and analysed to prevent reoccurrence.

Staff told us they were supported by the management team and they received supervision to discuss their performance and any concerns they had. Staff received training to ensure they had the right skills to support people. People's communication needs were assessed. There was a complaints procedure for people to use. There were systems to obtain people's and relative’s feedback about the service. Meetings with staff were held with the management team to discuss important topics. The service worked with health professionals and other agencies to ensure people’s health and wellbeing were maintained.

Rating at last inspection

The last rating for this service was good (published 28 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the staffing levels, infection control, the environment and the overall safety of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see all the sections of this full report. You can see what action we have asked the provider to take at the end of this report.

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 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.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Manor Lodge provides personal care and accommodation for up to 15 people with mental health support needs and physical disabilities. At the time of our visit nine people were using the service.

People’s experience of using this service:

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Risks associated with people's care and support had been assessed.

There was a policy and procedure about safe administration of medicines. People were supported to take their medicines in the way they wanted. Systems were in place for the monitoring and prevention of infection.

The provider had effective recruitment and selection processes in place. There were enough staff to meet people’s needs. Staff received appropriate professional development and were knowledgeable about their roles and responsibilities.

People’s needs were assessed and care and support were planned and delivered in line with their individual care needs. People were supported to maintain good health and to access health care services and professionals when they needed them. They had a programme of activities in accordance with their needs and preferences.

Staff understood their responsibilities in relation to consent and supporting people to make decisions. People were able to make choices about their care and their views were taken into account. Staff knew people well and interacted with them in a professional manner. They treated people with kindness and encouraged them to do as much for themselves as possible.

People and their relatives were comfortable raising any concerns with the management team or with a member of staff if something was wrong. The management team had good links with a number of health and social care professionals and this helped to ensure people’s needs were fully met.

The provider had systems in place to check and monitor the quality of the service provided. The registered manager demonstrated a good understanding of their role and responsibilities. Appropriate notifications were always made to us when required. People, relatives and staff spoke positively about the management of the service.

Rating at last inspection:

Requires Improvement (report published 17 March 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection 12 February 2018, the service was rated as requires improvement. We asked the provider to take action to make improvements regarding the administration of medicines to people. Staff were not following the prescribed administration time or reading the instructions on the medicine charts before they administered medicines to people and this could put people at risk. We also asked them to improve the system for monitoring how people received their medicines. During this inspection we found the actions have been completed.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on CQC website at www.cqc.org.uk.

Manor Lodge 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 service provides personal care and accommodation for 15 people with mental health support needs and physical disabilities. At the time of our visit 11 people were using the service.

There was a registered manager in place. 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.

Staff were trained in the administration of medicines. However, they were not following the prescribed administration time or reading the instructions on the medicine charts before they administered medicines to people. This could have a negative impact on people’s health.

There were systems in place to manage, monitor and improve the quality of the service provided. However, the system for monitoring how people received their medicines was not effective and this put people at risk.

Survey results from people and their representatives were positive and any issues identified were acted upon. People and their representatives were able to raise concerns or complaints if they needed to.

People and their relatives felt the service was safe. The provider had systems in place to protect people from the risk of harm. Staff knew how to identify abuse and had appropriate information to report any concerns. The risks associated with people’s support were assessed, and measures put in place to ensure staff supported people safely.

There was a recruitment system in place that helped the provider make safer recruitment decisions when employing new staff. People were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Staff received a structured induction at the beginning of their employment and received on-going training whilst working for the provider.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. People or their representatives had been involved in writing their care plans.

People were encouraged to do as much for themselves as possible. Staff were knowledgeable about the people they cared for. They were treated with kindness and respect.

The requirements of the Mental Capacity Act 2005 (MCA) were in place to protect people who may not have the capacity to make decisions for themselves. Staff had a good understanding of how to support people who lacked capacity to make decisions.

People were supported to have meals that met their needs and choices. The registered manager worked closely with other health professionals to ensure the needs of people were fully met.

The registered manager was clear about their responsibilities and accountabilities. There was an open culture that put people at the centre of their care and support. Staff had a clear understanding of what was expected of them.