Archived: Manor House

Updated 18 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 5, 6, 7 and 8 May 2016 and was unannounced. The inspection was carried out by two inspectors and one inspection manager. This inspection was brought forward and undertaken as a result of concerns received by the Commission. Therefore the provider was not asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Prior to the inspection we reviewed information we held about the service. This included notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

We spoke with two relatives, the provider, the registered manager and six members of staff. Most people were not able to tell us about living at Manor House, therefore we observed staff carrying out their duties, communicating and interacting with people to help us understand their experiences. We reviewed people’s records and a variety of documents. These included 11 people’s care plans, risk assessments, medicine administration records, accident and incident records, daily reports made by staff, policies and procedures and the staff rotas. We asked for information on how the quality of the service was monitored and managed but this was not available.

We contacted eight social care professionals before and after the inspection that had had recent contact with the service and received their feedback.

Updated 18 June 2016

We undertook an unannounced inspection of this service on 5, 6, 7 and 8 May 2016. Manor House is registered to provide accommodation and personal care for up to 22 older people who may be living with dementia. The premises are a detached house with a garden, situated in Lydd. The service has 19 bedrooms, three of which are twin rooms. Eight rooms have ensuite facilities. Bedrooms are spread over two floors which can be accessed by the use of a passenger lift. People had access to two bathrooms, separate toilets and a dining room, lounge and quiet lounge. 14 people were living at Manor House at the time of the inspection.

Our previous focused inspection, on 9 February 2016, found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to staffing levels, safeguarding people from abuse, staff recruitment processes and to protect people in the event of an emergency. The provider gave us an action plan, although this did not address the actions required. At this inspection we found that no improvements had been made.

The service had 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 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 registered provider and registered manager did not have oversight of the service. The quality of all areas of the service had not been checked to make sure they were of the required standard. The registered provider and registered manager were not aware of the shortfalls in the service that we found at the inspection. The registered manager had not informed us of important events that happened at the service without a delay.

People did not always receive care at the time that they needed or wanted it. Staff did not always respond to people’s needs or calls for assistance.

People were not protected from abuse and avoidable harm as incidents had not been recognised or recorded and responded to appropriately.

The provider had not ensured there were enough staff to meet people’s needs. Staff said, “There are not enough staff and people don’t get the care they need.”

Safe recruitment practices were not followed to help ensure only suitable people worked in the home. Not all staff had received a criminal records check.

Staff did not monitor people’s risks appropriately, although we saw risk assessments in people’s care files we found staff did not always follow relevant guidance. People were left at significant risk of developing skin sores as they slept in old beds or divan beds with mattresses which were not fit for purpose.

The provider had failed to maintain the environment. Furniture was old and falling apart, padding from some armchairs was missing and seat cushions were old and worn. The smell of urine was overpowering, from being greeted at the front door and throughout the service. Carpets were stained and dirty. In people’s bedrooms, mattresses and bedding were covered in urine stains and some curtains had faeces on them, which had been left to build up for months, in some areas the smell was unbearable and eye-watering.

The provider and staff did not understand their responsibility in relation to infection control. The home was dirty. There were stained toilet seats, old dirt and grime around baths and carpets were covered in crumbs and dirt.

Staff did not receive an adequate induction when they started working at the service. Most staff had received training, although some had not received recent updated or refresher training to ensure they followed current best practice guidance. Training was not effective as staff were not providing support to meet the needs of people and ensure their health, welfare and dignity.

The provider failed to support staff or ensure they did not work excessive hours. Some staff regularly worked over 50 hours a week.

People who required encouragement to eat were not provided this. Some people did not eat their lunch at all although staff failed to notice this or offer an alternative.

We did see some examples of kind actions from staff. However, we saw many examples of people being treated in an uncaring manner. Some people sat for long periods of time and staff did not acknowledge them, or enter the room to check they were ok. People’s privacy and dignity was not maintained.

The provider had not ensured people had the opportunity to participate in regular activities or social interests relevant to them. The provider had allocated 6 hours to ‘activities’ each week, although this was more often than not used to care and support people due to the lack of sufficient staff being employed at the service. People were left sitting with nothing to do and no social interaction from staff.

The provider did not have a hold on the day to day management of the home and did not offer support to the registered manager. The provider told us that they had appointed a ‘consultant’, who was in control of the day to day running of the service. During discussions with the provider they did not demonstrate a suitable understanding of the running and organisation of the service. Furthermore, the provider had knowingly appointed an individual with a history of cancelled registrations with the Care Quality Commission, to oversee the management of a service for vulnerable people.

We raised our concerns about what we had seen and found during our inspection with the provider. Over the four days of our inspection the provider failed to take action in response or mitigate the major risk to people with regard to their health, safety and well-being. The provider did not take any action to ensure people who lived at Manor House were treated with care, respect and dignity and lived in an environment that was caring, fit for purpose, free from risk and free from infection.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As a result of our findings we applied to Folkestone Magistrates Court for an order to urgently to cancel the provider’s registration under our powers set out in section 30 of the Health and Social Care Act 2008. The Court ordered that the provider’s registration be cancelled on 9 May 2016. The home was closed on 9 May 2016.