Little Manor Care Centre

Little Manor is a residential care home providing personal and nursing care for up to 30 people. The service provides short term support to people being discharged from hospital who require support with rehabilitation before returning home or moving to a long-term care home. The provider works in partnership with a local organisation developing therapeutic plans to support people on their discharge from hospital. The aim is to continue supporting people’s recovery, independence, and skills, enabling people to return home or move on to other services. At the time of our inspection there were 25 people using the service.

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

People were not always supported safely. Health and Safety audits were not completed in line with the provider’s policies which meant that there was not adequate oversight of health and safety requirements.

Medicine care plans did not always have enough detail to ensure people were receiving effective and safe support. Medicine audits failed to identify these concerns.

Systems to check for legionella were not detailed and audits were not completed to identify this.

Staff were recruited safely. However, they were not always receiving regular supervisions to support their development.

People and their relatives told us they felt well supported. They valued the involvement they had from the on-site physiotherapist and felt this helped them with their recovery.

There was enough staff to support people and we saw people being supported in a person centred way.

Professionals told us that the home was professional and warm and friendly.

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 Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 May 2016). The service was closed for redevelopment from November 2018 until November 2020. An Infection Prevention Control (IPC) inspection was completed on 19 January 2021 to check how they were managing during COVID-19. We found that the service was supporting people safely. This was not a rated inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe 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 good to requires improvement based on the findings of this inspection.

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

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

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

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.

We found the following examples of good practice.

Admissions to the designated unit were carried out safely. People had a discharge assessment completed by a hospital 'trusted assessor', which was reviewed by the Operations Director to ensure their needs could be met. People accessed the unit via an 'admission only entrance' and were received by staff wearing personal protective equipment (PPE).

Robust processes were in place for all visitors to the designated unit. Temperature, oxygen level checks and a lateral flow test (LFD) were taken. Visitors were requested to use a higher standard of face mask (FFP2) and over arm gowns. Shoes were sprayed with anti-bacterial/viral spray. Names and contact details were taken for tracking. There was clear signage and instructions at the entrance and around the building.

The designated unit was split into self-contained 'pods' of four to six beds. To reduce the risk of cross contamination, all pods could run independently and had their own kitchen, equipment and a sluice with a macerator for waste. There was an air extraction system which was used as ventilation throughout the whole building but could also operate in each pod separately. All room doors were sealed at the bottom, so contaminated air remained in the room and was eliminated via the vents. The ceiling vents were used to air and opened automatically in the case of a fire. There was a misting system as opposed to a sprinkler system in the event of a fire. This dampens the fire without soaking the people. All fire risk assessments were in place and fire safety checks were up to date.

Robust processes were in place for effective social distancing. The staff entrance and exit were separate to visitors. Staff had a designated area in the unit where they could shower, change and rest. Staff shifts of three to four hours were all staggered. Two staff were scheduled for breaks at any one time to reduce social contact. The building was structured to promote the movement and flow of staff around the unit and by using separate up and down stairs.

There was specialised equipment in place such as an ultra-violet light machine and fogging sanitizers to decontaminate rooms and equipment. Thorough cleaning schedules were in place and all cleaning materials were PHE approved. All staff scrubs were laundered on site and all clinical waste disposed of correctly and safely.

The personal protective equipment (PPE) used was above the minimum requirements. Staff wore FFP2 masks, visors, scrubs, gowns and footwear protection. All staff had thorough and detailed training on infection control procedures, COVID-19 and the care of people with infectious diseases and end of life care.

Staff have regular weekly nasal swab testing (PCR) and daily lateral flow testing (LFD). Risk assessments were in place, including for staff from minority ethnic backgrounds. Regular audits were carried out and increased during the pandemic. The provider had staff support structures and systems in place for well-being and counselling. These included one to one support through supervision, occupational health support and guidance and Pilates and mindfulness sessions.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

The inspection took place on the 1 and 2 March 2016 and was unannounced.

There was a registered manager in post at the service. 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 living at the home. Staff understood their responsibilities and the actions they needed to take to keep people safe from harm and abuse. Risks to people’s health and safety were identified and plans were in place to minimise these risks.

People’s medicines were managed safely and they had access to health care services when required.

Staff knew people well and supported them with maintaining their independence. People and their relatives told us staff treated them or their relative with kindness and respected their privacy and dignity.

People were supported to have sufficient to eat and drink to maintain good health. People told us they enjoyed the food and that there was always plenty available.

The registered manager investigated complaints and concerns. People, their relatives and staff were supported and encouraged to share their views on the running of the home. Their views were taken into account in the planning of the service.

Health and social care professionals spoke positively about the care and support people received and praised the management team. They said they found the staff and management team approachable and told us they sought advice and guidance where appropriate regarding changes to people’s care and support.

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff and at team meetings to minimise the risks of reoccurrence.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections.

Staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have the capacity to make the decisions themselves, mental capacity assessments were in place and records showed that decisions had been made in line with best interests. Where required Deprivation of Liberty Safeguarding applications had been submitted by the registered

manager.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We saw that the home and the garden were accessible and well maintained.

Staff received appropriate professional development. One person said 'I can ask if I want to go on training and go if I want to'. Another staff member said 'supervision is adequate'.

The provider had some effective systems to assess and monitor the quality of service that people receive.

People said they liked the meals and they could choose what they ate. A person who had been admitted to the home recently told us 'I was very surprised at the choice of food ' I didn't think it'd be like this.' We saw people received the support they needed to eat and drink.

The home was clean throughout, including areas such as sluice rooms and the laundry. All staff told us they were regularly trained in infection control.

People living in the home and staff said there were enough staff, with the right skills to meet people's needs. A person who remained in their bed all the time told us they weren't left on their own for long.

People said they could bring up issues of concern. A relative told us 'you can tell the person in charge and it'll all be taken care of. '