Manor House Residential Home

Manor House Residential Home is a residential care home providing accommodation for up to 22 people who require personal care , some of whom are living with dementia. The service is a converted period property. At the time of our inspection there were 17 people using the service.

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

The provider’s systems and processes to assess and monitor the safety and quality of people’s care continued to require further improvement and development.

We found the provider had not fully implemented the actions they told us they would take following their previous inspection.

We found improvements were needed in areas not identified by the provider.

The provider’s policies and procedures were not consistently implemented by staff or understood.

Audits and practices to monitor the service had failed to monitor and keep under review staff knowledge, training and competence in key areas, which included medicine management and safeguarding people from abuse. Some staff had not undertaken training in topics related to the promotion of people’s health and well-being.

People’s safety was not assured as staff were not confident in identifying all types of potential abuse. Staff did not always follow the procedure for the administration of medication or the monitoring of safe medicine management. However, we found no evidence that people had not received their medicine as prescribed.

People and their family members told us they felt safe at Manor House Residential Home, as staff were available to help them when required. People were supported by sufficient staff who had undergone a safe recruitment process. People lived in an environment with safe infection and prevention measures.

People’s health and wellbeing needs were assessed, and their health and welfare monitored by staff. Staff liaised with health care professionals about people’s care. People’s dietary needs were met and people were assisted by staff where required to eat and drink. Snacks and drinks were served throughout the day. A plan for ongoing environmental improvements to décor and furnishings was in place.

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.

People and family members were complimentary about the service and spoke of good communication with the management team. The provider sought feedback from family members about the quality of the service and undertook an analysis of the findings.

The provider had identified areas for improvement, which included the planned introduction of an electronic system for the recording and monitoring of people’s care, including medication and medicine systems.

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 5 February 2020) and there were breaches of regulation. The service remains rated Requires Improvement. This service has been rated Requires Improvement for two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We carried out an unannounced comprehensive inspection of this service on 7 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, Safeguarding service users from abuse and improper treatment and Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 remains the same. 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 Manor House Residential Home on our website at www.cqc.org.uk.

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.

Enforcement and Recommendations

We have identified continued breaches in relation to safeguarding people from abuse and good governance, which included staff training and competency, and the implementation of some policies and procedures. We also found concerns related to medicine administration and medicine systems.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manor House Residential Home is a residential care home for up to 22 older people living with dementia. At the time of inspection there were 21 people living at the home.

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

There was a registered manager who had been the manager of the service since it registered with CQC in October 2010.

The provider did not have adequate systems in place to assess and monitor the safety and quality of people’s care. Their policies were outdated and did not reflect current practice. The provider had not carried out regular audits to maintain the safety of the environment, fire safety procedures, decoration or repairs. Immediately following the inspection, the provider implemented systems to monitor and improve the safety of the home; these systems needed to be shared with staff and embedded into practice.

Staff did not always understand how to safeguard people from the risk of harm. Following the inspection, the provider updated their policy and put in systems to identify when incidents occurred and when to report to safeguarding. These systems require embedding to be effective.

Staff were recruited using safe recruitment practices, however, the provider did not have systems in place to ensure staff remained safe to work.

There were enough staff deployed to meet people’s needs. People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care that mitigated these known risks. People were supported to access relevant health and social care professionals.

People received care from staff they knew. Staff had a good understanding of people's needs, choices and preferences. People and their representatives were encouraged to be involved in planning how their care was provided. Staff gained people's consent before providing personal care and ensured their privacy and dignity were maintained.

Staff received training to enable them to meet people’s needs and were supported to carry out their roles.

There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

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.

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 22 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified three breaches of regulation in relation to safety of the environment; safeguarding and management oversight. 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 last inspection, the service was rated Good; at this inspection we found the service remained Good.

The service continued to provide safe care to people living with dementia. Staff understood their responsibilities for safeguarding people from harm and followed the provider’s policies to provide people’s prescribed medicines safely. There were enough suitably skilled staff to meet people’s needs. Staff had been recruited using safe recruitment practices.

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 care from staff that had received training to meet people’s specific needs around their dementia. Staff were compassionate and helped to develop positive relationships with people which helped to manage behaviours which may challenge others.

People received a balanced diet from staff that understood their dietary needs. People were helped to maintain their independence and dignity by the use of suitable crockery and support from staff.

People were treated with respect and helped to maintain their dignity.

People were supported to access healthcare professionals and staff were prompt in referring people to health services when required.

People’s risks were assessed and staff had person-centred care plans they followed to mitigate these risks. Care plans were updated regularly and people and their relatives were involved in their care planning where possible.

Staff sought people’s consent before providing care and people’s mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguarding.

The provider and registered manager continually assessed, monitored and evaluated the quality of the service to identify areas for improvement, and implement change where required.

We were unable to speak with people who used the service about the safety and suitability of the premises. We spoke with a relative of a person who had recently moved in. They told us they were satisfied with the care and support their relative received. They said "the staff are very caring and spend a lot of time with people".

We looked at the safety and accessibility of the premises. The provider had carried out some refurbishment since our last visit in January 2013. We saw that risk assessments of the premises had not been carried out for some time.