Archived: Antron Manor Care Home

Antron Manor is a care home which offers care and support for up to 16 predominantly older people. At the time of the inspection there were 15 people living at the service. Some of these people were living with dementia. The service uses a detached house over two floors. People could use a stair lift to access the first floor. None of the people living at Antron Manor at the time of this inspection required any moving and handling equipment to assist them. No one was being cared for in bed and no one required to have their food and drink intake monitored. Many people were self-caring but required encouragement, prompting and confidence to maintain their level of independence.

The service had 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. The registered manager is also the owner of the service and referred to as the registered provider in this report.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. The premises were clean and well maintained. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicine as prescribed. Regular medicines audits were consistently identifying if any errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff were supported by a system of induction training and supervision. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being considered by the provider.

Informal staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Activities were provided at the service. There was a varied programme of activities including external entertainers and volunteers who came to provide film shows, music, games and exercise.

The provider was supported by senior care staff and a stable long standing staff team.

During our inspection of this service we considered our findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

We judged the service to be safe on the day of our inspection.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support.

All the people we spoke with, who lived at Antron Manor, told us they felt safe and well cared for.

People were safe because the service had an effective system to manage accidents and incidents and learn from them so they are less likely to happen again.

We reviewed the medication administration records (MAR). All the records were appropriately completed except for one case of a person who had two gaps in their records. This was addressed with the member of staff responsible for the omission at the time of the inspection. We checked to ensure this person had received all their prescribed medications at the correct time. They had received their medication but it had not been recorded by staff.

The safe storage of medicines which required storage in a fridge was ensured as the fridge temperatures were monitored daily.

Policies and procedures were in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

We judged the service to be effective on the day of our inspection.

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, people who used the service, that staff had a good understanding of people's needs.

People told us 'Lovely place, I am very happy here, the staff are lovely,' and 'All very good, staff come when I call.'

We saw eight of the 12 twelve staff who administered medication had completed update training in medication management. Four staff were in the process of completing this training.

Risk assessments were carried out to ensure people were protected from the risk of harm and guided staff on any action needed to minimise risk.

Is the service caring?

We judged the service to be caring on the day of our inspection.

Our observations of the care provided, discussions with staff and records we looked at enabled us to conclude that individual wishes regarding people's care and support were taken into account and respected.

From discussion with the staff, it was clear they understood people's needs well. We were told the registered manager did their best to ensure the people were well cared for, and promoted people to have suitable opportunities and choices.

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people.

Is the service responsive?

We judged the service was responsive on the day of our inspection.

Antron Manor had a member of staff who was responsible for arranging and supporting most of the activities that took place at the home. People told us they enjoyed the 'armchair jerks', which referred to the exercise class held regularly at the home.

From discussion with the staff, and from inspection of records we judged there were suitable links with local health services. Records showed there was appropriate contact with medical professionals.

We saw people who lived at the home were supported to make choices such as where they wanted to spend time and what they would like to eat.

People's care needs were regularly reviewed; however, it was not recorded that this was always done with the involvement of the person or their representative.

Is the service well led?

We judged the service to be well-led on the day of our inspection.

Staff told us the provider met most days with all the care staff to discuss work related issues that may affect their working shift. We saw a meeting take place during the inspection. We did not see any records of these meetings.

The provider had reviewed and updated all the policies and procedures used at the home, for example, aspects of management of the premises, risk management, Safeguarding adults and medication procedures. This addressed the compliance actions set following our last inspection.

The provider had installed a new purpose built medication fridge and designed an enclosed locked space for the safe storage of medicines and medication records. This addressed the compliance action set at the last inspection.

The provider monitored all accidents and incidents at the home. This ensured that any patterns or trends would be addressed, and thus reduce any re-occurrence.

People who lived at the home told us they could approach the provider at any time and felt they would be listened to.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

People were treated with dignity and respect by the staff. People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided.

People were cared for in an environment that was safe, clean and hygienic.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguarding which applies in care homes. Staff were aware of the legal requirements of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. We were told no applications have needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The Safeguarding policy and procedure had not been reviewed and gave inaccurate information.

The medication procedure was not robust.

Is the service effective?

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

We spoke with the families of two people who lived at Antron Manor, their comments included 'this is the perfect place for X, the staff are wonderful, nothing is too much trouble' and 'I am really pleased with Antron Manor and the care X receives'.

People who used the service, and their representatives, were not involved in their care plan reviews. People had not been given the opportunity to sign their care plans to indicate their agreement with the content.

Some risk assessments were carried out to ensure people were protected from the risk of harm and guided staff on any action needed to minimise risk. However, these assessments were not always dated to advise when they were carried out.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. People who lived at Antron Manor told us 'I am happy here, the staff are lovely', 'the food is very good' and 'I can come and go as I please'.

People's preferences, interests, aspirations and different needs had been recorded and care and support had been provided in accordance with people's wishes.

We saw people were given choices as to where and when they had their meals. We saw people choosing to eat their meals in their rooms; others ate in the communal dining area. People we spoke with told us 'lovely food' and 'I am quite ok here'.

Is the service responsive?

We observed activities were arranged and advertised in the home. People who lived at Antron Manor told us 'We enjoy the armchair exercises' and 'sometimes we have visiting entertainers'.

We saw people had been asked their preferences regarding food choices. These had been detailed in the kitchen records.

People using the service, their relatives and friends had completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed.

One person required assistance with remembering where her room and bathroom were. The staff had created large signs to assist the person with recognising these areas. This showed staff responded to people's needs.

We saw people's needs had been assessed before they moved in to the home.

Is the service well-led?

People at Antron Manor had regular support from the district nursing team and the GP. This ensured people received appropriate care in a timely way.

We were not able to evidence any staff or residents' meetings that were held. Staff told us that meetings were informal and took the form of daily chats at which information was shared. Residents told us they could always talk to the registered manager and felt they would be listened to.

Staff told us they were offered relevant and useful training on a regular basis. Staff told us they did not receive formal supervision or appraisals, but felt well supported.

We did not see any evidence of regular audits of accidents and incidents to ensure any trends or patterns would be addressed and reduce the risk or reoccurrence.

Care provided was not clearly recorded on a daily basis and reviews did not result in clear documentation to guide and direct staff as to how to provide the care required.

Policies and procedures held incorrect information and had not been regularly reviewed.

Risk assessments had not been clearly dated and reviewed.

People told us staff were kind and helpful. The staff cannot do enough for me. I have no complaints at all'. We observed staff interacted with people in a respectful manner.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care documentation was sufficiently detailed to direct, inform and guide staff about the way to assist people. We saw risk assessments for people were in place and were regularly reviewed.

At the time of the inspection the home was clean, odour free and well maintained. An Environmental Health inspection took place on the same day as the CQC inspection and it was remarked that satisfactory health and safety precautions and adequate food hygiene standards were in place.

During the last inspection we were aware of at least two incidents which should have been reported to the Care Quality Commission (CQC) that had not been reported. Records showed all required notifications were now accurate.

People told us that staff were kind and helpful, for example one person said that 'staff were wonderful and were always eager to please'. Many people were very complementary about the homely atmosphere at Antron Manor; a typical comment was 'I feel very much at home here; we are like one big family'. We observed that staff interacted with people in a polite and pleasant manner.

Although care and support were good, some care documentation did not provide sufficient detail, evidence of effective risk assessment and care plan review. We were particularly concerned regarding how decisions were made regarding the risk of falls regarding one individual. This concern was referred to the local authority.

At the time of the inspection the home was clean, odour free and well maintained. Furnishings and d'cor helped to provide a homely and comfortable environment. Satisfactory health and safety precautions were in place.

At the time of the inspection staffing levels were satisfactory, and there was evidence that staff are recruited and trained appropriately.