Archived: Manon House

Manon House is a residential care home which can support up to 6 people in one adapted building. The service specialises in supporting people with mental health needs. There were 2 people using the service at the time of this inspection.

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

The quality and safety of the service had improved for people since our last inspection. The provider had acted to make the premises safer for people by addressing the concerns we previously found. The provider made sure safety systems and equipment had been checked and serviced to make sure these were in good order and safe for use.

Cleanliness and hygiene around the premises had improved and communal areas and people’s rooms were cleaner, tidier and free from odours. Staff followed current practice when preparing and handling food which reduced hygiene risks.

Staff were now more up to date with current practice as the provider had made sure staff received relevant training to support people with their specific needs. Staff had opportunities to discuss their working practices with managers. These discussions were not always formally documented. Managers were taking action after this inspection to make sure this was done.

The provider had acted on the recommendation we made at the last inspection to seek current guidance and to update their practice in relation to medicines. Staff had received refresher training in safe handling of medicines so they were now up to date with current practice in how to manage and administer medicines in a safe and consistent way. Staff made sure people received the medicines prescribed to them.

The registered manager now fully understood their responsibility for meeting regulatory requirements. They notified us of events or incidents involving people which helped us check that appropriate action was taken to ensure the safety and welfare of people in these instances.

Despite the improvements made since the last inspection some areas of the service continued to need improvement. Information about the support people needed to meet life goals and aspirations was not always consistent and current. Managers were taking action after this inspection to make sure plans were up to date and supporting people to meet their goals.

Some of the activities planned for people were not always relevant to their social and cultural needs. We have made a recommendation about the provision of activities for people.

Although the provider had made improvements there were no formal mechanisms in place to monitor action was being taken where needed. This meant managers did not always make all the improvements needed in a timely manner.

Records had not been maintained in a consistent way so that they contained up to date and accurate information about people and staff. This was not having a significant impact on people at the time of this inspection but may present a risk in future.

People’s needs were assessed prior to them using the service to help plan the care and support they needed. People’s care plans contained information for staff about how their physical and mental health needs should be met. People told us their needs were met by staff. Staff were friendly and knowledgeable about people and how their needs should be met.

Staff helped people stay healthy and well. They supported people to eat and drink enough to meet their needs and to see healthcare professionals when they needed to. Recommendations from healthcare professionals were acted on so that people received the relevant care and support they needed in relation to their healthcare needs.

There were enough staff to support people. People said they were safe and staff treated them well. Staff understood how to safeguard people from abuse and how to manage identified risks to people to reduce the risk of injury and harm to them. Staff supported people to maintain their dignity, privacy and independence. 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 and staff were encouraged to give feedback about how the service could improve further. People knew how to make a complaint if needed. The provider had improved their complaints procedure since the last inspection and people now had current information about who to make a complaint to. The provider had arrangements in place to investigate accidents, incidents and complaints and kept people involved and informed of the outcome. Learning was shared with staff to help them improve the quality and safety of the support they provided.

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 13 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan from the provider to understand how they will make changes to ensure they improve their rating to at least good. 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.

This inspection took place on 8 January 2019. At our last comprehensive inspection of the service in June 2016 we gave the service an overall rating of ‘good’. However, we rated the key question ‘is the service safe?’ as ‘requires improvement’. This was because the provider had not undertaken risk assessments with people to ensure they were capable of understanding and managing their own medicines. At a follow up inspection in August 2017 we found the provider had taken action to improve and meet legal requirements. However, we did not improve the rating for the key question ‘is the service safe?’ because to do so required consistent good practice over time.

At this inspection we found some aspects of the service had deteriorated resulting in the overall rating for the service changing from ‘good’ to ‘requires improvement.’

The service continued to have a registered manager in post. We found the registered manager had not fully met their legal obligation to submit notifications to CQC of events or incidents involving people at the service. Failure to notify CQC of these incidents meant we could not check that the provider had taken appropriate action to ensure people's safety and welfare in these instances.

The provider's systems to monitor and assess the safety and quality of the service were ineffective. In the absence of regular checks and audits they had not identified concerns we found during this inspection about the quality and safety of the service. This put people at risk of receiving unsafe and unsuitable care and support.

Aspects of the premises posed a risk of injury and harm to people. The provider did not formally assess and manage risks posed by the premises to identify potential hazards to people. However, the provider carried out some maintenance and servicing of the premises and equipment to ensure areas covered by these checks remained in good order and safe to use.

The provider had no system in place to monitor cleanliness and hygiene at the premises. Parts of the premises were not clean or hygienic which put people at risk of acquiring infections and illnesses that could arise from poor cleanliness and hygiene. The registered manager told us they would make immediate arrangements for a deep clean of the premises after this inspection.

Staff had not received all the support they needed to deliver effective care to people. They were not provided with all the training required to meet the specialist needs of people using the service. However, staff had regular supervision (one to one meetings) with senior staff to help them improve their working practices and the quality of support provided to people

Medicines were stored safely and securely, and people received them as prescribed. However, staff’s current working practices did not reflect national guidance and best practice when maintaining appropriate records related to people’s medicines. We have made a recommendation about improving the management of medicines administration.

People knew how to make a complaint if they were unhappy with any aspect of the service. The provider continued to maintain arrangements for dealing with people’s complaints or concerns if these should arise. However, the current complaints procedure was out of date and did not give people the correct advice about how to take their complaint further. The registered manager said they would update this immediately after the inspection.

Notwithstanding the issues above, people spoke positively about the registered manager and deputy manager and the support they provided. People were provided opportunities by managers to give feedback about how the service could improve.

People said they felt safe at Manon House. Staff had access to guidance on how to minimise identified individual risks to people due to their specific needs to help keep people safe. Staff knew how to safeguard people from the risk of abuse and how to report any concerns about people to the appropriate person and agencies.

There were enough staff to meet people’s needs at the time of this inspection. The provider carried out appropriate checks on staff’s suitability to support people. People were satisfied with the care and support they received from staff. People said staff were able to meet their needs. They said staff were kind and caring. Staff provided people with support that was dignified, respectful and which maintained their privacy. They prompted people to be as independent as they could with the tasks of daily living.

People continued to contribute to the planning of their care and support. Senior staff reviewed people’s care and support needs regularly to ensure staff had up to date information about these. Communication across the staff team was good and important information about people and their support needs was shared promptly with all staff.

People were supported to access external services and organisations about personal matters to ensure their voices were heard and their rights upheld. Staff encouraged people to stay active and to participate in activities to meet their social and physical needs.

People were encouraged to eat and drink enough to meet their needs. Staff monitored people’s general health and wellbeing and shared this information with all those involved in people’s care. When they had concerns about people they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

The design and set up of the environment provided people with flexibility in terms of how they wished to spend their time. 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.

The provider worked in partnership with others to develop and improve the delivery of care to people.

At this inspection we found the provider in breach of legal requirements with regard to safe care and treatment, premises and equipment, staffing, good governance and notifications of other incidents. You can see what action we told the provider to take with regard to these breaches at the back of the full version of the report.

We undertook this focused inspection on 10 August 2017. We checked the provider had followed their plan and made the improvements they said they would to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Manon House on our website at www.cqc.org.uk

Manon House is a small service which provides care and accommodation for up to six adults. The service specialises in supporting people with mental health needs. At the time of our inspection there were five people using the service.

At this inspection we found the provider had taken the action they said they would and were now meeting legal requirements.

Risk assessments had been undertaken with each person using the service to determine whether they could take and look after medicines themselves. Where people required assistance to take their medicines the reasons for this were detailed in their records and people had consented to the support that was provided.

Where a person was able to self-medicate their individual risk assessment set out the support they required to do this safely whilst maintaining their independence to do so. They had been provided a secure lockable medicines cupboard to keep their medicines safe. The provider reviewed risk assessments every 3 months, or sooner if required, to check that current arrangements continued to meet people's needs.

At the previous inspection, in September 2015, the service was found to be breaching a number of regulations and required improvements in the following areas: person centred care; safe care and treatment; safeguarding; receiving and acting on complaints; good governance; and, staffing. The

specific details of what required improvement in these areas are outlined in the report. We found the service had made improvements in response to the September 2015 inspection and were meeting the regulations. However, at the inspection in June 2016 we found improvements were needed in the management of medicines.

The service had a 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.

Manon House provides care and treatment for up to six males with mental health conditions. There were four people using the service at the time of the inspection.

The service did not always manage medicines safely. We found the service did not have appropriate risk assessments in place for people who were managing their own medicines. Otherwise, medicines were managed safely. People told us they felt safe. Staff knew how to recognise the various types of abuse and the procedures for reporting abuse. They were aware of how to escalate concerns and understood whistle blowing procedures. Staff were confident that they could report any concerns and had completed safeguarding training. People’s needs were assessed and risk assessments created. There were sufficient, suitable staff to meet people’s needs. The environment was a safe place for people, staff and visitors.

Staff were supported with training and supervision. The service was working within the principles of the Mental Capacity Act. People had sufficient food to eat and liquids to drink. People were supported with their healthcare needs.

The service was caring. Staff were respectful, attentive and knew people well. People were very positive about staff. Staff respected people’s privacy and dignity and encouraged independence. People were involved in their care and treatment.

People received personalised care. People’s needs were assessed before they came to the service. Care plans were developed with people taking into account their needs and preferences. The views of people using the service were sought to improve service provision. People were confident they could raise issues with staff. A complaints system was in place.

There was a system of audits, formal and informal checks and reviews to assess and monitor service provision. People and staff said the manager was approachable and accessible. Staff worked closely on a daily basis with the manager due to the small size of the service and provided regular feedback on a one-to-one basis. Staff could call the manager at any time of the night or day.

During this inspection we met with two of the people using the service and two support workers.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

We found there were care plans and suitable arrangements in place for everyone using the service. These plans responded to the physical health, mental health, social, financial and cultural needs of people who used the service. The service had arrangements in place to identify and manage appropriately risks presented. Staff received the training they required to ensure they had the skills and knowledge to support people who used the service. People were supported by support staff in accordance with their care plans.

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with three of the six people using the service, speaking with three staff and from looking at records. We requested additional information from the provider, and we spoke with three community based mental health care professionals who were care coordinators for people using the service.

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

This is a summary of what we found:

Is the service safe?

People we spoke with told us they felt safe in the home. People told us there were enough staff to make sure people received the care and support they required.

Staff also told us there were usually enough staff available to meet people's needs, but felt a need to keep staffing levels under review since the service increased the numbers of people using the service.

The home was safe and well maintained. Arrangements were in place for regular health and safety checks and for the servicing and maintenance of equipment.

People living in the home had assessments of possible risks to their mental and physical health and these were reviewed at least quarterly, they had systems in place to manage these appropriately.

Is the service effective?

Care plans in place identified the physical health, mental health, social, financial and cultural needs of people who used the service. People were supported by staff in accordance with their care plans. A care co-ordinator from the local NHS mental health trust told us they found that people using the service received the care and support they required.

Staff received the training required to ensure they had the skills and knowledge to support people who used the service.

The service had not developed suitable care plans for every individual who used the service. One person recently admitted did not have a care plan, and as result staff did not have the necessary information they needed to support the person.

This lack of information could lead to the risk of the person receiving inappropriate care and support. This resulted in a breach of Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010.

Is the service caring?

People using the service told us staff were kind and patient. People found their views were acknowledged, they were offered choices and staff knew about and respected their preferences and daily routines.

Staff meetings and training included topics on promoting dignity and respect, and staff were able to tell us how they included this in their work with people in the home.

Is the service responsive to people's needs?

People were supported to express their views and were actively involved in making decisions about their care, treatment and support. Staff were responsive to people's needs and care and support was delivered in line with their interests and preferences. People were offered opportunities to engage in activities they enjoyed and to develop independent living skills.

People knew who to speak to if they had concerns. We saw that complaints made had been responded to quickly, including explaining to people why certain processes were in place. People had the opportunity to discuss the service and identify any concerns or suggestions through regular meetings for people who lived there.

Is the service well-led?

There were basic processes in place to monitor the quality of the service, but further work could be undertaken to ensure that these are effective in driving improvement and best practice at Manon House.

The registered manager has been absent from the home for some months, temporary management arrangements were in place to address this. The registered manager/provider will need to keep the Care Quality Commission informed on the future plans for managing the service.

When we spoke to the person living in the home about the complaints procedure they told us 'It has been explained to me and I know it's outside near the telephone,' 'I don't have any complaints' and 'I would speak to the owner if I need to complain.'

The person we spoke with told us they were satisfied with the care and support they received at the home. They reported that they were treated with dignity and respect.

When we looked at the care plans we found these were in line with the needs and risks assessed at the initial assessment.

Staff had received up to date training to support the needs of people who lived in the home.