Manor House Residential Home

We found the following examples of good practice.

The home was clean. Systems were in place to ensure good levels of hygiene.

Risks in relation to visitors had been assessed and action taken to ensure the service followed national guidance.

Regular Infection prevention control audits were undertaken. The home's infection prevention and control policies were up to date and in line with current guidance.

Staff had access to supplies of PPE and had received training to ensure they used this correctly. All staff had regular testing for COVID-19, and all eligible staff had received both vaccinations.

Staff were trained on how to keep people safe from the risk of infection.

People’s experience of using this service: At the last inspection we found improvements were required to the premises of the home to ensure this was safe and that accurate records were maintained. At this inspection we found improvements had been made.

People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to people.

The management of medicines was safe. Risk assessments had been completed and provided detailed guidance for staff to follow. Incidents and accidents were managed effectively; lessons learnt were shared with staff to reduce the risk of further occurrences.

There were enough skilled and experienced staff to meet the needs of people who used the service. Recruitment checks were robust and staff completed an induction and training programme.

Most health and safety checks were carried out to ensure people remained safe. However, the electrical checks had been unsatisfactory. The registered manager arranged for checks to be carried out on the day we inspected to ensure people remained safe in the home. Staff used personal protective equipment to prevent against cross infection.

People and their relatives said staff were kind and caring. People and relatives said they were well supported and provided positive feedback about staff. Staff treated people with respect and dignity. People were involved in decisions about their care and encouraged by staff to be as independent as possible.

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.

Initial assessments were carried out to ensure people’s needs could be met. Staff understood people’s likes, dislikes and preferences and people told us they were offered choices about their care.

Some people using the service required end of life care. Care plans recorded people’s preferences for their end of life care.

Care records identified people’s nutritional and dietary needs. People were supported to live a healthy life and staff supported people to access health care professionals when required.

A complaints system was in place and these were managed effectively. People and staff told us they felt confident to raise any concerns and felt these would be managed.

The provider had embedded quality assurance systems to monitor the quality and safety of the care provided. The provider worked in partnership with other services to support people’s care. Surveys were carried out with people using the service to gather their views.

Staff told us the management team were honest and supportive. People told us the management team were approachable and felt concerns would be effectively managed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (published 25 April 2018). The overall rating has improved to good.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good. If any concerning information is received, we may inspect sooner.

Manor House Residential Home accommodates up to 30 older people and is situated in the Farnley area of Leeds. The home is on two floors with a passenger and chair lift access to the top floor. The lounges, dining area, kitchen and laundry facilities are located on the ground floor. There is a garden area at the rear of the home. At the time of our inspection, 27 people were using the service.

This inspection took place on 8, 9 and 18 January 2018. The inspection was unannounced on the first day; this meant the staff and provider did not know we would be visiting.

A registered manager was 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.

We found improvements were needed to fully ensure records were accurate and fully documented the dates of review and completion. Audits did not always have completion dates, care plans had been reviewed but not all had been updated with the date of review on and we found one risk assessment without a date of completion listed on it. In addition, care worker appraisals did not have a date on the documentation which reflected the date of completion.

Improvements were required to ensure the environmental safety of the home. Carpets were worn and loose and this was a potential tripping hazard which may increase the risk of falls, particularly to those people already at risk. The wall paper was old and falling from the wall. During the dates of inspection the provider had taken some action to address the issues we identified and following the inspection the provider informed us of their plans to change the carpets.

Medicines were managed and recorded safely. ‘As required’ medicines were administered accordingly and protocols were in place for care workers to follow.

Staffing levels were sufficient to meet people’s needs although some people living in the home felt that more staff were needed.

People told us they felt safe and care workers had a clear understanding of the procedures relating to safeguarding and whistleblowing.

Risk assessments were completed and reviewed to support people with specific needs to avoid any harm.

The provider followed The Mental Capacity Act 2005 with capacity assessments documented and best interest meetings recorded, when required. We found consent was obtained from people verbally on a day to day basis and formally at review meetings.

People were supported with their nutritional needs and fluid intake. People were also supported with their health needs.

People living in the home had positive relationships with the care workers, they told us they felt well cared for.

People were encouraged to be independent and make choices regarding their care. Staff respected people's privacy and dignity.

Care plans were detailed and contained relevant information. This included people’s preferences, likes and dislikes which made them person centred. There were instructions for care workers to follow although one care file had differing information within the care plans.

Complaints had been responded to with outcomes recorded. Incident and accidents were managed and people using the service told us they felt confident to discuss any concerns with the provider.

The manager provided an action plan from the last inspection to show what improvements had been implemented. Surveys were provided to people living in the home, relatives and care workers to gather their views of the service and the quality of the care provided was monitored through governance systems which highlighted where improvements were needed.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, namely, Good governance. You can see what action we told the provider to take at the end of the full version of this report.

At the inspection on 16 August 2016 we found improvements had not been made with regard to this area and we found other areas of concern.

Manor House Residential Home is a converted stone building that has been extended to provide residential care, without nursing, for 30 older people. The home is located west of Leeds.

There was a registered manager in post; however, they were on annual leave when we visited. 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.

We found care plans did not contain sufficient and relevant information. People were not protected against the risks of receiving care which may be inappropriate or unsafe. People told us they were bored. We saw the list of activities displayed in the home; however, these did not always take place.

We found staffing levels were not sufficient to meet people’s needs. Appropriate recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. Staff training was up to date to ensure people were cared for by knowledgeable and competent staff. Most staff had received regular supervision but this was not in line with the registered provider’s supervision agreement. Staff had received an annual appraisal. Staff told us they felt supported by the management team.

Systems were in place for the management of medicines; however, people were not protected against the risks associated with the administration of medicines. Medication discrepancies were not investigated and during our inspection we noted, the room the controlled drugs and the refrigerator were located was not always locked. People were supported to maintain good health and had access to healthcare professionals and services.

People had opportunity to comment on the quality of service provided and influence service delivery. However, the quality assurance systems in place were not always effective. The deputy manager told us there were no complaints open for the home at the time of our inspection. We saw ‘how to make a complaint’ was contained within the home’s ‘service user guide’.

Staff had received training in Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). At the time of our inspection 22 DoLS applications had been completed. However, it was not clear how many applications had been granted. The care plans we looked at did not contain appropriate mental capacity decision specific assessments.

People who used the service told us they felt safe with the care they were provided with. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. We found one window on the ground floor did not have a restrictor fitted and we noted the window led to a nearby drop to a main road. Individual risks had been identified.

We observed the dining experience was a pleasant occasion and people had choice and variety in their diet. We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. Staff had a good knowledge and understanding of people’s needs and worked together as a team. Staff were aware and knew how to respect people’s privacy and dignity.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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 from looking at records.

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff we spoke with could speak confidently about the types of abuse and they all said they felt the manager would take any concerns very seriously.

We looked at the recruitment of new staff. This showed the required recruitment checks into qualifications and experience were being followed.

Where risks were identified, the associated care plan did not give sufficient details for staff to ensure people were kept safe.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and keeping them safe.

Is the service effective?

We looked at care plans and found they contained some good information, however we noted in some people's care plans there was little or no information about the person, their interests, significant life events.

We saw some occasions in the care records when there was conflicting information about peoples' needs. This conflicting information meant there was a risk of inappropriate and potentially unsafe care being delivered. Care plans were therefore not able to support staff consistently to meet people's needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving them in planning their care.

Is the service caring?

We spoke with 5 people who lived at Manor House Residential Home, one person told us, 'It's alright here, it's clean and it's comfortable.' Another person said, 'The staff are lovely, they are run off their feet but they always have time for you.'

We saw staff were attentive to people's needs and were interacting with people whilst serving them their lunch. People were given choice and explanations of food. People who needed assistance were offered it in a sensitive way.

Is the service responsive?

We saw the complaints procedure displayed in the hallway of the home. The manager told us there have been no complaints since the last inspection though they try to attend to any concerns as soon as they are raised.

Is the service well-led?

The manager and assistant manager are currently reviewing all the quality assurance systems at Manor House. They will include feedback from people who live in the home, their friends and family as well as staff and other agencies.

One of the staff said there were now appropriate on going learning and development opportunities with a system to maintain mandatory training up to date. Regular ongoing training enables staff to support people appropriately and safely.

We looked at five people's care records and these showed that people were being weighed regularly and they had not lost significant amounts of weight. We spoke to three people who sat in the communal lounge; they appeared to be relaxed and looked clean and appropriately dressed.

We found two staff had worked in the home without any pre-employment checks. This means there was no evidence that their suitability to work with vulnerable people had been checked. We also found one of the two staff had no training as a carer and the other staff's training had not been verified.

There were no effective recruitment and selection processes in place nor appropriate checks undertaken before staff began work. Therefore we could not be confident people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We were unable to audit the staff's level of training as there was no longer a system to monitor this. However we found that not everyone had completed their mandatory training. We also had concerns that the fire safety training was not robust enough to ensure that staff would know how to respond in the case of a fire in the home.

We spoke with six people who lived in the home to gain their views of Manor House. People spoken with all said they liked the new decoration and the new carpets. They enjoyed the food, there was plenty and they had a choice. Everyone spoken with were all complimentary about the staff and the manager. Their comments included:

'I like the new decoration it is much better'

'I like my new room which has better access for me'

'This is my home now'

'The staff are fine, they are good you can have a laugh'

We spoke with the manager and the owner and had a tour of the home to see the redecoration, new carpeting and furnishings.

We looked at people's care plans and saw that they were more descriptive of the person, their preferences and how they wished to be supported. We saw that people had good access to health care professionals.

We used a number of different methods to help us understand the experiences of people who used the service, because many of people using the service had various stages of dementia, which meant they were not all able to tell us their experiences.

We case tracked three of the people who lived in the home. This meant we spoke with them, reviewed their care records and spoke with the staff who supported them. We were unable to speak with one of the people as they were sleeping. We spoke with another person who lived at the home and with two relatives to gain their views of the home.

The people we spoke with were complimentary about the care and support they received at Manor House. Everyone said they enjoyed the food. We found care records did not record people's preferences or document their wishes about end of life care.

One relative said; 'People get good care here. We are very happy there is always someone here and staff are good to our relative. We would recommend anyone to come here.'

We spoke with the manager, the deputy and two carers. The owner was present and made themselves available throughout the inspection. All the staff we spoke with had worked at the home for a number of years and were clear about their roles and responsibilities,

We observed staff relating kindly with the people who lived in the home.

At the time of our visit we found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

People said they were able to choose when they got up and went to bed and said that staff respected their privacy and dignity such as knocking on their doors before entering their room.

Relatives we spoke with said they could visit at anytime and were made to feel welcome by staff. They said they thought the staff were friendly and that their relatives were well looked after.

People spoken with said they had no concerns or complaints about the home.