Archived: Manorcroft

Manorcroft is a care home providing accommodation, personal and nursing care for up to 40 people, including people living with dementia. It is purpose built, providing accommodation across 2 floors. At the time of our inspection there were 35 people using the service.

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

Medicines records did not always contain enough detail. Quality assurance and supervision systems and processes were in place, however they needed further embedding into the service.

We have made a recommendation regarding medicines management, quality assurance systems and supervision processes.

Risks to people’s health and safety were managed effectively. People felt safe at the service and were safeguarded from the risk of abuse. Effective Infection Prevention and Control (IPC) practices were in place.

Staff were recruited safely and appropriately trained. There were enough staff to meet people’s needs.

Care was person centred and respected people’s choice. People were involved in their care and the service worked effectively with other healthcare agencies to meet people’s needs.

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.

There was a positive culture at the service that created an open and honest environment. People and relatives spoke positively about the service and the care received. The service had taken steps to engage people and drive improvement.

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 11 December 2019).

Why we inspected

We received concerns in relation to medicines management, care delivery and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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.

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

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Recommendations

We have made a recommendation regarding medicines management, quality assurance systems and supervision processes.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home was clean and had regular cleaning regimes in place. Clear infection prevention signs reminded everyone at the point of entry and throughout the home about procedures for infection control.

Clear communication with staff reinforced hygiene practices, such as in shift handover and daily meetings. Hand sanitising points were readily accessible throughout the home and staff used these frequently.

People isolating in their rooms had regular contact with staff who wore personal protective equipment (PPE) appropriately. Staff told us they had plenty supplies of PPE.

Further information is in the detailed findings below.

Manorcroft is registered to provide accommodation, personal care and nursing care for up to 40 people. There were 27 people living at the home on the day of our inspection. Manorcroft is a two storey purpose built building providing accommodation across two floors.

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

The manager was open and honest with us about the performance of the service and areas for further development. Staff spoke positively about the manager and improvements they had made. Some of our findings had not been identified through audits and other systems of governance and action plans required clearer recording. However, people, relatives and staff were engaged in the running of the home. A complaints system was in place, although one incident which required a complaint to be opened had not been actioned.

Medication was safely managed by staff who had been trained and assessed as competent. The recording of the application of creams required improvement.

We discussed a concern about one person’s dietary need not being followed with the manager who said they would take action. People enjoyed the food provided and had a positive mealtime experience. Care plans contained sufficient information around people’s needs. End of life care planning required some improvement which the manager said they would address. Positive feedback was received around the activities programme.

People felt safe living at this home and staff were able to recognise and report abuse. There were sufficient numbers of safely recruited staff to meet people’s needs. Overall, risks to people’s health and safety were assessed and mitigated. Work was ongoing to ensure fire safety requirements were met.

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. Staff ensured people had access to healthcare services. Staff received formal support through supervision and training. People’s living spaces were personalised and they were consulted about redecoration in the home.

Consistently good feedback was given by people and relatives about staff demonstrating caring attitudes and values. Staff were familiar with people’s care needs and their preferences. People and relatives were involved in their care planning. People’s privacy and dignity was respected. Visitors were made to feel welcome at all times.

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 14 November 2018) and there was a single breach of regulation. The registered 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 regulation for consent to care from the last inspection.

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.

Manorcroft is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Manorcroft is registered to provide accommodation, personal care and nursing care for up to 40 people. There were 37 people living at the home on both days of our inspection. Manorcroft is a large two storey purpose built building offering accommodation across two floors accessed by a passenger lift. Each floor has a communal lounge and bathrooms. Outside there is a garden and patio area with seating.

The home had a registered manager who was available throughout our inspection. 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.

People told us they felt very safe living at Manorcroft and their relatives felt assured their family member was safe. Staff had received safeguarding training and knew how to identify and report suspected abuse and knew the procedure to report any incidents.

Staff received training and support required to meet people’s needs. Recruitment procedures were robust to ensure suitable staff worked in the home. People were cared for, or supported by, sufficient numbers of staff.

Standardised risk assessments were used in care plans so risks to people’s health and safety could be effectively tracked and monitored.

Medicines were administered safely and with due consideration to national guidance.

The registered manager had audit systems in place, including for monitoring accidents and incidents, although not all checks were documented thoroughly, for example, the registered manager told us they undertook a daily walkround of the home but there was no documentation to support this.

Care plans contained personal histories and people’s preferences in relation to their physical needs. People were offered choice and their care plans contained some mental capacity assessments. Consideration had been given to people’s consent, and some consideration given to people’s capacity to do so for some aspects of care and support needs. Applications to lawfully deprive people of their liberty (DoLS) had been appropriately submitted to the local authority and were well managed. However we found some instances were people had not had their individual rights upheld.

Training was available and took place although some people had not been trained there were plans in place to do so. Staff supervisions and appraisals were taking place however these had not been undertaken in line with the registered provider’s policy.

People were provided with a good choice of freshly prepared food and snacks and drinks were available throughout the day.

People were supported to receive access to healthcare which was demonstrated and recorded in care plans.

People were consulted and had been involved in the refurbishment of the home, choosing colours and items for both communal areas and their own bedrooms.

Staff were aware of the need to ensure people’s dignity and their privacy. Staff were aware to support people’s independence wherever possible.

The registered provider’s monthly quality reports showed oversight of the service. The registered manager followed and completed these systems. Senior staff within the home were responsible for completing audits and reviews of care files however there was no evidence of manager oversight of these because we found many of the system alerts had not been actioned.

Feedback was sought to engage people, relatives and staff in the running of the service.

People and their relatives felt they were well looked after at Manorcroft. People enjoyed different activities and staff engagement and interactions with people was kind, caring and dignified.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

Manorcroft is a ‘care home’. People received 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.

Manorcroft accommodates up to 40 people on two separate floors with a lift or stairs access to the upper floor. People had ensuite facilities in their bedrooms with communal bath and shower rooms located on each floor. On both days of our inspection there were 37 living at Manorcroft. People with both residential and nursing needs were supported on both floors.

At the time of our inspection the home did not have a registered manager. The manager was in the process of submitting the application form and other relevant documentation to the Care Quality Commission to become the 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.

People told us they felt safe in the home and staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. However, risks to people were not always identified and managed safely, accident and incidents were not always analysed accurately and some areas of medicines were not well managed.

People were offered choice; however, the care plans did not always contain decision specific mental capacity assessments. Deprivation of Liberty Safeguards were mostly well managed.

Staff did received training and support required to meet people’s needs. Recruitment procedures were not robust to make sure suitable staff worked with people who used the service. We found people were cared for, or supported by, sufficient numbers of staff.

People’s care plans did not always contain sufficient and relevant information to provide consistent, person centred care and support.

People’s mealtime experience was good and people received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity and people were able to individualise their bedrooms.

People and relatives told us they found the manager approachable and they listened to them. We found some of the quality assurance systems needed to be improved to ensure people received a consistent quality service.

The manager and staff explained they knew people well and as such they provided a person-centred approach to end of life care.

Throughout our visit, people were treated with sensitivity, kindness and compassion. Staff had a good rapport with people. People told us they liked living at Manorcroft and they were well cared for. Relatives told us their family members were well looked after. People enjoyed the different activities available and we saw people smiling and engaging with staff in a positive way. Staff understood how to treat people with dignity and respect and were confident people received good care. We observed people were well cared for. People were supported to remain independent and advocacy services were available if required.

The home was clean and tidy and there were effective systems in place to reduce the risk and spread of infection. People and relatives told us they knew how to complain and were confident the manager would address their concerns.

Staff told us they involved people and family members in their care plan, however, this was not always evidenced in the care plan. The manager told us they were in the process of carrying out six monthly care plan reviews.

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

The inspection visit was carried out by two inspectors. During the inspection, we spoke with the chief operating officer of Silverline Care Ltd, the operations manager of Orchard Care Homes.com Ltd; two nurses and seven people who lived at the home. Not all of the people spoken with during the inspection were able, due to complex care needs, to tell us about their experience of living at the home. We also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

Prior to the inspection we received concerns regarding the care and welfare of people living at the home. We were told people were being nursed in bed due to low staffing levels. During our visit we found evidence which partially substantiated the concerns we received.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

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

Is the service safe?

People were cared for in an environment that was clean and hygienic. We saw that people's care records contained care plans which provided staff with clear guidance on how to meet the person's needs. However, the provider had failed to take appropriate action where issues were identified which impacted on peoples' care, safety and welfare. We have asked the provider to make improvements. Staff were not available to meet people's care needs appropriately.

Is the service effective?

We looked at five people's care records. We saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs. On the day of the inspection 23 people were being nursed in bed with bed rails in place. We could not find evidence in care plans about why people were being nursed in bed. People did not receive the support they needed to maintain good nutrition and hydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. However, when we spoke with staff about people who lived at the home we found they referred to people by their room number and not their names. People who lived at the home told us the staff were very good, one person said they were completely reliant on them and appreciated them very much.

Is the service responsive?

We saw care records contained evidence to show that people's needs had been assessed before they moved into the home. Records we looked at contained some details of people's preferences, interests and life histories. However, we found little evidence of people having opportunity to engage in meaningful activity. When we looked at the documentation in place for the purpose of recording people's engagement in social activities we found entries on documents which stated 'Chatted with whilst giving continence care' 'Sleeping' 'Watched TV'.

Is the service well-led?

The service was not well-led. Whilst there were systems in place to evaluate care, the assessment and monitoring of the quality of the service provided was not effective. Some of the issues we found during the inspection were long standing but had only been identified by the provider within the three days prior to our inspection. Therefore, people were not routinely protected against the risks of inappropriate or unsafe care. This was particularly in relation to the environments in which support was provided, staffing levels, record keeping and provision of activities to meet people's social needs. We spoke with the chief operating officer of Silverline Care Ltd and the operations manager of Orchard Care Homes.com Ltd who told us there had not been manager in post for approximately four months. Recruitment was ongoing at the time of our inspection. We spoke with a nurse who told us they felt unsupported and 'left to get on with it' during this period of time. We saw the home had high agency staff use to cover vacancies within the nursing team.

The chief operating officer told us that they had identified many of the concerns raised during their current visit and assured us they were taking immediate action.