Mariana House is a residential care home in Whalley Range in south Manchester. The home is registered to provide care and accommodation for up to 23 people. At the date of our inspection there were 19 people living in the home, all of them women. Mariana House is a large detached property. It has two lounges, a dining area, and a large garden. It has bedrooms on both the ground floor and first floor. The bedrooms have washbasins but no ensuite bathrooms.This inspection took place on 4 and 5 January 2017. The first day was unannounced, which meant the service did not know in advance that we were coming. The second day was arranged on the first day of our inspection.
At the previous inspection in November 2015 we had found breaches of four regulations, and judged that the service required improvement. We issued two warning notices, in relation to two of the breaches.
Those five breaches at the last inspection related to the storage and recording of medicines, assessment of risks, obtaining of consent, timeliness of care planning, and quality monitoring systems. At this inspection we found that some improvements had been made in all these areas, although there was still room for improvement, as set out in the full report. The warning notices related to failure to assess correctly and implement advice regarding dietary needs, and secondly to failure to operate effective audits, in particular of care plans and medication. We found that sufficient improvement had been made in these two areas.
The registered service provider is also the registered manager, and has been registered as manager since 2011. He was not present during this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
The service had appointed a manager on 30 August 2016, who was present during the inspection. They told us it was their intention to apply to become registered manager. We refer to this person as “the acting manager” in this report.
There had been an incident in October 2016 when someone living in Mariana House had walked out of the building and been found in a neighbouring road. Action had been taken to prevent a recurrence and the home had co-operated with the local safeguarding authority. However, the person’s care plan and risk assessment had not been updated after the incident. We judged there had been a breach of the regulation relating to assessing risks.
In September 2016 a person suffered a mini-stroke, and there was evidence that it had not been recognised from symptoms earlier in the day, resulting in a delay calling the ambulance. This was a breach of the regulation relating to reducing risks to people’s health and safety.
There was information about people’s mobility in their care plans but there was no immediately accessible information for the fire service in the event of an emergency. The acting manager created a file of emergency evacuation plans during our inspection.
The layout of the building was safe for people to move around, with the exception of one doorway. We also saw furniture creating an obstacle in a corridor at one point.
We checked on the ordering, administration and storage of medicines and found that it was much better than at the previous inspection. The provider was now meeting the regulation in relation to the management of medicines.
Staffing levels were constant and met the needs of people living in the home. There had been little recruitment recently which created some pressure on the staff rotas. When people were recruited, safe recruitment methods were used, although we have made a recommendation that the application form should be updated.
Accidents and incidents were recorded but there was no analysis of the causes with a view to reducing the recurrence. We saw records relating to maintenance of the building. The home was fresh and clean, and there was an infection control lead who carried out regular audits.
Since the last inspection Mariana House had introduced a form for people to give consent to their care and treatment. However, we found staff practice did not meet the requirements of the Mental Capacity Act 2005. We found that medicines were being given covertly (without the person knowing) and bedrails were in use without mental capacity assessments and without best interests decisions having been made. This was a breach of the regulation relating to consent.
Staff had received training in the Mental Capacity Act 2005 and in the Deprivation of Liberty Safeguards (DoLS). Applications under DoLS had been made but were still awaiting authorisation by Manchester City Council.
Training was provided by an external provider and we saw there had been several training sessions in the autumn of 2016. Supervision was provided regularly to support staff, but there had been no annual appraisals for two years.
Despite a recommendation in the previous report, the environment still required some attention, to make it more suitable for people living with dementia. The failure to respond to feedback in our report was a breach of the regulation relating to good governance.
People liked the food and the cook had an understanding of people’s dietary needs. The mealtimes were a pleasant experience. People were supported to access health services.
People living in the home and their relatives spoke highly of the staff and the care provided. The service had a homely atmosphere. Staff worked to maintain people’s dignity and were sympathetic to their needs. People were well dressed and well presented.
We saw a good example of reducing a person’s anxiety by getting a family member to speak to them on the telephone.
Staff at Mariana House were equipped and prepared to cater for the needs of people at the end of life.
The acting manager was implementing new care plans. These were very detailed although perhaps a little too long in places. Family members were encouraged to supply a biography about their loved ones so that staff would have more personal knowledge about them. The system was an improvement on the one at the previous inspection, and assisted staff to deliver person-centred care.
The care plans were reviewed each month. However, necessary updates were not always carried out.
There was a programme of activities for every day of the week. Not everyone wanted to take part, but those who did enjoyed them. A favourite was singing songs led by a volunteer who was themselves a relative of someone living in the home.
The menu on the wall was intended to enable people to know what they would be eating, but the wrong menu was pinned up while we were there. The acting manager was creating a new menu which would meet people’s needs better.
There was a clear complaints policy and we saw from the record that complaints were investigated and a response made to the complainant.
The home had a good reputation amongst relatives and professional visitors. The rating from the previous inspection was not displayed either in the home or on the home’s website. This was a breach of the relevant regulation.
Medication audits and care plan audits were considerably better than they had been at our last inspection, although not many care plan audits had yet been carried out. Other audits were also being carried out.
There had been one staff meeting in the last four months but more were planned.
We found several examples of incidents or events which should have been reported to the CQC.
Following the last inspection we had not received an action plan or any response to our two warning notices. This was the responsibility of the provider. We regarded this seriously. noted that the Breaches found in the last inspection had largely been remedied, although we found new breaches at this inspection. We found evidence of improvement, thanks largely to the appointment of the acting manager, although there was still room for further improvement. We considered that the breaches and other issues identified at this inspection represented a further breach of the regulation relating to good governance.
We found breaches of four regulations 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 end of the full version of the report.