Philiphaugh Manor

Philiphaugh Manor is a residential care home providing personal care to up to 32 people. The service provides residential care to older people who may have a physical disability. At the time of our inspection there were 21 people using the service.

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

At this inspection we found improvement had been made in relation to the management of fire risks. Automatic fire door release mechanisms had been recommissioned and no fire doors were propped open during this inspection. Additional fire doors had been installed and evacuation plans developed detailing the level of support each person would require in an emergency.

Risks were identified and mitigated, and staff supported people to safely mobilise. Pressure relieving mattresses were set correctly, and bath hoists had been repaired.

Staff had not consistently documented incidents that had occurred, and accident audits were not comprehensive. We have made a recommendation in relation to these issues.

There were now systems in place to provide staff with guidance on how and when to use ‘as required’ medicines and people had been appropriately supported with medicines in tablet and liquid forms. However, further improvements were required in relation to medicines systems and records. One person had run out of a prescribed cream and this issue had not been promptly resolved. In addition, notes had not been maintained on the effectiveness of PRN medicines and there was no system in place to record where patch-based medicines had been applied to people’s bodies.

Recruitment practices were safe and there were enough staff to meet people’s needs. The service had experienced some recruitment challenges and as a result was operating at reduced capacity to ensure people’s needs could be met by the available staff.

Staff training had not been regularly updated to ensure all staff had the skills necessary to meet people’s needs. In addition, staff new to the care sector had not been supported to complete the care certificate.

Staff understood how to report safety concerns within the service and records showed the manager had appropriately raised safeguarding issues with the local authority.

Water pressure issues had been resolved and the decor in bathrooms upgraded. However, both bathrooms were noticeably cold on the day of the inspection and there was no heating available in one bathroom. Records showed people had not been regularly offered opportunities to bathe or shower contrary to people’s identified needs and preferences.

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; the policies and systems in the service supported this practice. Systems to record people’s consent for photographs had been introduced and there were systems in place to assess people’s capacity to make specific decisions.

Issues in relation to damaged carpets and malodourous furniture had been resolved and clutter in the manager’s office had been cleared. A new maintenance person had been employed and prompt action was taken to address a maintenance issue identified during the inspection.

People were well supported at mealtimes and told us they enjoyed the food provided. The oven was working correctly, and kitchen staff understood people’s needs and preferences.

People’s care plans had been updated since the last inspection. However, these documents lacked clear guidance on how to meet people’s specific and individual support needs. In addition, care plans for people who had moved in recently contained only limited life history and background information.

People were comfortable in the service and told us they were safe. Staff offered support promptly when required and people requested assistance without hesitation. Relatives and visiting professionals were also complimentary of the services performance.

People’s care plans were now stored securely in a locked room when not in use. However, some staff did not know how to access these records.

The service does not have a registered manager. The service’s manager was supported by 2 duty managers and the roles and responsibilities of each manager were now well defined.

The provider’s quality assurance systems were not effective as they had failed to ensure compliance with the regulations and identify that some management tools were being used incorrectly.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 6 December 2022). We found breaches of the regulations and issued 2 warning notices in relation to failures to provide safe care and treatment and good governance.

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 some improvements had been made and that the warning notice in relation to safe care and treatment had been complied with. Although the service’s governance systems had improved these issues had not yet been fully resolved. The breaches of the regulations in relation to consent and premises and equipment had been resolved. However, new failings were identified at this inspection, these were in relation to person centred care and staff training.

Why we inspected

We carried out this inspection to check that warning notices issued after the last inspection had been complied with.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified new breaches in relation to person-centred care, and staff training and support. There was an ongoing breach in relation to recording and quality assurance at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Philiphaugh Manor is a residential care home providing personal care to up to 32 people. The service provides residential care to older people who may have a physical disability. At the time of our inspection there were 23 people using the service.

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

We found repeated concerns from the last inspection. Risks were not always identified, assessed and recorded. Care plans were completed for each person and contained details of the person's needs and preferences. However, changes in people’s needs were not always recorded. Reviews had not taken place monthly as stated by the provider in a recent Provider Information Return (PIR).

There were sufficient staff to support people at the time of this inspection. However, the service was not fully staffed and was struggling to recruit new staff to vacant posts. The service was not using any agency staff at the time of this inspection, but some staff were working over 60 hours a week to cover shifts. Recruitment procedures were robust.

We found repeated concerns with medicines management and administration, as at our last inspection. People did not always receive their medicines as prescribed. This was because some medicines were unavilable. Medicine records contained gaps. We were not assured people had prescribed creams applied as required. Risk assessments for medicines such as anticoagulants were not in place. Four out of five staff were overdue for medicines training.

As at the last inspection, auditing and monitoring processes were not robust at the time of this inspection. Monitoring records were not being reviewed. Some skin check records had inappropriately ceased several days before this inspection. The service had not implemented effective quality assurance systems to monitor the quality and safety of the care provided.

There were concerns with the premises. Water pressure and supply had been an issue due to a large mains leak under the building. This was being addressed but water pressure issues were causing difficulties for staff providing baths for people.

A recent fire survey had found some non-compliance with regulations. The provider was asked for written assurances about when recommended actions would be completed. This had not been received.

Carpets in the lounge were torn and badly stained and malodourous throughout the service. Some corridor carpets had been replaced. Some furniture was malodourous. The gas cooker was faulty during this inspection. The gas oven could not be turned off and needed to remain lit to prevent gas escaping. The provider and staff made arrangements for food provision for the next few days and notified relevant agencies to resolve the matter.

Accidents and incidents were recorded. However, these events were not currently being audited or reviewed. This meant the opportunity to reduce the risk of reoccurrence of accidents had been missed.

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet. Some people were having their food and drink intake recorded; however, this was not recorded in their care plans or on the shift handover record. This meant new or temporary staff would not be aware of the need for this monitoring.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There was no record of people, or their legal representative, having been asked for their consent to having their photographs displayed in their records.

Mental capacity assessments had been carried out where it was indicated. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately. We were told there was one authorisation, for a restrictive care plan, in place at the time of this inspection. However, the manager’s records were not an accurate oversight of people’s DoLS status and no authorisations were in place. This meant people may be being unlawfully restricted.

The transition to a new electronic care planning system was not managed well. The maintenance person was leading this task and had inappropriately advised are staff to cease keeping some paper records before being taught how to use the electronic system. This meant there was a risk changes in people’s need would be missed.

People told us they felt safe with staff. There were systems to help protect people from abuse. Posters displayed the contact details for the local authority safeguarding unit.

People were supported by staff who were knowledgeable and were skilled in their role. Some staff training updates were overdue, but we were assured there was a plan to address this.

Staff were tired but felt supported and were able to access the management team whenever they needed any assistance or guidance. Staff comments included, “(Manager’s name) works with us regularly at the moment, they have found themselves in the deep end, it's really hard at the moment with not enough staff,” “Things are tough, we have often got none or very few staff. The weekends and the nights are a struggle. The managers are doing nights, we are so short” and “The place is looking tatty to be fair, the carpet in the lounge is awful. Two new bathrooms, but they don’t work that well. We have not been able to do baths as we don’t have the staff the water is not running well. We had to boil pans a couple of months ago because of the water problem.”

People told us they liked living at Philiphaugh and that the staff were caring and responded when they called. Comments included, "Yes, I am fine here they are kind to me." "I like the food good enough" and "I am ok here, I have visitors sometimes. I can do what I like." A relative told us, “(Person’s name) is always clean, her room is clean and the staff are kind to her. Staff are always nearby.”

People were asked for their views by the management team. A survey in February 2022 and a residents meeting had sought people’s views on the service provided. However, the responses had not been audited or reported upon so any actions which may have been needed had not been addressed.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 21 June 2019) We found breaches of the regulations and also had made recommendations following the last inspection.

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 the provider remained in breach of regulations.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found repeated breaches in relation to risk management, management, governance and oversight. New breaches were found regarding consent and premises at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified breaches in relation to the management of risk, premises, medicines, provider oversight and consent at this inspection. We issued warning notices requiring the provider to meet the requirements of the regulations by 26 August 2022. If they fail to do this we may take further action.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using the service:

Some people were not all able to fully express their views therefore they were not able to tell us verbally about their experience of living at Philiphaugh. Therefore, we observed the interactions between people and the staff supporting them.

The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and chatted with people as they provided care and support. Relatives told us they were welcome at any time and any concerns were listened and responded to.

Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere.

Staff recruitment processes were not always robust. Induction provided was not always clearly recorded.

The environment was well maintained. Recent renovations and redecoration had taken place.

Not all staff had received necessary mandatory training and support to enable them to carry out their role safely. Staff did not have regular supervision or annual appraisals.

People did not always receive their medicines as prescribed. Medicines management was not robust.

The provider had not ensured adequate management oversight or governance arrangements to cover the recent consecutive annual leave of the registered manager and two team leaders.

The provider had moved the head of care to another service in the group for over a year. Their role had not been replaced. Their last audit at the service was February 2019. Actions identified in that audit had not been addressed by the registered manager at the time of this inspection.

Quality monitoring systems were in place but had not been carried out for the last few months. This had led to concerns identified at this inspection.

The environment lacked appropriate stimulation for people living with dementia. Activities provided were not always meaningful and relevant to people’s backgrounds and interests. We have made a recommendation about this issue in the Responsive section of this report.

People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These correctly set at the time of this inspection.

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.

Care plans were not always reviewed to take account of changes to people’s needs. However, appropriate care was being provided by staff and handover sheets provided some direction for staff.

Risks were identified during this inspection that had not been identified prior to this inspection. For example, fire doors were seen propped open with furniture and other items, these would not close in the event of an emergency. Person Evacuation in an Emergency Plans (PEEPS)for people living at the service were not in place.

Monitoring records were not audited to ensure they were always completed appropriately. There were gaps in these records. Staff were recording care and support retrospectively.

Visiting healthcare professionals told us they had no concerns about the care provided at Philiphaugh.

Rating at last inspection: At the last inspection the service was rated as Good (report published 23/12/2016)

The rating for this service has changed to Requires Improvement. There were breaches of the regulations identified at this inspection.

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

Follow up: We will carry out a further inspection, in line with our inspection programme, to check improvements have been made to ensure the service is meeting the regulations. We will continue to monitor intelligence we receive about the service. If any concerning information is received, we may inspect sooner

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

A previous comprehensive inspection of this service was completed in September 2015. This inspection found that the service required improvement in all five of our key question areas and identified breaches of the regulations.

In April 2016 we completed a focused inspection to check required improvements had been made. The focused inspection found significant improvements had been made in most areas but further improvements were required as the service remained in breach regulations in relation to risk management and the display of inspection reports.

Philiphaugh Manor is a detached building located within its own grounds, that provides accommodation and personal care for up to 30 people who do not require nursing care. On the day of this inspection 27 people were using the service. Some people were living with dementia.

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 service has a registered manager in post, however at the time of our inspection the registered manager had been away from work for some time. The provider had appointed an acting manager to provide appropriate leadership and ensure the staff team were adequately supported during the registered manager’s absence. The acting manager had previously been registered at another service and had been providing the additional management support at Philiphaugh Manor since our previous comprehensive inspection.

People said they felt safe Philiphaugh Manor and their comments included, “I feel safe because nothing is too much trouble for the staff” and “There’s nothing to worry about living here.”

The service was fully staffed and records showed that the service was now consistently staffed at safe levels. Since our previous inspection the provider had reviewed staffing levels and taken action to enable care staff to spend more time with people providing care and support.

People told us staff responded promptly to their requests for support and relatives commented, “When I visit there always seems to be enough staff on duty.” In addition staff told us positive changes had been made to how they worked each day. A new system had been introduced where staff were allocated to support named people each morning. Staff reported that these changes combined with the increased staffing level meant they now had more time to spend with people. Their comments included, “There is loads more care staff”, “the kitchen porters have helped a lot because you have time to sit and talk to the clients now” and “The allocation means you can spend a lot more time with people. Time to chat while shaving and things like that. It is very positive.”

During both previous inspections we found accidents and incidents were not always documented or investigated. At this inspection records showed that necessary accident or incident forms had been completed for all significant events recorded within people’s daily care notes. The acting manager had completed monthly audits of these records and taken appropriate action to manage any areas of identified increased risk.

Risk assessment documents now provided staff with detailed guidance on how to protect people from identified areas of increased risk. People’s care plans had been regularly updated and staff told us these documents had significantly improved over the last year.

The service had systems in place to ensure staff were sufficiently skilled to meet people’s care needs. Records showed all staff completed formal induction training and systems had been introduced to ensure all staff now received regular training updates. One recently recruited staff member told us, “I had an induction and I have done all my on line courses. There was a lot of training” while existing staff commented, “Courses have come thick and fast” and “The training is absolutely spot on.”

Staff understood the requirements of the mental capacity act and where people lacked the capacity to make decisions independently the service consistently acted in their best interest. Where people’s care plans had been identified as potentially restrictive appropriate applications for their authorisation had been made.

On-going improvements to the service’s environment were under way during our inspection. Since our previous inspection the kitchen had been replaced and maintenance staff were in the process of replacing a bathroom on the day of this inspection. The service was well maintained and numerous areas had been redecorated.

People were well supported at meal times and encouraged to eat as independently as possible. People told us, “The food is very good” and the lunch time menu options looked appetizing.

The service employed an activities coordinator and during our inspection we saw people engaged with a variety of activities in the lounge. People told us, “I enjoy the activities, they make them fun” and “They (staff) keep me active and keep my brain going.” In addition, care staff spent time chatting and laughing with people in the lounge.

Staff told us the service was well led, that they felt supported and that morale had significantly improved. Staff comments included, I am happy going to work and look forward to it”, “It is a hell of an improvement over when you were here a few months ago” and “The new acting manager is absolutely fantastic she listens and gets things done.” Records showed staff now received formal supervision and that staff meetings were held regularly.

During our April inspection we found the service had failed to display their inspection report within the service or on their web site. At this inspection we found that the previous inspection report was displayed on a notice board in the reception area and that the service’s website now included a link to the most recent online inspection report.

This report only covers our findings in relation to topics of concern identified during our previous inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Philiphaugh Manor on our website at www.cqc.org.uk.

Philiphaugh Manor provides accommodation and personal care for up to 30 people who do not require nursing care. At the time of this inspection there were 22 people living at the service. Some people were living with dementia.

The service is a detached house located within its own gardens. At our previous inspection we found that people were only being accommodated on the ground floor as the first floor rooms were in the process of being redecorated. At this inspection we found that these works had been completed, areas of damaged carpet identified during our previous inspection had been replaced and rooms on the first floor were now occupied.

At this inspection we found that the service was being led by the registered manager who worked in the service on a full time basis. 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. Since our pervious inspection the provider had supplied additional managerial support to the service. The provider’s area manager had visited the service. Their care planning and training lead were now working within the service three days a week. Staff reported that morale had improved and told us; “It is better now the registered manager is back”, “It really has changed. It is better” and, “The atmosphere is much, much better, absolutely without a doubt.” Team meetings had been held regularly, staff had received appropriate supervision and annual performance appraisals were due to be reintroduced.

In September 2015, we found the service was short staffed and staff had been working an excessive number of hours with insufficient rest periods. During this inspection we found that seven additional staff had been appointed and staff were no longer working excessive hours. The service staff rota had been redesigned and we found on our unannounced arrival at the service that the correct number of staff were available to meet people’s care needs. Staff told us, “There are four of us on all the time” and, “The hours are much better. I don’t feel exhausted the way I was.”

However, a number of staff reported on going issues during periods of staff sickness or leave. Staff told us they had been unable to book time off for holidays and the registered manager’s attempts to recruit bank staff to provide additional cover during periods of staff sickness or holiday had so far been unsuccessful.

During our previous inspection we found there were was a lack of systems for the recording of incidents and accidents that had occurred. At this inspection we found new systems had been introduced but not used to record details of a number of significant incidents that had occurred within the service.

At this inspection we again found that risk assessments within people’s care plans did not provide staff with accurate information on how to protect individuals from identified areas of risk.

Significant improvements had been made since our last inspection to ensure that staff training needs had been met and staff told us, “There is a lot more training coming our way.” Induction training for new staff required further improvement as the service had not yet introduced training in accordance with the requirements of the care certificate.

Where managers had identified that Deprivation of Liberty Safeguards (DOLS) applications were needed they had been made to the local authority. However, assessments had not been completed to assess people ability to make decision independently and managers remained unclear on their roles and responsibilities under the Mental Capacity Act 2005.

All of the care plans within the service had been reviewed and updated since our September inspection. People’s care plans now more accurately reflected their care needs and all care plans now included some information about each person’s back ground, life history and interests.

An activities coordinator had been appointed two weeks before our inspection. We observed during both days of our inspection that people were encouraged and supported to engage with a range of activities including; knitting, reminiscing and a newspaper review group. Staff told us, “There is a lady who is doing activities regularly now” and, “There are more staff so there is more time to do things with people.”

Quality assurance processes had been formalised and the provider’s directors had completed regular site visits and an inspection of the service. Where issues had been identified during directors visits an action plan had been developed to identify how each issue would be resolved.

Improvements had been made in all areas since our previous inspection. However, in relation to risk management and investigation of incidents within the service the improvements made were insufficient and the concerns previously identified had not yet been fully addressed and resolved. In addition during this inspection we identified one additional breach of the regulations as the service had failed to display links to their inspection report from their website. You can see what action we told the provider to take to address these breaches at the back of the full version of the report.