The Manor House Care Home

• Visitors were required to complete a pre-visiting risk assessment and on arrival to the service they were required to complete a health screening risk assessment. There was a dedicated room near to the entrance of the service for visitors to use for donning and doffing of personal protective equipment (PPE) when entering and exiting the service. The room was well stocked with the appropriate standard of PPE. There was information displayed in the room about IPC techniques such as donning and doffing, hand washing and disposal of used PPE.

• There was a dedicated part of the service to accommodate people with COVID-19 symptoms to enable safe isolation when this was required.

• There was a designated lead for cleaning and decontamination within the service. There were clear visible signs in place for staff highlighting the levels of cleaning required in each area.

• There were measures in place for staff to socially distance during breaks. Staff were provided with clear guidance around social distancing.

• Safe procedures were followed for admitting people to the service. Virtual assessments were carried out and people and their representatives were provided with a virtual tour of the service prior to admission. Following admission people were required to self-isolate for 14 days.

• There were PPE stations and designated areas across the service for staff to use for donning and doffing.

• Signage about current IPC procedures was clearly visible across the service and available in easy read and picture format.

• Staff used the appropriate PPE and disposed of it safely in clearly labelled bins which were located across the service.

• Staff reassured people who were anxious about CV-19 and they supported people to maintain contact with their family and friends through the use technology.

Further information is in the detailed findings below.

The Manor House is a residential care home providing accommodation and personal care for up to 59 older, there were 38 people using the service at the time of the inspection.

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

At our previous inspection in May 2018 the service was in breach of Regulations. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations.

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.

There were now sufficient numbers of suitably skilled and qualified staff to meet people’s needs safely and in a timely way. People felt safe living at the service. Staff understood their responsibilities for keeping people safe and for reporting any concerns they had about people’s health and safety. Risk was assessed, and plans were in place to minimise the risk of harm to people and others. Medicines were safely managed. Action was taken to reduce the risk of recurrence when things went wrong or there was a near miss and lessons were learnt.

Staff now received the support and training they needed for their role. Staff received regular support from managers in the form of one to one and group meetings. Staff told us they felt well supported, valued and listened to. People’s needs, and choices were assessed and effectively met. People were encouraged to maintain their independence wherever possible. Staff assisted people to maintain a healthy and balanced diet.

People, family members and staff told us the management of the service had improved a lot. They told us that the registered manager was always visible around the service, very supportive and approachable. The processes in place for monitoring the quality of the service were now effective in identifying and actioning areas for improvement.

People received personalised care and support. People had developed good relationships with staff who understood their individual preferences and care needs. The environment was adapted and decorated to meet people’s needs. Adaptations and signage were in place to assist people with their mobility and orientation.

People and family members told us that staff treated them well and were kind and caring. People`s personal information was kept confidential and their privacy and dignity was respected. People were involved in making decisions about their care and they felt listened to. People and family members were confident about complaining and complaints were dealt with in a timely way and used to make improvements to the service.

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 requires improvement (published July 2018). The service has improved to good.

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.

The home is in an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had en-suite toilet, wash basin, and shower. Attached to the building but not owned or operated by the same provider is a separate sheltered housing building. This is not accessible from the home other than in an emergency.

The manor is registered to provide accommodation and nursing or personal care for up to 59 people. 34 people were living at the home at the time of the inspection. Of these only six were assessed as needing nursing care.

At our last comprehensive inspection of the home in May 2017 the service was rated requires improvement overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 11, 12 and17.

This was because the provider did not have appropriate arrangements to maintain a safe environment, at our focused inspection of the home in July 2017 we found further breaches of safety including fire doors and staff training in moving and handling people and fire safety.

We had also found that the provider did not have appropriate arrangements in place for people to consent to their care and appropriate arrangements were not in place to safely manage the home.

After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of regulations 11 and 12. We found that although improvements had been made to the management of the home there were still breaches of regulation 17 and a breach of Regulation 18 of the Health and Social Care Act 2006.

The home 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. The manager had been registered in January 2018 and was at the time of the inspection working their notice.

During the inspection we spoke individually with 10 of the people living at the home and with five of their visitors. We spoke with 17 members of staff who held different roles within the home. We examined a variety of records relating to people living at the home and the staff team. This included four care plans relating to people living there and five staff recruitment files. We also looked at records and systems for checking the quality and safety of the service.

People living at the home were complementary of the environment and of staff who supported them. One person commented “Lovely, well decorated. The people are very kind. The food is excellent.” Another person told us “It’s marvellous. I am very impressed.” People also told us that at times they did not think enough care staff were available to provided support. One person told us, “They are always short of staff, it puts pressure on them. They have to rush you in a morning.”

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. People felt safe living at The Manor and staff knew what action to take if they felt people were at risk of abuse. People knew how to raise a concern or complaint and felt confident to do so.

People’s medication was safely managed and they received it on time and as prescribed. People’s health care was monitored and they received the support they needed with their health and personal care.

A series of assessments of people’s care needs had been carried out and used to form the basis of a care plan advising staff on the support the person required. The quality of information within plans varied. Some were detailed and provided clear guidance to staff. Others were incomplete or contradictory in places. Senior staff were aware of this and working on updating all care plans.

The building and equipment within it were monitored regularly to check they were safe. Actions identified on the fire risk assessment had been completed or had a plan in place for completion. Some fire drills and training for staff were outstanding and the provider had a plan in place to deliver this in a timely manner.

The building had adaptations and equipment to support people with their mobility and personal care. This included a passenger lift hoists, call bells and adapted bathing facilities. Potential risks to people from un-secured furniture identified during the inspection were addressed by the provider during the inspection.

People living at the home, relatives and staff said that at times there were not enough care staff available to support people. Although the home employed a number of staff in different roles the provider had not deployed these in a way that made people feel confident staff would always be available to provide personal care in a timely manner.

Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

Staff had generally received training the training the provider considered mandatory and had mixed views as to how effective they had found this. The provider had plans in place to provide more face to face training which staff told us they found more beneficial. Not all staff had received training in moving and handling people or fire. Some staff had received supervision from senior staff whilst other staff had not. Senior staff were aware of these issues and had a plan in place to rectify them.

A number of different activities were offered at The Manor and people told us that they could always join in of they wished to. This included on site entertainment such as quizzes, board games, singers and parties as well as trips out to areas of local interest.

Mealtimes at the home were sociable occasions during which people received the support they required with meals. A choice of menu was always available. People told us that they liked the meals provided at The Manor and could always request a drink or snack. Staff monitored people’s weight and food and drink intake if needed and made referrals for people who required additional nutritional support.

People living at The Manor and their visitors told us they liked the staff team and described them as caring, kind and helpful. People told us that staff were always polite and respectful towards them.

We observed that although busy staff spent time with people, interacting with them and not rushing them. Staff had a good understanding of people as individuals and could explain people’s interests, hobbies and concerns as well as their healthcare needs.

Staff knowledge of the Mental Capacity Act 2005 had increased and they were able to discuss how they supported people to make choices and decisions. This information was not always clearly recorded within people’s records, which at time contained contradictory and incomplete information. Where people required the protection of a Deprivation of Liberty Safeguard (DoLS) this had been applied for.

Systems were in place for checking the quality of the service provided. A series of audits had been undertaken and plans put in place to implement improvements where needed. These checks had not identified and improved all the areas we noted during the inspection. This included people’s view of care staffing levels and the impact they felt this had.

There had been a number of changes to management of the home within the past few years which some relatives and staff had found unsettling. There was some confusion amongst staff as to who was in charge of the home at times when the registered manager or deputy manager were not on site.

Further changes were planned to the management of The Manor and the provider had taken action to update people on the forthcoming changes.

This inspection took place on 12 July 2017 and was unannounced.

The Manor House Care Home is an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had been refurbished during 2015 and had an en-suite toilet, wash basin, and shower.

The service is registered to provide accommodation and nursing or personal care for up to 59 people and 37 people were living at the home when we visited. The people accommodated were older people who required 24 hour support from staff. The home also provided respite stays for people who usually lived in their own homes. The home is part of the range of services provided by Bupa Care Homes.

The home did not have 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 Regional director and temporary manager told us that the company was seeking to recruit a home manager and a new clinical services manager had recently been appointed and was awaiting recruitment checks prior to commencing in post.

We looked at the high number of safeguarding concerns that had occurred since our comprehensive inspection in May 2017. We did have some concerns about the actions that had led to these situations but we could see that the temporary manager was conducting detailed investigations into each incident.

We found that people’s safety was not always maintained as we noted that a number of accidents had occurred when people in the home were being supported to move. Not all staff had current moving and handling training and fire safety training was still out of date. The temporary manager told us that they were aware of this and had arranged updated training.

We saw that two fire doors did not close properly during the inspection. We raised this with the temporary manager who agreed to ensure the maintenance team reviewed all fire doors immediately to ensure they would close in the event of a fire.

There were no concerns raised regarding staffing levels within the home.

We saw that the temporary manager had developed and implemented a new system to check the quality of the service and to improve communication within the staff team. Any issues identified by the temporary manager had been dealt with effectively.

Ratings from the last comprehensive inspection were displayed as required.

The home is an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had been refurbished during 2015 and had en-suite toilet, wash basin, and shower.

The service is registered to provide accommodation and nursing or personal care for up to 59 people and 45 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff. The home also provided respite stays for people who lived in their own homes. The home is part of the range of services provided BUPA Care Homes.

The service had a registered manager, however we were informed that they had left their employment shortly before this inspection. 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.

One of the people living at the home told us “Some time ago it was very good. Now it is not.” Our findings during this inspection confirmed that the standard of care provided by the home had decreased since our last inspection.

We found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the home was not maintained to a safe standard and that regular checks had not been carried out to ensure that maintenance was up to date. For example we noted concerns with most radiator covers in the home and had to request that these were made safe.

The home was not compliant with the Mental Capacity Act (2005). Appropriate arrangements were not in place for people who were unable to safely consent to their care.

There was no manager working at the home and the home had lacked any clear and effective leadership for a period of time which had resulted in a decline in the service being provided.

Most of the day duty shifts were run by agency nurses who had limited knowledge of the people who lived at the home.

Staff were caring and were well thought of by people living in the home and their relatives.

There were regular activities in the home and people were happy with what was on offer and took part in and enjoyed them.

We saw that people who lived at the home and/or their relatives had been informed about the reported incidents of missing money or personal belongings, the incident reporting procedure and the options for safe storage of personal belongings and money at the home. The provider had also ensured that each person now had access to secure storage for their personal belongings.

We reviewed the records relating to the one incident of missing money reported since our last visit. We saw that the provider had undertaken an appropriate internal investigation and made appropriate referrals to the local safeguarding team, the Police and the Care Quality Commission in order to safeguard people against the possibility of abuse.

We spoke to five people and one relative. People/relatives were positive about the support received. People's records showed individual needs were assessed and views/preferences identified. There was evidence of regular,prompt access to health professionals when people's health declined and appropriate care for people with pressure sores. People's care records were stored securely in their own room.

We found equipment was well maintained, regularly checked and there was enough equipment to support people.

We reviewed medication arrangements and saw medicines were stored securely and administered safely.

Staff records showed appraisal and supervision of staff was undertaken and appropriate training provided.

We reviewed complaints/incident records. We saw three incidents where money/belongings had gone missing which had not been reported or fully investigated by the provider. This meant reasonable steps to identify or respond to the possibility of abuse had not been taken.

'Staff are lovely, they are excellent'

'Staff know me and they are good'

'The children have seen their mother here and they are very happy'.

We observed people were well cared for and treated kindly. We reviewed three care records and found people's needs were assessed and reviewed. We found care records contained relevant information in relation to personal details, individual needs and preferences. Care plans and risk assessments were in place, individualised and up to date.

People were offered a balanced diet and a choice of menu options. People's dietary requirements were assessed and adequate nutrition provided. On the basis of people's feedback, a service improvement plan was in place to improve the quality of the food offered to people who lived at the home.

We reviewed three staff records. We found staff were not appropriately trained, supported and appraised to care for people.

The care records we looked at contained information that was either inconsistent or out of date in relation to people's care. This meant that there could be a risk of people's needs not being met. Care records were seen to be left in corridors accessible to outside visitors to the home and staff not directly involved in the delivery of care. This posed a risk to people's confidentiality.