Located near Southport town centre, Manchester House is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability. Shared areas include two dining rooms and three lounges on the ground floor. A lift is available for access to the upper floor. There is an enclosed garden to the front and rear of the building. A call system operates throughout the home. The home is situated opposite Hesketh Park and is within easy reach of Southport promenade.This was an unannounced inspection which took place over four days on 24 to 25 October and 28 and 29 November 2016. The service was last inspected in April 2016 when we found four breaches of regulations. The service was rated as ‘Requires Improvement’.
During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, person centred care, consent to care and treatment and good governance. Two of these, person centred care and consent to treatment, where continued breaches of regulations from the last inspection in April 2016.
Following the first two days of the inspection we found the seriousness of the breaches of regulations to pose a ‘high’ risk to people living at Manchester House. We used our enforcement procedures and served an urgent notice telling the provider to take action to put things right. The notice also told the provider to not admit any more people to the home until the areas of risk we identified had been addressed. We visited again on 28 and 29 November 2016 to complete a full inspection and check to ensure people were safe.
We found that the provider had made improvements to reduce the risk to people living at the home. This report and outcome is based on the evidence we found over the four days of the inspection.
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.
We found not all medicines were administered safely. We found concerns around the way some medicines such as creams, medicines for pain relief and thickeners added to drinks were administered and recorded which placed people at risk.
We found that some people’s risks regarding their health care were not being adequately assessed and monitored. This was in relation to wound care, pressure ulcer monitoring, accident recording and following up on medical recommendations.
We found people’s written care plans did not contain accurate, up to date information and had not been reviewed in good time. This had been a breach at our last inspection and was still not met.
We found that when people were unable to consent, the principles of the Mental Capacity Act 2005 were not always followed.
Some of the systems for auditing the quality of the service needed further development and did not provide adequate monitoring of standards in the home.
We found the management structure was not clear and did not support the home with clear Iines of accountability and responsibility.
Although these findings were addressed in the short term following the Notice we served and the risk to people reduced, we continue to have concerns regarding the sustainability of standards and will therefore continue to monitor the service closely.
You can see what action we took with the provider at the back of the full version of the report.
We found there was not always enough staff on duty at all times to help ensure people’s care needs were consistently met. This was in relation to nurse cover during the evenings. The provider listened to our concerns and allocated nurse cover for this period. When we asked people about the staffing in the home they told us they felt there was generally enough staff to meet their care needs.
We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people; this had been a breach at the last inspection. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people. This breach had been met.
The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.
Prior to the inspection, we were informed of a number of safeguarding matters, where concerns had been raised. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. The overall reviews of these matters had not been concluded at the time of our visit and therefore we are unable to comment on the findings in this report.
Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. Planned development / maintenance was assessed so that people were living in a comfortable environment. We discussed with the acting manager some further improvements for consideration.
We observed staff interacting with the people they supported. We saw how staff communicated and supported people. People we spoke with and their relatives told us staff had the skills and approach needed to ensure people were receiving the right care.
There were two people who were being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The registered manager had also applied for another 26 people to be assessed; we found these were being monitored by the registered manager of the home.
We saw people’s dietary needs were managed with reference to individual preferences and choice.
Most people we spoke with said they were happy living at Manchester House. They spoke about the nursing and care staff positively. When we observed staff interacting with people living at the home they showed a caring nature with appropriate interventions to support people.
People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.
Activities were organised in the home. The activities team were motivated to provide meaningful activities.
We discussed the use of advocacy for people. There was some information available in the home regarding local advocacy services if people required these. The activities staff were also responsible for linking in when needed and referring people through the advocacy service if needed.
We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw there were good records of complaints made and the registered manager had provided a response to these.
The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.
The rating for the key questions ‘Is the service safe?’ and ‘Is the service well led’ are ‘inadequate’. This means that the service has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.