Archived: Manor Park Care Home

Manor Park Care Home is registered to provide accommodation and personal care for up to 49 people, including people who were living with dementia. At the time of the inspection there were 32 people using the service, 23 of whom needed nursing care. Manor Park consists of three units, Blanchland, Wynyard and Cameron. Each unit support and care for a mix of people who require either nursing or personal care needs. Cameron is a male only unit. .

A registered manager was in place at the time of our inspection. 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.

At the last inspection of the home in January 2016, we asked the provider to take action to make improvements. This was because we found the provider had breached a number of regulations.

We found risks to the health and safety of people who used the service, as well as staff and visitors. Risks had not been appropriately assessed and actions had not been taken to minimise those risks. Staffing levels were not sufficient to safely meet the care needs of the people who used the service. The assessed needs of people were not always accurate therefore the method of determining staffing levels could not be relied on. Staffing levels were not increased following the changing needs of people living at the home.

The registered manager did not ensure care and treatment was provided with the consent of the relevant person. Staff were not familiar with the principles and codes of conduct associated with the Mental Capacity Act 2005, or how to apply them for the people they were caring for. People were not supported in making decisions about their care and well-being.

The provider did not ensure staff received appropriate training and development to enable them to carry out the duties they are employed to perform. Care records did not always reflect people’s needs and preferences. The provider did not always ensure people’s nutritional and hydration needs were assessed. People’s choices were not respected in relation to nutrition. There were inadequate support facilities and amenities provided for the number of people using the service. We also found the provider did not have effective quality assurance processes to ensure that people received appropriate and safe care.

During this inspection we found the provider had continued to breach a number of regulations. Staffing levels were still not sufficient to safely meet the care needs of the people who lived at the home. Risks were not being recognised, therefore risks were not being assessed and mitigated against to minimise the risks to people, staff and visitors. Care records did not reflect people’s needs and preferences. We also found the provider’s quality assurance processes remained ineffective, failing to identify issues found during the inspection.

The registered manager conducted thorough investigations into safeguarding concerns and ensured all relevant authorities were informed.

The provider had a monitoring system in place to identify when reviews were required for people’s Deprivation of Liberty Safeguards (DoLS). Staff understood and applied the principles of the Mental Capacity Act and consent.

Personal Emergency Evacuation Plans (PEEPS) were in place and included an individual assessment of each person’s evacuation needs however these were not reviewed as stated by the provider’s own policy.

The provider had a robust recruitment procedure in place which included ensuring appropriate checks were undertaken before staff started work.

Mandatory training was up to date including safeguarding and moving and handling.

The home recently purchased and installed two purpose-built baths which people told us they enjoyed.

Communal areas within the service were clean and tidy. However, we found some equipment within the kitchen was dirty and cleaning records were incorrect.

People were not always offered an alternative meal if they declined to eat their first choice.

During meal times staff engaged with one person who was able to converse and hold a conversation but engagement with the other people who had limited verbal communication was functional and limited.

The provider had systems in place for the receipt, return, administration and disposal of medicines. Audits did not always identify gaps in the administration of medicines.

Where people had no family or personal representative we saw the service assisted people to obtain support from an advocacy service.

People had access to a range of activities including bingo, crafts, armchair exercises and going on outings. Staff supported people to maintain links with the local community.

The provider used an iPad feedback point called ‘Quality of Life’ to capture views about the quality of the service from people, relatives, external professionals and staff.

People told us they saw the registered manager around the home regularly. One staff member told us, “She’s always on the floor and if there’s anything that she can do – she’ll do it”.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 18 January 2016 and was unannounced. This meant the provider did not know we would be visiting. A second day of the inspection took place on 19 January 2016 and was announced.

We conducted a focused inspection in August 2015. We found care plan documentation did not always reflect people’s individual needs and were not always reviewed in a timely manner. People did not always receive care and treatment with dignity and respect. Systems for protecting people from abuse were not always in place and investigation of safeguarding incidents were not timely or documented appropriately. Sufficient skilled and experienced staff were not always deployed in the home. The provider advised us all these concerns had been addressed.

A registered manager was in place at the time of our 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.

During this inspection we found the provider had breached a number of regulations. Risks to the health and safety of people who used the service, staff and visitors, had not been appropriately assessed and actions had not been taken to minimise those risks. Staffing levels were not sufficient to safely meet the care needs of the people who used the service as the assessed needs of people used when determining staffing levels were not always accurate. Staffing levels were not increased following the changing needs of people living at the home.

The registered manager did not ensure care and treatment was provided with the consent of the relevant person. Staff were not familiar with the principles and codes of conduct associated with the Mental Capacity Act 2005, and were not able to apply those when appropriate, for any of the people they were caring for. People were not supported in making decisions about their care and well-being.

The registered provider did not ensure staff received appropriate training and development to enable them to carry out the duties they are employed to perform. The registered provider did not ensure equipment was in place to ensure the safety of service users and to meet their needs. Care records did not reflect people’s needs and preferences. The provider did not assess people’s nutritional and hydration needs. People’s choices were not respected in relation to their nutrition. There were inadequate support facilities and amenities provided for the number of people using the service. We also found the registered provider did not have effective quality assurance processes to ensure that people received appropriate and safe care.

You can see what action we told the provider to take at the back of the full version of the report.

Personal Emergency Evacuation Plans (PEEPS) were in place but were found to be out of date and did not contain information pertinent to people’s mobility and ability to leave the premises safely.

The provider had a comprehensive recruitment process with checks in place to ensure safety and suitability was explored prior to offering employment to staff.

From mealtime observations we saw people were not always encouraged to maintain their independence and appropriate equipment was not used to ensure this.

People’s medicines were managed safely. The provider had effective systems in place for ordering, obtaining and checking medicines upon receipt into the home.

Staff demonstrated a general knowledge about people’s likes and dislikes, however they were limited in their understanding of people’s needs and how to support them.

We saw evidence in care records of co-operation between care staff and healthcare professionals including social workers, community psychiatric nurses, occupational therapists, and GPs to ensure people received appropriate care.

Where people had no family or personal representative, we saw the home provided information about advocacy services.

Relatives told us they were always made welcome by the staff and the registered manager.

People did not receive sufficient engagement or stimulation. No specific activities were available for people living with dementia.

The Provider used an iPad feedback point called ‘Quality of Life’ to capture views about the quality of the service from people, relatives, external professionals and staff.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent

enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service caring?

During our visit, we observed staff interacting with people in a caring and considerate way. They were polite and friendly in the way they spoke to people and used touch appropriately. A person who had lived there for a year told us 'The staff are very kind and this feels like home now'. We undertook a SOFI observation which indicated positive interactions having a good effect on people.

When we were there we noticed that many people had personalised their own rooms with furniture, pictures and decorated walls to their own taste.

Is the service responsive?

Records showed that care needs were assessed and reviewed regularly. One relative told us 'If you have a concern that you raise it gets sorted out'. The staff mentioned that the managers were approachable about any issue and would help where they could.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We examined one DoLS application which was fully documented showing the people involved in the decision making. This included the person's GP, another independent GP, local authority professionals, psychologists, family and carers. We saw copies of best interest meetings which included full mental capacity assessments and these were approval by the local authority. There were policies and procedures in place. staff had been trained to understand when an application should be made, and how to submit one.

The home had systems in place to monitor people's weight and where needed introduced meals with supplements to help people with their nutrition under the guidance of a dietician.

Staff training was up to date so they could do the tasks they needed to do safely.

Is the service effective?

The service assessed people's needs and the risks associated with their care. One person told us that recently she was ill and staff noticed 'I wasn't well, and I went to hospital quickly'.

There was evidence of risk assessments being implemented should people living in the home have swallowing difficulties, or needed support to eat and drink.

A visiting district community matron told us the home was good at keeping them informed of issues.

Is the service well-led

The people who lived there and their relatives spoke of the approachability of the registered manager and deputy manager and that the managers acted on information they received. One person told us 'The manager is very approachable'.

The manager had systems in place to check that people were doing what they should be doing and that individual's needs were being met.

The manager told us that at least twice a day 'she went around checking on the people in the home and what the staff were doing, making sure people were well and their needs were being met'.

One person told us, 'The staff are very, very good. If you ask for anything to be done for you, then they do it'. People also said, 'They encourage you to do as much as you can for yourself, they encourage me and give me confidence' and 'They are extremely kind.'

Relatives and people who used the service told us that they there were satisfied their views were respected. People found that care workers consulted them about their preferences for care, food and routines. One relative told us, 'I come here every day, we have been married for 64 years and I know she is well cared for in here. The staff do talk and listen to me and they let me know if there is anything amiss. I have peace of mind.'.

We checked whether the staff applied the requirements of the Mental Capacity Act 2005. We found that the staff had a good understanding of the Act, how to apply it, and completed the appropriate records.

We found people's needs were assessed and care was planned in line with their needs. At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Also an effective system was in place to ensure the on-going quality of the service was maintained.

We spoke with two people and two relatives. People told us that 'The girls (staff) are lovely'. They also told us that the care home was 'Fine' and they were 'Generally happy'. Relatives told us that overall they were pleased with the care their relatives received. One person said that their relative was 'Content and settled' since they had come to live at the care home and staff 'Now know his needs better than I do'.

We saw that suitable arrangements were in place to obtain consent to care and treatment from people. We also found that people were protected from the risk of infection because appropriate guidance had been followed.

The provider also had effective recruitment procedures in place and also kept accurate records of service users and persons employed. The records were stored securely.