When we carried out an unannounced comprehensive inspection at Manor Gardens on the 27 and 28 January 2015. Breaches of Regulation were found and two Warning Notices were issued in respect of ensuring people’s safety and the management of medicines. We undertook this inspection on 24 and 25 September and 2 October 2015 to follow up on whether the required actions had been taken to address the previous breaches identified. At this comprehensive inspection we found Manor Gardens had taken appropriate action to address all breaches to Regulations identified at the last inspection. The service was found to be fully compliant with all required Regulations and establishing ongoing improvements for the benefit of people using the service. Details of previous breaches will be found under each of the five question headings.
Manor Gardens provides accommodation and nursing care for up to 64 people living with a range of complex care needs, including end of life care, diabetes, stroke, heart conditions and Parkinson’s disease. Many of the people needed support with their personal care, eating and drinking and mobility. Some people were also living with dementia. The service also provided respite care to give people and their supporters a break from caring roles.
You can read a summary of our findings from both inspections below.
Comprehensive Inspection of 27 and 28 January
2015.
There were 43 people living at the service on the days of our inspection.
We identified a number of areas of practice which potentially placed people at risk of receiving inappropriate care and support. Risks had not been identified through auditing or quality assurance.
Management systems for medicines were not consistently safe. For example some medicines were signed for as being administered and taken when they had not been taken.
The service was not following best practice guidelines on moving people in a safe way. For example we observed staff moving a person in an unsafe way in front of a more senior member of staff.
Where people had undergone assessments for bed rails or lap belts, these had not been reviewed to reduce potential risk. There was a lack of best interests’ decisions about the use of devices that included bed rails and lap straps, corresponding risk assessments had not been reviewed. There was no consideration if these matters should be considered under Deprivation of Liberties Safeguards (DoLS).
The service had not identified environmental hazards and had not taken action to reduce risk this included the security of the home.
Some people felt the service was not caring and we found it did not always promote people’s dignity. For example some staff did not explain the care they were giving and net underwear was shared.
Some people’s records were not completed accurately, so their needs could not be fully assessed and evaluated. People’s social needs were not assessed and documented, so there was no evaluation to assess if people’s individual needs were met in this area.
Some people told us the service was not well led, particularly commenting on changes in managers. Although audits of service provision had taken place they did not consistently identify areas for action or detail action plans for improvements. The service’s aims and objectives had not been updated to reflect changes in the service.
People commented on the difficulties caused by high staff turnover and communication issues relating to some staff. We saw a few areas where attention was needed to cleanliness, for example bed rail covers.
Comprehensive Inspection of 24 and 25 September and 2 October
2015.
There were 39 people living at the service on the days of our inspection.
After our inspection in January, the provider wrote to us to say what they would do to ensure all regulations would be met. We found the Warning Notices had been met and significant improvements had been made. These will need to be embedded into everyday practice to ensure they are consistently met. However we found no breach of regulations at this inspection.
The service had appointed a new manager in August 2015 who had applied for registration with the Care Quality Commission (CQC) to become the registered manager. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.
We found people’s safety was not always fully promoted. Environmental risk assessments did not ensure all risks were identified, monitored and responded to effectively. Therefore risks to people may not be minimised. Recruitment practice did not ensure all checks were undertaken in a robust way to ensure suitable people were employed.
The new management team needed further time to establish and embed best practice. The quality monitoring systems needed further development to ensure they were used to identify shortfalls and demonstrate effective responses. This included the establishment of care documentation that was accurate up to date and completed in a consistent way.
People were looked after by staff who knew and understood them well. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. Care plans were personalised and reflected people’s individual needs and preferences.
All feedback received from people and their representatives through the inspection process was very positive about the care, the approach of the staff and atmosphere in the home. One relative said “Everything is absolutely fine here. When my mum rings her bell staff come she is happy staff are friendly food is good and mum is very content.
All feedback from visiting professionals was very positive. They appreciated the improvements made to the service and endeavour to drive further improvement with a commitment to learning.
Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They had a clear understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.
Staff were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people’s needs could be met in a timely and safe fashion. The registered nurses attended additional training to update and ensure their nursing competency.
People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be. A complaints procedure was readily available for people to use.
People were complementary about the food and the choices available. Mealtimes were unrushed and people were assisted according to their need. Staff monitored people’s nutritional needs and responded to them.
People were supported to take part in a range of activities maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.
The management of the service responded positively to feedback received from safeguarding investigations and information identified through the inspection process. Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed an action plan had been written to respond to information received.