Himley Manor Care Home

Himley Manor is a residential care home providing accommodation and personal care people for up to 51 people aged 65 and over. At the time of the inspection 30 people were living at the home. The accommodation is provided over two floors each of which has its own communal areas.

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

Since the last inspection there had been a change in the management team. We found that this meant that improvements found at the last inspection had not been fully embedded and the provider was now in breach of regulations.

This inspection found that people's care plans did not comprehensively reflect their current risks and improvements were needed to ensure people were supported to stay safe. Care plans would also benefit from more personalised information on the support required by individual people.

The provider had quality monitoring systems in place, however, this inspection found they did not always identify issues and ensure that action was taken in a timely way.

People received support to take their medicines. People were supported by staff who were aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond to concerns.

Appropriate Personal Protective Equipment (PPE) was made available by the provider and worn by staff. Following recent concerns, the provider had worked with the local authority to ensure government COVID-19 guidelines were followed as required.

Staff and relatives told us that activities that are socially and culturally relevant to people could be improved. Relatives also told us that communication to support people maintain relationships important to them could be improved; especially during the pandemic. The provider told us of the improvements they had planned for activities and communication.

People and relatives said staff were caring and we saw positive interactions that supported this. Staff told us they could talk to manager for advice and support and felt confident any concerns they raised would be acted on.

Since the last inspection there had been a change in the management team. Relatives and healthcare professionals raised concerns about the number of management changes as they felt this impacted on the consistency of the service provided. However, staff, healthcare professionals and relatives all spoke positively about the new manager and the changes she had made in her four weeks in post.

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 on 05 October 2019).

Why we inspected

The inspection was prompted due to concerns about poor infection prevention and control (IPC) and whistleblowing concerns. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. We only looked at safe, responsive and well led during this inspection. We did not look at the key questions of effective and caring. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains as Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well led sections of this full report.

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

Enforcement

We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (good governance) at this inspection.

You can see what action we have asked the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

Following the failings identified at a previous inspection we imposed a positive condition on the providers

registration. It was agreed that this would stay in place and the provider will continue to be required to send monthly reports to CQC on how they are ensuring effective oversight of Himley Manor.

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

Himley Manor is a residential care home providing accommodation and personal care for up to 51 people aged 65 and over. At the time of the inspection there was 21 people living there.

The home is purpose built and care is provided across two floors.

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

Some further improvements were needed to ensure the quality systems in place were fully effective and embedded into day to day practice. Improvements were needed to how activities for people to take part in were decided and provided.

People and staff felt well supported and told us that the service was well managed, and many improvements had been made since our last inspection.

Risks to people had been assessed and staff had a good understanding of these risks and how to minimise them. People were supported to receive their medication as prescribed and staff demonstrated a good knowledge of types and signs of abuse and how to report concerns of abuse.

People were supported to access healthcare professionals when required.

Improvements had been made to the training and support that staff received so they had the skills to meet people’s needs. Where further training was needed plans were in place to provide this. Staff had been recruited safely and there were sufficient numbers of staff to support people.

People's care records were person centred and guided staff on the way they preferred their care and support to be provided. The provider had a system in place to ensure any complaints received would be logged, investigated and responded to and any learning used to improve the service provided.

People's dietary needs were met, and people had access to healthcare services where required.

People were supported by staff who were caring. People were involved in decisions around their care and were treated with dignity.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion or belief etc. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.

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 Inadequate (report published April 2019)

At our previous inspection we found a breach of regulation 12, 13 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. There were ineffective systems in place to keep people safe. People did not get the support they needed to keep safe. Staff were not knowledgeable about how to support people effectively. The provider had not ensured appropriate audits and governance systems were in place within the service and there were failures in effective reporting systems. At this inspection we found that improvements had been made and breaches had been met.

This service has been in Special Measures since our inspection in January 2019. During this inspection, the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any key question. Therefore, the service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Prior to this inspection we received an escalation of Information of concern about the service. These were relating to the attitude of the registered manager, poor care and staffing issues. We reviewed the information we received and made a decision to bring forward our comprehensive inspection.

This inspection took place on 15 and 16 January 2019 and was unannounced.

Himley Manor 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. A maximum of 51 people can live at Himley Manor. On the day of the inspection there were 35 People living at the home.

At this most recent inspection we found that the improvements reported on following our last inspection had not been sustained. We found multiple breaches of the regulations.

A registered manager had been appointed in November 2017 and was registered with CQC in April 2018. However, they were dismissed by the provider in December 2018. At the time of our inspection the provider had employed the services of an interim manager. 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.

People were not always protected from the risk of abuse. Where lessons could be learned to improve the service, and make the care people received safer; these were not always identified and addressed.

There were significant staff changes that had impacted negatively on people’s care. Staff were not supported in a way that ensured they were effective in their role.

People’s dignity was not always maintained and respected. Staff did not have time to spend quality time with people. Staff did not have information about people's social history or interests and were task focused with their approaches and engagement with people.

People did not always receive care and treatment that was responsive to their needs or provided in a person-centred way. People were not supported to be involved in the planning or review of the care they received. Care plans had not always been updated to reflect changes in the support people received. People had limited opportunities for social stimulation.

People told us they felt confident to raise a complaint and arrangements were in place for complaints to be investigated. Staff who gave people their prescribed medicines demonstrated a good knowledge and understanding of how to do this safely although the managements of external creams and ointments needed improvement. People had food and drink that they liked, but if they needed support with this it was not always provided to people in a way that met their needs.

People who lived at the home did not benefit from a service which was well-led. There had been a failure in the leadership and governance of the service. The systems in place to monitor or improve the quality of care had not been effective. Ineffective leadership in the home had impacted

on the people who lived at the home and the staff team. The ethos of honesty, learning from mistakes and admitting when things had gone wrong was lacking. The provider had not always met their legal responsibilities to inform the Care Quality Commission of significant events which had occurred in the home.

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 of 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 inadequate.

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the 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.

Himley Manor 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. A maximum of 51 people can live at Himley Manor. On the day of the inspection there were 30 people living at the home.

We previously inspected this service in January 2017. We found that the provider was not always meeting the legal requirements set out by the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and were rated as Requires Improvement. The provider was failing to meet regulation 17 of the HSCA which related to the governance of the service and included a lack of effective quality assurance, inconsistent record keeping and a lack of training for staff. After our inspection in January 2017 the provider met with us and provided us with an action plan outlining what they would do to meet legal requirements in relation to the breaches. We revisited the home and conducted a focussed inspection in July 2017 and found that the provider had adhered to their action plan and improvements had been made in order to meet the legal requirements.

We then carried out an unannounced comprehensive inspection of the service on 13 and 14 November 2017. At that inspection we found that areas previously improved had in the main not been sustained, with further breaches of the regulations identified and repeated. The overall rating for this service was 'Inadequate' and the service was placed into 'special measures'. We found that the provider was not always meeting the legal requirements set out by the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and was failing to meet the requirements of regulations 12, 13 and 17. Following the inspection we imposed a condition on to the provider’s registration which meant they were unable to admit people in to the home without seeking prior agreement from CQC. This was to ensure people living at the home remained safe while improvements were made. We also proposed to take further enforcement action against the provider. This included imposing additional conditions on to their registration which requires them to make the necessary improvements; at the time of writing this report these remain under review. During the inspection we also found a number of notifiable incidents that hadn’t been reported to CQC as required by law. As a result we have issued Fixed Penalty Notices against the provider.

Following the inspection in November 2017 we received whistleblowing concerns about a number of key care aspects, including staffing and a high number of incidents between people living at the home. Whistle-blowing is the term used when someone who works in or for an organisation raises a concern about malpractice or wrongdoing; staff should be supported to raise their concerns within the organisation without fear of reprisal. As a result we undertook a further focused inspection to look into those concerns. The focused inspection took place on 24 January 2018 and reviewed two of the five key questions, ‘Is the service safe?’ and ‘Is the service effective?’. We found improvements had been made and the overall rating for the service was changed to ‘Requires Improvement’. However, the service remained in ‘special measures’ as timescales since the last inspection meant the provider could not fully evidence the sustainability of the changes implemented and as such was in continuing breach of regulations 12 and 17 of the HSCA.

At this most recent inspection we found the provider and management team had made further improvements and were no longer in breach of the regulations. However, some improvements were still required and the overall rating remains ‘requires improvement’.

A manager had been appointed in November 2017 who was in post at the time of the inspection. Although the manager was not yet registered, they had submitted an application for registration and were awaiting their interview for this at the time of the 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.

Systems used for the effective handover of information about people’s changing needs and risks required further embedding to ensure people’s safety. The manager was now notifying the local authority and CQC about incidents and events as required by law. Staff received training in protecting people from harm and knew how to escalate any concerns for people’s safety and well-being. There were sufficient numbers of staff available to meet people’s care and support needs. People received their medicines as prescribed and systems used for the management of medicines were safe. The home environment was clean and well maintained and there were systems in place to monitor and audit infection control practices.

Improvements had been made to the training and support that staff received. However, we found that training delivered to ensure staff were able to support people safely with their mobility had not always been delivered by a competent person. People were asked for their consent before care was provided. Where people’s rights were restricted this had been done lawfully, however not all staff were aware of who was subject to a Deprivation of Liberty Safeguards DoLS authorisation or the reasons for this. People received sufficient amounts of food to maintain their health and improvements were required to fluid monitoring to ensure people were not placed at risk of dehydration. The home environment was well maintained and appropriate for the needs of people living at the home. Some opportunities to better meet the needs of people living with dementia had been missed due to a lack of reminiscence areas throughout the home.

People were supported by staff who were caring and gave them time to respond to questions or support. People were supported to make their own decisions about their daily lives and staff were aware of people’s life histories and diverse needs. Staff supported people to maintain their independence where possible. Relatives and visitors were welcomed in to the home by staff who knew them and staff supported people in a way that maintained their privacy and dignity.

Improvements had been made to people care plans, which now contained detailed information about people’s individual preferences and wishes. These were in the process of being updated and reviewed. Staff understood people’s likes and dislikes and supported them in accordance with their wishes. Improvements had been made to the support people received to take part in activities or events that interested them. People and their relatives knew how to raise a concern if they were dissatisfied with the care they or their family member received. Where people had specific wishes for the end of their lives, their views had been sought and recorded in line with good practice guidance.

There was a manager in post who had applied to register with us. They demonstrated a good understanding of the responsibilities of their role. People, relatives and staff commented on the improvements made by the manager and deputy manager. Improvements had been made to the quality assurance systems used to monitor and assess the standard of care people received. However, further improvements were required to ensure that where areas of improvement were identified, action was taken in a timely manner. The manager had continued to submit notifications to CQC of events as required by law.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Himley Manor Care Home is a home for people who receive accommodation and nursing care. A maximum of 51 people can live at the home. There were 32 people living at home on the day of the inspection.

We carried out an unannounced comprehensive inspection of this service on 13 November 2017. After that inspection we received whistleblowing concerns about a number of key care aspects, including staffing and a high number of incidents between people living at the home. Whistle-blowing is the term used when someone who works in or for an organisation raises a concern about malpractice or wrongdoing; staff should be supported to raise their concerns within the organisation without fear of reprisal. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Himley Manor Care Home on our website at www.cqc.org.uk.

Following this focussed inspection the overall rating for this service is ‘Requires improvement’. However, the service will remain 'special measures' until the next comprehensive inspection where all Key Questions will be reviewed.

Whilst steps had been taken to improve people’s safety there was a continuing breach of legal requirements due to the limited timescales since our last inspection. People’s incidents were now being recorded by staff and a new reporting process had been implemented. This new process will take time to implement and we will continue to monitor and check these improvements on the next comprehensive inspection.

People living in the home, their friends and relatives told us that staff support and guidance had improved. People told us that recently staffs assistance maintained their safety and staff understood how they were able to minimise the risk to people’s safety. We saw staff helped people and supported them by offering guidance or care that reduced their risks of harm. Care staff now had a clearer understanding of their responsibilities in reporting any suspected risk of abuse to the management team. Whilst staff were now confident that reported incidents were reviewed to improve care, continued evidence of this practice was needed. Staff were available for people and had their care needs met in a timely way. People told us their medicines were managed safely and administered for them by staff.

The manager had a range of audits ready to implement to demonstrate how they monitored the quality and safety of people’s care and support. The provider’s planned improvements will need to be fully implemented and demonstrate continued improvements are sustainable over time.

The manager had started to make improvements to the overall leadership of the home and both people and the staff team told us there were now opportunities to raise concerns and issue which were listened to.

You can see the action we have asked the provider to take at the end of this report.

Himley Manor Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection.

Himley Manor Care Home accommodates 51 people in one building. At the time of our inspection there were 43 people living at the home who were receiving support with their care needs relating to old age and/or dementia.

At our last inspection in January 2017, we found that the provider was not always meeting the legal requirements set out by the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and were rated as Requires Improvement overall. The provider was failing to meet regulation 17 of the HSCA which related to the governance of the service and included a lack of effective quality assurance, inconsistent record keeping and a lack of training for staff.

After our inspection in January 2017 the provider met with us and provided us with an action plan outlining what they would do to meet legal requirements in relation to the breaches. We revisited the home and conducted a focussed inspection in July 2017 and found that the provider had adhered to their action plan and improvements had been made in order to meet the legal requirements. . At this inspection we found that areas previously improved had in the main not been sustained, with further breaches of the regulations identified and repeated.

The service did not have a registered manager. The provider had been managing the service with support from a deputy since the previous registered manager left in early September 2017. A new manager had been appointed and commenced in post on 23 October 2017, but had not yet registered with us. 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.

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.

The provider was failing to keep people safe. Admissions decisions including risk assessments that balanced and considered the needs and safety of people using the service were not in place. Staff were reactive not proactive to people’s needs as a result of being rushed due to the high levels of dependency of people at the home. This meant they did not always prevent incidents that had the potential to cause harm to people, despite knowing the risks associated with their care needs. The provider was not reviewing the levels of staffing in relation to the complexity of people’s actual needs. Recruitment practices were not robust and did not fully assure the provider that staff were safe to work with people at the home.

The provider had failed to take appropriate action without delay to investigate and/or refer to the appropriate body when concerns were reported to them. Incidents that affect the health, safety and welfare of people using services were not reviewed effectively or reported to relevant external bodies. On the whole, people received their medicines as prescribed. This meant that systems and processes implemented for medicines management were effective.

Peoples care was not always well coordinated and delivered in line with their needs and choices, as these were not consistently established. The mealtime experience lacked structure, choices and a sense of event, with insufficient staff to support people to eat and drink safely and in a timely manner.

Assessment and/or reviews required of people’s physical well-being were sought appropriately; however people’s mental well-being was not as well supported by referral to appropriate healthcare professionals. A number of people using the service were identified as having needs that required staff to have specialist training. Staff had not received training at a level that supported them to deal with people at the home with behaviours that challenge. Many staff had not received adequate supervision for a considerable period of time and in some instances none had been received since joining the service. Checks in relation to staff practices and competency were not completed.

Staff lacked knowledge about which people at the home were subject to a Deprivation of Liberty Safeguards [DoLS] and the application of DoLS by the provider was not effectively maintained.

Whilst most staff were seen to positively interact with people and actively support them within the restrictions of time constraints, there were isolated instances where language used to describe people was disrespectful. The provider failed to demonstrate a caring approach as they had not ensured the safety and quality of the service being provided to people.

Needs in relation to people’s diverse needs, such as their cultural, sexuality and spiritual needs were not routinely explored and or care planned around therefore went potentially unmet.

Activities were limited and people were under stimulated due to lack of staff available to provide support to people to be meaningfully occupied. A lack of knowledge about some people as individuals and their lives due to lack of holistic assessment was apparent. Complaints and concerns raised were not always effectively dealt with or taken seriously.

Involvement of people or their relatives in the development of care plans and reviews was variable. Care records were not updated in a meaningful way and so were not fully reflective of people’s needs, particularly in relation to their dementia needs.

The service has been rated as Requires Improvement for the past three comprehensive inspections has not been fully compliant in all areas since August 2014. Following the previous 'requires improvement' rating, a minimum ‘good’ overall rating would be expected, but this had not been the case as we found the quality and safety of care that people received had deteriorated.

We found four breaches 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 back of the full version of the report.

We undertook a focused follow up inspection on 19 July 2017. The inspection was unannounced. This focused inspection was conducted to check that the provider had followed their action plan and to confirm that they had met their legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Himley Manor Care Home on our website at www.cqc.org.uk.

Himley Manor Care Home is registered to provide accommodation, personal and nursing care to 51 people. At the time of our inspection there were 43 people living at the home. People who lived there have health issues related to old age and/or dementia.

There was a 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.

The provider had taken action and the legal requirements had been met.

Peoples care needs were being reviewed with them or their representative’s involvement. People’s feedback, our observations and conversations with staff provided evidence to us that people’s needs were understood, including their preferences, likes and dislikes. The provider had made significant steps toward improving the availability of more personalised activities at the home.

The provider had made sufficient improvements to monitor the quality of the service provided. This included monitoring the safety of the environment and ensuring staff training was up to date. Care records had been updated to ensure staff had the information they needed to deliver support in accordance with people’s individual preferences.

This inspection took place on 5 and 6 January 2017 and was unannounced. At our last inspection in April 2016 we found a breach of the legal requirements of the Health and Social Care Act and issued an overall rating of requires improvement. The breaches found related to the governance of the service and included a lack of effective quality assurance, inconsistent record keeping and a lack of training for staff. After our inspection in April 2016 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this our most recent inspection we found they had not fully completed the necessary improvements in a timely manner.

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.

Medicines within the service required more comprehensive checks to be completed and guidance for staff in their administration to be implemented. Risks to people’s health and ongoing wellbeing were not consistently assessed, reviewed and updated; although staff were able to describe how they supported people to keep them safe from harm. Records in relation to incidents that occurred did not always clearly demonstrate the outcome or outline any learning or changes to practice as a result. Recruitment processes in place were not robust and some gaps and omissions in the necessary checks required before staff began working at the service were evident. Staff protected people from abuse and harm and knew how to recognise signs of abuse and raise an alert if they had any concerns. Staffing levels were adequate in order to meet and support people’s needs.

Training provision was inconsistent and was lacking in terms of variety and availability for all staff, particularly new starters, who were commencing work without any up to date training being provided. Deprivation of Liberty Safeguard’s [DoLS] was not clearly understood by all staff and most had not received the training necessary to improve their knowledge in this area. People’s consent was sought by staff before supporting them and some consideration was given to their mental capacity to make informed choices. Staff accessed input from health care professionals for people when they needed it. Meal times lacked a sense of occasion and people were not supported as effectively as possible in relation to making food choices. Staff were provided with supervision and had access to the support they needed when they needed it.

People were most complimentary about the caring nature of staff; however the areas requiring improvement outlined in this report demonstrated that the provider did not always show caring for the welfare of the people using the service. Staff were patient, reassuring and gave people the encouragement they needed when supporting them. Information about local advocacy services was displayed and staff we spoke with were aware of how to access advocacy support for people. Staff treated people with dignity and respect and were discreet in relation to assisting people with their personal care needs.

People’s cultural needs were not always understood by staff or met. Assessments and reviews of peoples individual care needs lacked their involvement or that of their representative in their development. People had some planned activities made available to them, for example visiting singers and film days, but more personalised activities were not in place. People were encouraged by staff to maintain relationships with their friends and families. Information about how people could make their views or concerns known, including information about how to make a complaint were available.

Issues identified at our last inspection in April 2016 had not been fully addressed, in the timely manner expected. The provider’s quality assurance systems were not always effective in identifying and addressing issues of concern and that may affect people’s safety. People’s feedback in relation to the quality of the service was sought through a variety of meetings and surveys. People were positive about how effectively the service was managed. The provider promoted an open and inclusive culture within the service with people and staff able to freely raise any concerns they had. The registered manager understood their responsibilities for reporting certain incidents and events to us that had occurred at the service or affected people who used the service.

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

Himley Manor Care Home is registered to provide accommodation, personal and nursing care as well as diagnostic and screening procedures and treatment of disease, disorder or injury. They are registered to provide care to a maximum of 51 people. At the time of our inspection there were 46 people living at the home.

There was no manager registered with us. A manager was in post and had made an application to register. 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.

Quality assurance audits had not been completed to monitor the quality of the service. Medication audits had identified issues but the action taken had failed to address the issue.

We saw that staff had not received timely updates to their training to ensure they remained competent in their role.

Records kept about people’s care had not been kept up to date and available for staff. We saw that one care plan had not been kept secure.

People were supported to take their medication. However records kept about people’s medication were not always accurate.

People had been involved with an assessment of their needs before moving into the home but were not supported to be involved in reviews of their care.

People told us they felt safe at the home. Staff had an understanding of how to identify and report abuse and had a good understanding of how to manage risks to keep people safe.

The provider had undertaken checks to reduce the risk of unsuitable staff being employed. We saw there were systems in place to ensure there were sufficient numbers of staff on duty.

People were supported to make decisions and had their rights upheld in line with the Mental Capacity Act 2005.

People were given choices at mealtimes and were supported to have enough food and drink. People’s health needs were met as they were supported to access a range of healthcare support when required.

People were supported by staff that had a kind and caring approach. Staff treated people with dignity and respected their privacy.

People told us they had access to a range of activities that reflected their personal interests.

People and their relatives were aware of how to make complaints. Complaints made had been investigated fully by the manager. People were supported to give feedback on the service via resident meetings and questionnaires.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We received information before our visit and found that people were sometimes cared for staff that were not appropriately deployed to ensure their safety and meet their needs. For example we found that there were insufficient numbers of staff on duty in the morning to ensure that people were not woken early but were safely supported when they woke naturally. We saw that the lounge was not adequately staffed to keep people safe and we saw that people did not receive food in a timely way to meet their needs.

The provider had not notified the local authority or us, as required, of some incidents that had occurred that should have been reported under safeguarding procedures. This placed people at risk as allegations were not investigated and appropriate steps were not taken to minimise the risk to any vulnerable person.

There were no people who had restrictions placed on them through the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). These safeguards apply where it is thought that it is in someone's best interests to be placed in a care home but they lack the capacity to make a decision about what is being proposed for them or restraints are used that limit a person freedom of movement. In these circumstances the provider must apply for authorisation to deprive the person of their liberty. We found that insufficient safeguards were in place to ensure that limits to people's movement were not depriving people's freedom of movement.

Risks to people's health, safety and welfare had not always been assessed and remedial action had therefore not been taken. Some people who had bed rails on their beds did not have an assessment for them. We spoke with a person that had climbed over their bedrails and saw records of another person that had attempted to get over bed rails. Neither person had these risks re-assessed which meant no more appropriate solutions had been found to help keep them safe. We found that there was inadequate review of incidents and accidents which meant that opportunities to learn and avoid similar occurrences were missed.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

Some people living in the home became disorientated about time and we saw from records that they had unsettled nights. We observed and records showed that the home's practice was that people who had disturbed nights were washed and dressed in day clothes with no attempts made to resettle them back to bed to continue resting. We found that four people were washed and dressed in day clothes at 5am when we arrived at the home. This did not assist people living with dementia understand it was very early morning or help them establish a good sleep pattern.

Some people's care plans indicated that their preferred time of rising and going to bed was different to what they experienced. There was no assessment of the night time checks and how they were carried out to see if they prevented a good sleep pattern for people living in the home.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to meeting the individual needs of people with adequate numbers of staff.

Is the service caring?

We saw that when staff interacted with people they were kind and caring. People had their personal care needs met. We saw that people's hair and nail care had been attended to. We saw that staff did not always have enough time to provide care to people in meaningful way because of pressure and competing needs of other people in the home. People were not always cared for in a compassionate manner which was demonstrated in some people being woken early, not in line with their wishes, and supported to get dressed and remain up for the day rather than being supported to return to bed after their personal care needs were met.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to ensure people are cared for and receive compassionate individualised care.

Is the service responsive?

People did not always have the support they needed. At different times during the inspection we saw that people were placed at physical or emotional risk when no staff were available to attend to them and provide support. Situations observed included seeing a person who was upset and distressed had been left alone; a person told us they had climbed over their bed rails and we saw people who needed support at the breakfast meal who did not have access to staff in a timely way.

We found that in recent times prior to the inspection that more staff had been made available to increase the numbers on each shift. However we found that the routines and care practice in the home did not ensure that people received support to meet their needs safely in a timely manner.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to responded to and meeting people's needs.

Is the service well led?

Quality monitoring measures used in the home were not effective and failed to ensure that enough staff were deployed appropriately at all times to meet the needs of people living in the home.

The systems to manage risk were not effective and failed to ensure that measures were put in place to learn from accidents or incidents that had occurred and ensure that people were cared for as they expected in line with the requirements of the regulations.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to meeting responded to and ensuring that they meet the requirements of the regulations.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with five people who used the service and spoke with five relatives and visitors during the course of our inspection. At the time of the inspection there were thirty two people living in the home. We spent time with people during the inspection and spoke with seven members of staff about their work at the home.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was clean and hygienic. There were enough staff on duty to meet the needs of people living at the home and a management team was available on call in case of emergencies. Relatives we spoke with were all happy with the care being delivered. One relative said:"Can't fault any of them, I have peace of mind when I leave".

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) and the Mental Capacity Act 2005; one DOLS application had been submitted in the last year. Another DOLS had been considered but the person who used the service had moved from this service. Proper policies and procedures were in place. This meant that people using the service were protected from being restricted of their liberty unlawfully.

Staff personnel records contained all the information required by the Health and Social Act 2008. This ensured that people were supported by people who had the skills and experience to support people living in the home.

Is the service effective?

People told us they were happy with the care they received and felt their needs were met. Our observations and discussions with staff showed they understood people's care and support needs. One person told us: 'I'm treated extremely well, everything is excellent here'. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

We saw that people were supported by staff who were kind and caring towards them. People were relaxed and accessed all areas of the service. One person told us: 'The staff do whatever they can for you, help me as I need'. One person told us: "The staff do whatever they can for you, help me as I need".

We saw evidence that assessments were used in the planning of care and support to people who use the service. This meant that people using the service were protected against the risks of inappropriate care.

Is the service responsive?

We saw that before a person started to use the service, an assessment of their needs and abilities was undertaken. Records confirmed people's preferences and interests and showed the support and care that had been provided to meet their needs and wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff told us they were able to talk to the manager and senior staff when they needed to and that they received regular supervision, training and support. People told us they were asked for feedback on the service they received and how their comments were acted on. Staff told us that they were clear about their roles and responsibilities and that they felt well supported. Staff told us that they received regular supervision that they found helpful and helped them to carry out their duties well.

The manager had systems in place to monitor various aspects of the service's operations. We saw that the service had robust contingency, emergency planning in place to ensure that people using the service always had their needs met.