Manorhey Care Centre

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

People told us they felt safe and were well cared for by staff who treated them kindly and with respect.

Staffing levels were sufficient to meet people's needs. However, some staff felt they could sometimes be short staffed. The service manager confirmed they would review the staffing levels further.

Risks to people's safety had been identified and assessed. During the tour of the home we identified a potential safety concern. On the corridors we found vinyl gloves were easily accessible to people particularly on the dementia ground floor. During the inspection the service manager resolved these potential hazards on all floors when we brought this to their attention.

People lived in an environment which was well maintained and clean, with safe infection control and prevention measures.

Staff had attended training relevant to their roles including safeguarding. Any concerns were recorded, investigated and reported to relevant authorities. All incidents were reflected upon for learning and improvement.

Medicines were managed safely. Staff received training and had their competencies checked to ensure safe practice. Regular audits and checks were completed on all aspects of medicine administration.

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.

The provider had systems in place to monitor the quality of the service. The provider sought feedback from people and used this to develop the service. The service manager worked well with other professionals and took appropriate actions when required.

Rating at last inspection

The last rating for this service was good (published 24 June 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We did not inspect the key questions of effective, caring and responsive.

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

overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for

Manorhey Care Centre on our website at www.cqc.org.uk.

Follow up

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

Manorhey Care Centre is a modern purpose-built care home. The building is fully accessible. Accommodation is provided over three floors. The ground floor is dedicated to caring for people living with dementia, nursing care is provided on the first floor, and residential care on the second floor.

Care and support was provided to 67 people at the time of this inspection. The service can support a maximum of 83 people.

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

Medicines were ordered, stored, administered and disposed of safely. Staffing levels were in line with current occupancy levels and based on people’s assessed needs. There were effective systems to ensure people were protected from the risk of abuse. Records showed staff had received training in relation to safeguarding, and staff we spoke with confirmed they had received this training. We were assured staff were following safe infection prevention and control (IPC) procedures. Current government guidance was being followed to support visitors into the home, and to enable people to participate in visits outside the home.

Significant improvements had been made to the overall ‘lived experience’ for people living with dementia. The positive energy and enthusiasm of staff clearly had an equally positive affect on people in their care. Staff were caring and sought to ensure people were treated in a dignified and respectful way. Improvements had been made to create a more inclusive and supportive environment.

Consideration was given to peoples likes, dislikes, interests and hobbies. The activities coordinator captured this information and then brought it to life through meaningful person-centred activities. Manorhey was accredited with the 'Six Steps' end of life care programme. This meant that wherever possible, staff were able to care for people who were nearing the end of life, in familiar surroundings, by people they knew well and could trust.

Leadership and management was effective. The registered manager led by example, creating and embedding a new culture and ethos, with clear direction and support provided to staff. Systems for audit, quality assurance and questioning of practice were greatly improved and operated effectively.

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 07 April 2020) and there were multiple 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

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of: Safe, Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We also 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

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.

Manorhey Care Centre, referred to as ‘Manorhey’ throughout this report, is a modern purpose-built care home. Accommodation is provided over three floors and the building is fully accessible. The ground accommodation specialises in providing care to people living with dementia; the first floor specialises in providing nursing care; and the second floor provides residential care.

The home can accommodate a maximum of 83 people. At the time of this inspection, 80 people were living at Manorhey.

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

Since the last inspection, there had been a deterioration in standards. The provider, Maria Mallaband 16 Limited (trading as Maria Mallaband Care Group) had failed to achieve a rating of at least ‘good’ in all key questions, which demonstrated systems and process for audit, quality assurance, questioning of practice and continuous learning are not effective.

Furthermore, since 2016 the provider has not met legal requirements and has consistently failed to ensure fundamental standards of quality and safety were maintained at Manorhey Care Centre.

At the time of this inspection, the home did not have a registered manager. However, the previous clinical lead had moved into the role of ‘home manager’ and had submitted an application to CQC to become the registered manager.

We spoke at length with the home manager and they shared with us their future vision for Manorhey. The home manager demonstrated a high values base and had the skills and experience to move the home forwards. However, this would equally require the provider and senior leaders within the organisation to provide a consistent and meaningful level of support.

Medicines continued to not be managed safely. We found issues associated with staff not following national guidance; medicines administration records (MAR) were not always completed fully; medicines were not always given as prescribed by the doctor; and, when medicines were administered in a covert manner (hidden in a drink or in food) staff did not always follow the guidance given from the doctor and pharmacist.

The home was carrying vacancies for nursing and care staff, with regular use of agency staff. We found the way in which staff were organised and deployed was not always effective. Shift leaders on each floor did not always have sufficient oversight because they were too busy engaged in other tasks.

Large pieces of equipment used for moving and handling were stored inappropriately in communal bathrooms and toilets. We observed the bathrooms/toilets to be in regular use which created a falls and trip hazard.

Throughout this inspection visit, we observed care and support being provided in communal areas. We focused the majority of our observations around people who were less able to self-advocate. On the ground floor, which is dedicated to people living with dementia, we observed the approach taken by some staff and the manner of their interactions and on occasions, found these to be abrasive and uncaring in nature.

There was a lack of meaningful person-centred engagement. We found this to be of most concern on the ground floor unit. A ‘one size fits all’ approach had been adopted when activities staff sought to engage with residents. We observed people were disinterested and did not want to participate. This contributed to feelings of frustration and agitation, and at times, an increase in behaviours that challenge.

Manorhey was accredited with the 'Six Steps' end of life care programme. This meant staff were able to provide care and support to those people who were nearing the end of life, to nationally recognised quality standards. People who were nearing the end of their life could choose to remain at the home to be cared for in familiar surroundings by people they knew well and could trust.

People were actively encouraged to provide feedback on any aspect of service delivery at Manorhey. We saw surveys and questionnaires were distributed and there was a regular programme of relatives' and residents’ meetings.

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 requires improvement (published 29 January 2019). The service remains rated requires improvement. This service has not been compliant with legal requirements since 2016.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

At this inspection we have identified breaches of legal requirements in relation safe care and treatment, dignity and respect, person-centred care and good governance.

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

Following this report being published, 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 also meet the provider to discuss how they will make changes to ensure they improve their rating to at least good.

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

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

Manorhey is a modern purpose-built care home and accommodation is provided over three floors and the building is fully accessible. The ground floor unit specialises in providing care to people living with dementia and memory problems; the first floor specialises in providing nursing care; and the second floor provides residential care. The service is registered with CQC to accommodate a maximum of 83 people. At the time of this inspection, 80 people were living at Manorhey.

We last inspected Manorhey in March 2018. At that inspection we found serious continued breaches of regulations associated with the Health and Social Care Act (Regulated Activities) Regulations 2014. As a result, the service was rated ‘Inadequate’ and placed in special measures. This inspection was planned to check whether the provider was now meeting legal requirements.

At this inspection, we found good progress had been made in many aspects of the service. However, further improvements were needed in relation to medicines management and good governance. Despite this, we were satisfied the home had made the necessary improvements overall to be removed from the special measures framework. You can see what action we have taken at the back of the full report.

There was a registered manager in post. 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.

At this inspection a medicines inspector (pharmacist) looked at medicines and records for 15 people. We found improvements had been made which meant that people no longer ran out of their medicines and people who needed their fluids thickened could have drinks safely without choking. However, there were still areas of medicine’s management that must be improved to ensure people’s health is consistently protected.

Aspects of governance were not being operated effectively and had failed to identify errors. This was of concern given that the providers own Service Improvement Plan (SIP) was not reflective of current practice for medicines management and that internal auditors have failed to identify these issues.

Following our inspection visit, the provider voluntarily sent CQC an action plan which addressed the areas of concern raised during the inspection. Furthermore, we took into account the fact that since our last inspection, a new registered manager and a new clinical lead were now in post, and, additional medicines management support was being provided by the local NHS Clinical Commissioning Group (CCG).

People had individual assessments in place which identified risks in relation to their health, independence and wellbeing. There were assessments in place which considered the individual risks to people such as mobility, nutrition and hydration, and personal care.

Accidents, incidents and untoward events were recorded and managed appropriately. there was clear information detailing any remedial action taken in order to reduce the likelihood of such events occurring again in the future.

We reviewed staffing levels and noted the providers ongoing recruitment strategy to recruit and retain permeant staff with the aim of reducing the use of agency staffing. Through our own observations of how care was being provided, we found people's needs were met in a timely way and staff were present in communal areas.

We found the home to be visibly clean throughout. Cleaning schedules were in place and staff understood their roles and responsibilities for the prevention and control of infection.

Before a person was accepted to move into Manorhey, the registered manager would complete a comprehensive pre-admission assessment. The purpose of this assessment was to ensure the service could meet the person’s individual needs.

From our review of records and through talking to staff, people who used the service and visiting relatives, it was clear Manorhey had a person-centred approach to the delivery of care and support. Person-centred is about ensuring someone with a disability or long-term condition is at the centre of decisions which relate to their life.

People living at Manorhey were cared for by staff who were skilled, competent and trained to fulfil their respective roles.

We observed lunch time service and found dining tables were well presented and the atmosphere was calm and conducive to a pleasant meal time experience. Dedicated hospitality staff served food from a hot trolley which freed-up care staff to help people who required additional support. Where a person had special dietary requirements, such as a soft or pureed diet, their meals were well presented in individual soft moulds.

Manorhey is a modern purpose-built nursing home, but retains a warm, friendly and homely atmosphere. We found people's bedrooms were personalised with their own memorabilia, photos of family, personal effects and ornaments.

Since our last inspection of Manorhey, there had been changes in personnel which meant noticeable improvements were felt across the service in terms of the culture, ethos and quality of care being provided.

People living at Manorhey were diverse and multi-cultural and the service benefited from an equally diverse workforce which was reflective of the local community.

During our observations we found staff treated people with dignity and respect. Staff shown patience and understanding and gave an explanation before a task or activity was carried out. The majority of staff clearly knew people well and understood their preferences, likes and dislikes.

People were actively encouraged to provide feedback on any aspect of service delivery at Manorhey. We saw that surveys and questionnaires were distributed and there was a regular programme of resident and relatives’ meetings. We also saw there was a monthly newsletter which kept people and relatives up to date with events and activities taking place within the home.

It was evident from our discussions with staff, and through our own observations, recent changes in personnel at Manorhey had led to tangible improvements across the whole service in terms of the culture, ethos, team work and quality of care being provided. This had been achieved by the commitment and dedication of managers and staff, and also through the supportive measures provided by the local authority and NHS clinical commission group.

At the previous inspection in December 2016 we found breaches of legal requirements in relation to notifications of incidents, evidence of seeking consent to care appropriately, person centred care, professional development of staff and evidence to verify equipment maintained in line with manufacturers’ guidelines and governance systems.

Following our last inspection (December 2016), we asked the provider to complete an action plan, which they submitted in April 2017, to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well Led to at least good. At this inspection, we noted improvements had been made in relation to submitting notifications, staff development and providing person centred care. However at this inspection, we found continued breaches of the regulation regarding the need for consent, equipment maintenance and good governance and significant concerns relating to the safe management of medicines. Further information about these concerns can be found in the relevant key question sections of this report.

Manorhey Care Centre (Manorhey) 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.

Manorhey accommodates 83 people across three floors. The ground floor unit specialises in providing care to people living with dementia, the first floor specialises in providing nursing care and the second floor provides residential care. At the time of this inspection there were 80 people living at the care centre.

There was a manager in post who had been registered with the Care Quality Commission since May 2015. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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. You can see what other action we have told the provider to take at the back of the full version of the report.

People told us they felt safe living at Manorhey. At this inspection, we found serious concerns relating to the safe management of medicines. For example, we found some people had not received their medicines as prescribed because these had run out and had not been re-ordered. Staff did not have sufficient information to help them administer medicines in a safe manner. This was a breach of the regulation in relation to the safe administration of medicines.

Lifting equipment used to transfer people was not serviced in line with legal requirements and was a breach of the regulation. This meant people were at risk of injury until this equipment was serviced. This concern was highlighted to the registered manager who immediately removed the equipment from use.

Governance systems continued to be ineffective as they failed to identify the concerns we found during our inspection such as the inadequate management of medicines and equipment that required servicing. The lack of thorough oversight by the provider and registered manager meant we found that concerns raised at the last inspection had not been remedied. This meant people were at risk of poor quality care because the provider and the registered manager did not provide suitable assurances they effectively monitored the service provided.

Staff employed at the home had undergone all appropriate pre-employment checks to help ensure they were suitable for the role. Staff we spoke with were aware of their safeguarding policy and procedures and knew what action to take if they suspected abuse was taking place.

The registered manager and staff demonstrated an awareness of the Mental Capacity Act 2005 (MCA). However, we found the service did not consistently follow the principles of the MCA and continued to be in breach of the regulation in this regard. This meant people’s rights were not correctly safeguarded.

Staff received an induction, mandatory training and shadowed experienced colleagues prior to working unsupervised. Improvements had been made in how staff supervisions and appraisals were scheduled. These interventions, training and professional development, helped to ensure staff were competent and well equipped to carry out their roles.

There was a suitable choice of nutritious food and drink on offer at Manorhey. People’s meals were prepared according to their preferences and specific needs, for example, texture-modified or halal. This helped to maintain people’s good health and wellbeing.

Staff’s approach was caring and empathetic though we found the service did not demonstrate the hallmarks of a caring organisation. This was evidenced by the serious concerns we found in the management of medicines and the manner in which the registered provider assessed and monitored the quality of the service.

People and their relatives gave us many examples of how staff supported with kindness and compassion. People said staff carried out their duties in a respectful manner and that they were supported by staff who knew them well.

People told us staff encouraged them to be independent according to their abilities. Staff we spoke with confirmed this. This helped to promote people’s general good health and wellbeing.

There was a variety of activities arranged within the home and in the community and suited to people’s individual preferences and abilities. Regular activities helped to stimulate people’s wellbeing and were facilitated by dedicated activity coordinators with the support of care staff.

People told us they knew how to make a complaint or raise concerns. There were systems in place to manage complaints and we saw these were investigated in line with the provider’s policy and procedures.

There was a registered manager in post and everyone we spoke with told us they and the entire staff team were approachable and helpful.

There were policies and procedures in place and regular staff meetings were held to help ensure staff were supported to undertake their role effectively.

The previous inspection took place in October 2014 and the overall rating for the service was ‘Good.’ The service had a registered manager who had been in post since May 2015. 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.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the end of the full report.

We made a recommendation that the service should consider options to improve the dining areas as this would improve the lives of people living at Manor Hey.

People and their relatives told us the care home provided a safe and friendly environment in which to live. All staff had been trained in safeguarding principles and knew what to do if they saw abuse occurring.

Fire drills were undertaken and we saw that a revised recording procedure was due to be implemented. This would help to ensure any actions resulting from fire drills were appropriately addressed to ensure people’s safety at the home.

We found some discrepancies in how medication was recorded on each floor of the care home. During our inspection, we observed that medicines were administered safely to people.

Manor Hey did not always work within the principles of the Mental Capacity Act 2005 (MCA). We found instances where relatives had signed care records on behalf of people but without appropriate authorisation such as lasting power of attorney. This meant that people could be receiving care or support where consent had not been obtained in the correct way.

Staff undertook induction and mandatory training and shadowed experienced staff before working unsupervised. This meant that staff should have the right skills to support people effectively and safely. Staff supervision and appraisals needed to be more consistently scheduled. This would give staff the appropriate forum to discuss service specific issues and help them improve outcomes for people living at Manor Hey.

People commented that the food at the care home was “really good” and we saw this was well presented and a choice of nutritious meals given at all times. We saw that diets were prepared to accommodate people’s specific health conditions or religious/cultural practices.

People and relatives told us they felt listened to and that staff were caring and respectful. We found however instances where the service did not demonstrate caring and respect for people’s dignity and privacy.

People were encouraged to maintain their independence and staff gave us examples of how they promoted this.

People and relatives knew how to make a complaint or raise concerns and some had done so. We saw that not all complaints were appropriately managed and action taken in response.

Care plans were person-centred and contained details of people’s preferences and interests and identified the support needed to meet their clinical, personal and social needs effectively.

People using the service and relatives we spoke with were generally complimentary about the standard of care provided. People living at Manor Hey told us the manager was approachable and supportive.

Quality assurance systems in place needed to be more robust to help ensure the safe and effective delivery of services. There were policies and procedures in place to help ensure staff were supported to undertake their role effectively.