Archived: The Manor Care Home

The Manor Care Home is a residential care home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 65 people.

The service operates over three floors that provide a secure setting for people who are living with dementia and associated needs. Each floor is keypad secured, preventing people from walking independently within the service. Staff support people should they wish to move between the floors. Each bedroom has an en-suite, that the person is able to use, in addition to communal bathrooms. Dining facilities and lounges are available on each floor. People can access the large communal gardens through the ground floor. An elevator enables access to all floors for people who have mobility issues. The ‘Sun lounge’ offers sensory stimulation to people and is accessible on the first floor.

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

The care and treatment of people was not always appropriate and did not always meet their specific needs. Care plans did not evidence that people were being involved to the maximum extent possible in their care or that their preferences were always being taken into consideration. We found that next of kin were making decisions for people without having the legal authority to do so, and without evidence of best interest meetings take place.

People were at risk of potential harm because the registered person had failed to ensure the proper and safe management of medicines.

People were at risk of potential harm because risks were not appropriately mitigated, or actions identified where a risk was prevalent. The service had removed call bells from peoples’ rooms without giving consideration on how they would seek support should the need arise.

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.

Systems to ensure compliance with legal obligations and the regulations were not effective. Audits although completed, did not assess, monitor and improve the quality and safety of the service provided. The lack of robust quality audits meant people were at risk of receiving poor quality care and, should a decline in standards occur, the systems would potentially not pick up issues effectively. The registered manager did not have a thorough overview of the service.

People had their healthcare needs identified and were able to access healthcare professionals such as the GP, optician when needed. The service worked well with other professionals to provide effective health care to people.

Activities were offered to people and their families to improve wellbeing. Staff engaged well with people focusing on prompting communication and reducing social isolation. Sufficient staff were deployed to support people.

Staff were compassionate and kind when speaking with and supporting people. We observed good examples of care being delivered to people, with staff taking their time when engaging and completing tasks.

People’s nutritional and hydration needs were well met. Staff ensured people were well supported to eat and drink. Meals were nutritious and met people’s specific health needs.

The environment was clean and appropriate for the service type. Signage could help improve people’s experience when living with dementia. 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 good (published 07 June 2017).

Why we inspected

The inspection was prompted in part due to concerns received about unsafe medicine management, poor practice and support for people and insufficient staffing. A decision was made for us to inspect and examine these risks in depth, as part of the scheduled inspection.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report to identify areas where improvement is required. You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Manor Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to regulation 9 (person centred care), 11 (need for consent), 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Care provided was not always person-centred; people did not always receive safe care and treatment and were not always protected from the risks of harm; staff and management did not have a comprehensive understanding of capacity and the MCA and effective systems were not in place to ensure the service met the required fundamental standards of care.

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

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.

At the time of the inspection, there was 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 manager had been in post continuously for some time, and knew the service well.

Our last inspection was on 11 and 12 March 2015 under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The overall rating was good, with all key questions rated good, except for 'Is the service effective?’ which was rated requires improvement. This was because there was a recommendation about people’s covert medicines administration. This was resolved at this inspection. This is our first inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were safeguarded from abuse. There was a system in place to ensure that people’s safety was maintained. Staff and the registered manager were knowledgeable about abuse and how to deal with any allegations.

Planning for people’s admissions was viewed by the service as an important step in delivering good quality care. After admission, people’s care risks were thoroughly assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

The safety of the premises, equipment and grounds were assessed and managed which protected people, staff and visitors from risk. We viewed maintenance records which demonstrated all required checks for health and safety were completed. We made a recommendation about the prevention and control of Legionella at the service. This was to ensure guidance from the Health and Safety Executive was always used.

There were plenty of staff deployed to support people. People and relatives we spoke with were satisfied that there was sufficient staff. Our observations showed that the staff were neither busy nor task-focussed and this led to them spending time with people promoting their independence and wellness. Staff worked well together in their respective teams, were flexible with the service’s requirements and were willing to assist their colleagues without hesitation.

Medicines were well-managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Registered nurses demonstrated good practice, in line with that set by national standards and guidelines. Regular pharmacist and GP input was sought and obtained for the management of people’s medicines.

Staff were knowledgeable and competent. They received appropriate levels of induction, training and supervisions. There was a passion for learning and development within the service. This was evident by the employment of dedicated trainers, a focus on ensuring the progression of staff careers and training topics not often used in similar services.

The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decisions meant the service complied with the MCA codes of practice. There was clear information at the service regarding people’s applications, reviews and expiry dates for standard Deprivation of Liberty Safeguards (DoLS) authorisations. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People received ample food which they had a positive opinion about. Hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them. Alternative menus were available. People told us they liked the food and had good choices. The kitchen staff were working towards better presentation of texture-modified food to people with swallowing difficulties.

We found the service was caring. People told us staff were kind and patient. We observed staff were warm and friendly when they interacted with people. Staff smiled and laughed with people, and encouraged them to enjoy their stay.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. The service’s complaints procedure was robust but could be better displayed and communicated to all parties.

The service was always well-led. We received a high volume of feedback from contacts of the service who told us they felt the culture at the service was always extremely positive. People’s observations of the everyday running of the service had accordingly influenced their opinion about the how it was well-led. Staff told us they enjoyed their roles, felt supported by the management and were encouraged to progress. We found the management team were dedicated, passionate about care and had extensive knowledge of older adults, people with dementia and end of life care. Numerous audits were used to check the quality of care. The service had forged excellent relationships with other local organisations to embrace and embed continuity of care for people, and prevent hospital admissions.

We saw people's personal preferences were documented, and staff attended to people as they wished. People were able to take part in community activities and their independence was promoted where possible.

The service facilitated people to make comments and complaints, and there was a system to respond to people's complaints.

Most people who use the service felt they were listened to and involved in planning their care. However some people felt they were not involved in the running of the home and the changes which had occurred in recent months. Some people were not satisfied with the community activities available to them.

We saw the service responded to people's needs when people requested assistance. Most communication between staff and people was appropriate. People were usually presented with choices or had care explained to them before they received it. People were supported to eat at lunch time by staff. However, staff were not able to help everyone who needed assistance when their food was served.

Care plans contained up to date information on people's needs and their care. However the care delivered did not always match people's preferences as listed in their care plans.

Staff had received appropriate training and professional development. Staff mostly said they felt well supported to undertake their roles.

The service had several monitoring tools which identified risks and improvements to the service. However an audit based on CQC's essential standard's outcome one did not identify problems we found related to this outcome.

However we saw the service did not always follow legal requirements in relation to the Mental Capacity Act (MCA) 2005. The service did not always make decisions using best interest decision making procedures and did not always assess people's capacity to make decisions about their care.

We looked at seven care plans and saw they contained personalised information relating to peoples needs and preferences.

Staff cared for people when they required assistance. However, staff were not always aware of information in care plans when caring for people. Some staff seemed to lack confidence undertaking certain tasks.

We found staff did not have appraisals. We looked at a training matrix which indicated nearly all staff had received mandatory training.

Staff were aware of the home's whistle blowing policy and said they would be confident to use it.

On the day before this inspection we were notified by the nominated individual the acting manager had resigned. On the day of our inspection we were advised one of the registered nurses had been designated as acting manager and the provider was advertising for a new manager.

There were 41 people living at the home when we visited. Although we spent time speaking with most of the people living at the home, what they told us did not relate to the area of compliance we were inspecting.

We found the provider had taken steps to identify and reduce risks to the safety and welfare of people living at the home. We found the provider was working towards reaching compliance in areas of non-compliance identified at our inspection on 28 August 2012.

We observed people received care which respected their privacy and dignity. Staff called people by their name, explained things to them and offered alternatives where possible.

Staff we spoke with told us they felt supported by the new manager and the provider. Staff had already held meetings with the manager and the manager told us that further meetings were planned. We looked at the staff training matrix, which showed some staff had not received refresher training in important subjects. For example only a small percentage of staff had attended basic first aid training and there was no record of staff completing basic life support training.

The care plans we viewed contained assessments of people's needs and how staff would assist with the care provided. Care plans were reviewed regularly, but contained some conflicting information about how to look after people which staff could find confusing.

We noted systems to monitor the quality and safety of the care were lacking. For example infection control audits and environmental risk assessments. However, the new manager told us she was committed to improving the care for people who use the service.