We carried out a review of the data available to us about Mansion House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Mansion House, you can give feedback on this service.
We found the following examples of good practice.
¿ The service and any equipment used were regularly cleaned to minimise the risk of people catching or spreading COVID-19.
¿ Measures had been put in place to support social distancing. Staff travelled to work separately and staggered their breaks; furniture had been rearranged to encourage people to socially distance themselves.
¿ Staff received training on infection prevention control, hand hygiene and appropriate use of Personal Protective Equipment (PPE). There were good supplies of PPE, which staff used appropriately to help keep people safe.
¿ There were safe areas where staff could put on, take off and dispose of PPE.
¿ People who used the service and staff were regularly tested and there were clear procedures in place to make sure people self-isolated when necessary.
¿ A visitor's policy and procedure helped minimise the risks associated with visitors to the service. Alternative arrangements had been made to support people to maintain social contact to reduce social isolation.
Further information is in the detailed findings below.
Mansion House is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. Some people were living with dementia or a physical disability. The service can support a maximum of 26 people.
The service accommodates people in one adapted building, which has an extension to the rear of the property. The main house has two floors and people can access the first floor by use of a lift or stairs. The extension accommodates people living with dementia and is ground floor only.
People’s experience of using this service and what we found
People felt safe and well supported by staff. The registered manager followed robust recruitment checks, to employ suitable staff, and there were sufficient staff employed to ensure care and support were carried out in a timely way. People's medicines were managed safely.
Staff received appropriate training to give them the knowledge and skills they required to carry out their roles. This included training on dementia care and on how to protect people from the risk of harm. Staff received supervision to fulfil their roles effectively and had yearly appraisals to monitor their work performance.
People had choice and control of their lives and the staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
There was a planned programme of activities open to everyone including family and friends.
Staff knew about people's individual care needs and care plans were person-centred and up to date. People and relatives gave us positive feedback about the staff and described them as "Exceptionally kind, caring and friendly." Staff treated people who used the service with compassion, dignity and respect.
The service was well managed and organised. The registered manager assessed and monitored the quality of care provided to people. People and staff were asked for their views and their suggestions were used to continuously improve the service.
For more details, please see the full report which is on the Care Quality Commission (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.
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’, but the provider was in breach of one regulation. This was Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities ) Regulations 2014. The breach was in relation to poor upkeep of records, ineffective quality monitoring and therefore ineffective risk management.
At this inspection we found the service remained Good and that the breach of Regulation 17 was now met. Records were well maintained and up-to-date, quality monitoring had improved and was more effective and risk management had also improved.
The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been registered for the last four months, but had managed the service since summer 2016. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.
People were protected from the risk of harm because the registered provider had systems in place to manage safeguarding concerns and staff were trained in safeguarding adults from abuse. Staff understood their responsibilities with regard to reporting safeguarding concerns. Risks were appropriately managed and reduced so that people avoided injury or harm.
The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people’s needs and we saw that rosters cross referenced with the staff that were on duty. Recruitment systems were followed to ensure staff were suitable to support people. The registered manager and staff safely managed the systems and practices for handling medicines and the premises were clean and hygienic.
Qualified and competent staff were employed and formally supervised. Their personal performance was checked at an annual appraisal. People’s mental capacity was appropriately assessed and their rights were protected. 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. Records of best interest decisions were not as complete as they could have been and had not been reviewed / updated recently.
People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitably designed and furnished for providing care and support to older people and to those living with dementia within the dementia unit.
People received compassionate care from kind staff that knew about people’s needs and preferences. People received the information they needed to support them with their care, were involved in their care decisions and asked for their consent before staff undertook any support tasks. People’s wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.
People were supported according to their person-centred care plans, which reflected their needs and were reviewed. They engaged in some pastimes and activities if they wished to. People had very good family connections and support networks. An effective complaint system was used and complaints were investigated and responded to in a timely way. People and their friends and relatives were encouraged to maintain relationships of their choosing.
The service was well-led and people had the benefit of a culture and management style that was positive and inclusive. An effective system was in place for checking the quality of the service using audits, satisfaction surveys and meetings. People made their views known through direct discussion with staff and via the complaint and quality monitoring systems. Confidentiality was maintained as records were held securely in the premises.
Further information is in the detailed findings below.
This inspection took place on 9 November 2015 and was unannounced.
The last inspection took place on 25 November 2013, the service was meeting all of regulations we looked at.
Mansion House is registered to provide residential and nursing care for up to 26 people. The home has a dedicated dementia care unit for 14 people. Mansion House is a detached house built on two floors. The upper floor is serviced by a lift. There are 26 single rooms the majority are en-suite. There is a secure garden which people can access.
At the time of our inspection the service did not have a registered manager. A new manager had been in post for two weeks and had applied to the Care Quality Commission to become the registered manager. 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.
Records related to people’s food and drink were poor and contained significant gaps. Although there was evidence of some audits taking place these were not robust and when issues were identified there was no clear record of action taken to rectify them. This meant the provider did not have systems in place to ensure they were providing a good standard of care.
You can see what action we told the provider to take at the back of the full version of the report.
Staffing levels had been reviewed by the provider, they listened to feedback from staff and the manager to ensure they had sufficient staff to meet people’s needs.
Staff knew how to protect people from avoidable harm. Staff had attended safeguarding training and the service had an up to date safeguarding policy which provided staff with clear instruction about the action they would need to take. The service had a whistleblowing policy which meant staff knew how to raise any concerns and who to contact.
People had risk assessments and risk management plans which staff followed to keep people safe. These were well developed and people, their families and the relevant health and social care professionals had been consulted. They provided staff with guidance about how to keep people safe. They balanced the need to keep safe with the right to freedom which meant people were not unnecessarily restricted.
The principles of the Mental Capacity Act (2005) were consistently followed by staff. Consent to care and treatment was sought. When people were unable to make informed decisions we saw a record of best interest decisions. There was a record of the person’s views and other relevant people in their life. The registered manager had a clear understanding of the Deprivation of Liberty Safeguards.
People told us the food was good. We saw people had access to regular drinks, snacks and a varied and nutritional diet. If people were at risk of losing weight we saw plans were in place to manage this and the appropriate healthcare professionals had been consulted.
Care plans contained up to date information which included their preferences, likes and dislikes. Although we were told reviews took place and families were involved we did not see signed review records within care plans.
People had access to a range of activities and were very positive about the role of the activities co-ordinator. Activities were based on interests of people who used the service and we saw the activities co-ordinator was skilled at getting people involved.
People and their relatives told us they knew how to make a complaint but had never needed to. The service had received a variety of compliments. Feedback was sought from people as part of the review of their care.
The manager was keen to make improvements to the service and their staff team demonstrated confidence in them. People and their relatives told us they had met the new manager and even though they had only been there a short time they said the manager was approachable.
We spoke with ten people and two visiting relatives they all said they were happy with the care and support provided by the care staff.
We looked at people's care records and saw arrangements were in place to identify those people at a greater risk of poor nutrition and dehydration. People told us they enjoyed the food provided.
Appropriate arrangements were in place in relation to obtaining, handling, storing and administering medication.
We saw that there was enough skilled and experienced staff who, on the whole, met people's needs in a timely way. This was confirmed by people we spoke with and by staff.
The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service.
The one relative we spoke with told us, 'I came here and knew it was right for my relative. I have not regretted a single day she has been here.' Some of the people who lived here told us they were really looking forward to their Christmas shopping trip; which had been organised for later in the week.
People said they thought everybody was very kind to them. We observed the care staff treating everyone with respect. They were unhurried when supporting people. They sat down and encouraged people to communicate with them.
Our observations showed the people who lived at Mansion House were relaxed and comfortable when the care staff approached them. The care staff we spoke with told us how they would respond to potential or actual abusive situations, to ensure people were safe. One staff member said, 'My main priority is for the people who live here to be safe and happy.'
Staff told us they had regular supervision and they 'worked in a good team.'
People who were able to, told us if they had a problem they would speak to the manager or nurse in charge. We saw evidence of complaints being properly responded to.
People told us they were involved in decision making in the home and that staff talk to them about their care and ask them if they were alright and that they had everything they needed. People told us that they were treated respectfully and that they felt well cared for.
On the day of the visit people said staff treated them with respect and that they were approachable. One person said. 'I talked all this through with the staff and they helped me do what I want.'
However, some people said they had not seen care plans and were unsure about the choices available to them. One person recently complained to the manager that a member of staff did not listen to a request for assistance and left him without the care he needed.
One person said 'It's hard work for the staff, they are sometimes pushed but they always seem to manage and have time for a quip.'
One person said she had been encouraged to manage her own medication following a review of her care. She said she was confident that she could administer her own medication and that she had signed to say she agreed to do so.
People said they felt safe at the home. One person said. 'They look after me and help me do what I want.' One person said ' The staff are very good. They get me dressed in the morning and help me at other times if I ask.'