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Inspection carried out on 22 October 2018

During a routine inspection

This inspection took place on 22 October 2018 and was unannounced.

Manor Field 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. Manor Field is registered to accommodate six people with learning disabilities and autism. At the time of our inspection there were two people living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection in October 2017 this service was rated requires improvement. At this inspection, the service remains rated as requires improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive, and well led to at least good. They submitted this action plan with information about the improvements to be made, however, at this inspection on 22 October 2018, although some areas had improved there continued to be aspects of the service that required improving.

There was not sufficient oversight or record keeping for staff training. The systems in place did not accurately monitor and record what training staff had completed, when they had completed it, and when it was due for renewal. This resulted in several staff not being trained appropriately to meet people’s needs. When the management had recognised that one staff member had not completed a particular training course, prompt action was not taken to ensure they completed the required training.

People were not always supported by staff who were trained to meet their needs. We saw that staff were supporting individuals who may display challenging behaviour, and who required support from staff that were adequately trained to manage these risks. Staff members were not always trained in this area.

There was not a registered manager in post, but a manager was in place that would be going through the registration process with CQC. 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 had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, and actions were taken to reduce risk where possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the manager.

Staffing levels were adequate to meet people's current needs, and rotas showed that staffing was consistent.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required.

Staff supported people with the administration of medicines, and were trained to do so.

People were protected by the prevention and control of infection. The service was clean and tidy, and had a maintenance staff member regularly carry out any works required.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Consent forms were signed and within people’s files.

People were able to choose the food and drink they wanted and staff supported people with this, and people could be supported

Inspection carried out on 4 October 2017

During a routine inspection

This unannounced inspection took place on 4 and 5 October 2017. This residential care home is registered to provide accommodation and personal care for up to six adults. At the time of our inspection there were three people living at the home.

There was no 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.

Improvements were required to ensure that staff had a good understanding of their safeguarding responsibilities and that any concerns were reported and investigated promptly. Improvements were also required to ensure that all required notifications were submitted to the Care Quality Commission in a timely way.

Improvements were required to the quality assurance procedures within the home. The quality assurance systems that were in place were not robust enough to identify or act on the failings within the home. People’s care plan records were incomplete and inaccurate and documentation relating to people’s care was not always easily accessible.

Accidents and incidents were not always recorded appropriately. As a result there had been an ineffective system of reviewing incidents, identifying trends and taking action to prevent similar occurrences. People’s risk assessments were not regularly reviewed or updated and it was unclear which guidance staff should follow to help manage people’s risks.

Improvements were required to ensure staff had the training they required before people moved into the home, and that they had regular supervision about their performance to identify any training needs. Improvements were also required to ensure that the home monitored people’s Deprivation of Liberty Safeguards (DoLS) applications and that staff understood who this applied to.

People were supported to eat the foods they liked however improvements were required to ensure that people received consistent support to have a balanced and nutritious diet. People’s healthcare needs were met however improvements were required to ensure these were monitored and kept under review.

Further consideration and improvements were required to the pre-admission assessment procedures to ensure that staff were able to meet people’s needs when they moved into the home. Management needed to give consideration to staffing skills and training needs, the location of each person’s bedroom, and how they would integrate with other people already living at the home.

People’s care plans were confusing, difficult to follow and required attention to ensure they were accurate and complete. Care plans had missing information, and duplicated information. There was also conflicting information and people’s care plans did not always correlate with the care they received.

There were no systems in place to ask people, their relatives, staff or any professional involved with the service for their feedback. The quality assurance systems in place were not effective at ensuring timely action was taken to improve the home.

People received their medicines safely however improvements were required to ensure that all medicines were stored in accordance with best practice. Staffing levels were sufficient to support people to receive the care they required, and staff were recruited in a safe way.

People told us they enjoyed living at the home. They had developed good relationships with staff and were comfortable spending time with them. Staff had a good knowledge about the people they supported and encouraged them to express their own views and make their own decisions.

Protecting people’s privacy and dignity were key values within the home and people’s individual preferences were respected. People were supported to maintain relationships that were important to