The Manor House

We found the following examples of good practice.

All staff and essential visitors had to wear appropriate personal protective equipment (PPE), complete NHS Track and Trace information and had their temperature checked prior to entering the home.

Staff supported people’s social and emotional wellbeing. The provider and staff kept family members up to date about the latest government guidance. Relatives were kept informed about people's health using telephone calls, letters and video calls. Relatives could also visit the care home using a specifically designed visiting room.

The registered manager explained the quality systems they had in place to check the service was providing safe care. There was a communication system in place to ensure staff received consistent updates in relation to infection control policy and practice.

All staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training. Additional competency checks regarding safe use of PPE was also carried out by the registered manager.

The Manor House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and care for up to 38 people and is part of Park Lane Healthcare. At the time of our inspection there were 26 people living at the home. The accommodation was on two floors with a passenger lift to connect all areas of the home.

At the time of the inspection there was a registered manager in post. The service is required to have a registered manager in post. A registered manager is a person who has registered with 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 in February 2018 we found that care and treatment was not provided in a safe way. This related to the lack of robust actions to reduce risk and this was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to the overall oversight and governance of the service. Following that inspection, the provider sent us an action plan detailing the improvements they would make.

During this inspection we reviewed actions the provider told us they had taken to become compliant with the breaches identified in February 2018. We found that the necessary improvements had been made and the service was no longer in breach of regulation.

Medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this. We found staff had been recruited safely and received regular supervision and appraisals. Staff told us they felt supported in their roles and trained to meet people’s needs. Some staff felt additional specialist training in dementia and behaviour would be beneficial and the provider was willing to arrange this.

Staff received training about safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Accidents and incidents were responded to appropriately and monitored by the management team. The service was clean and infection control measures were in place. People and relatives spoke positively about the clean and well-maintained environment.

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. We made a recommendation in the last inspection report in relation to the application of MCA and the provider confirmed they will continue to work to this recommendation.

People’s nutrition and hydration needs were catered for. A choice of meals was offered and drinks and snacks were made readily available throughout the day.

There was a positive caring culture within the service and we observed people were treated with dignity and respect. People’s wider support needs were catered for through the provision of activities provided by activity coordinators, visiting entertainers and activities undertaken in the local community.

There was a complaints policy and procedure made available to people who received a service and their relatives. All complaints were acknowledged and responded to quickly and efficiently. The service sought feedback from people; feedback provided was positive.

There was a range of quality audits in place completed by the director. These were up-to-date and completed on a regular basis. All of the people we spoke with told us they felt the service was well-led; they felt listened to and could approach the registered manager with concerns. Staff told us they enjoyed working at the service and enjoyed their jobs.

The Manor House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and care for up to 38 people and is part of Park Lane Healthcare. At the time of our inspection there were 28 people living at the home. The accommodation was on two floors with a passenger lift to connect all areas of the home.

The service is required to have a registered manager in post. A registered manager is a person who has registered with 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 time of the inspection there was a manager in place who had commenced the registration process with CQC.

At the last inspection on the 31 July 2017 we found that care and treatment was not provided in a safe way. This related to the cleanliness of the premises. This was a breach of Regulation 12. Following that inspection the provider sent us an action plan detailing the improvements they would make in relation to the cleanliness of the service.

During this inspection we reviewed actions the provider told us they had taken to become compliant with the breach identified in July 2017. We also looked to see if improvements had been made in respect of the breach. We found the breach of Regulation 12 had not been fully met. In addition we found a further breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to the overall oversight and governance of the service.

Measures which were required to reduce the risk of harm were not always in place when people’s needs had changed.

The provider had not ensured new staff received the support, supervision and induction they required to deliver effective care.

Staff were caring and aimed to deliver a good standard of care that was compassionate. It was clear that staff knew people well and this helped them to provide person-centred care. However, some people’s care plans and related documents were inconsistent. This meant there was no guarantee that people were receiving care that met their current assessed needs.

Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied, however this was not consistent and we found some decisions had not been made in line with MCA and DoLS best practice. We have made a recommendation about seeking best practice guidance on the application of MCA and DoLS.

The registered manager and registered provider used a variety of methods to assess and monitor the quality of care. These checks included a daily walk around to check infection control, care records and care delivery. However these governance systems had not picked up the shortfalls and inconsistencies of information in people’s care plans, risk assessments, infection control, medication practices and capacity assessments. These areas need to be strengthened to ensure people receive a safe and consistent service. We have made a recommendation about staff training in a number of areas.

Medicines were managed safely and staff had good knowledge of the medicine systems and procedures in place to support this.

Staff understood how to safeguard people from abuse; staff had training in this area and were able to put this into practice.

People’s nutrition and hydration needs were catered for. A choice of meals was available and snacks and drinks were made readily available throughout the day.

People were enabled to engage in activities within the service. The activities coordinators kept a record of activities undertaken on a daily basis which included an evaluation of the activity and whether it met that person’s needs.

People at the service, their relatives and visiting professionals gave positive feedback about the manager.

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

At the last inspection in June 2016 we were concerned that medicines records were not well maintained and that people had not received the right medicine at the right time. We issued a requirement in respect of Regulation 12 (2)(f) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that the management of medicines had improved and that the provider was no longer in breach of this regulation.

At the last inspection in June 2016 we were concerned that CQC had not been notified about DoLS applications that had been authorised as required by regulation. This was a breach of Regulation 18 of the Registration Regulations 2009. At this inspection we saw that notifications about DoLS and other issues had been submitted to CQC, meaning the provider was no longer in breach of this regulation.

At this inspection we identified concerns about the prevention and control of infection. The systems currently in place did not fully protect people from the risk of infection. We detected unpleasant odours in some areas of the home and found equipment and bedding that was dirty and stained.

This was a breach of Regulation 12 (2)(h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

The manager and senior managers carried out audits to ensure people were receiving the care and support that they required, and to monitor that staff were following the policies, procedures and systems in place. However, these audits had not identified the shortfalls we found in respect of the cleanliness of the premises, indicating they were not always effective. We made a recommendation about this in the report.

There was a manager in post who was not registered with the Care Quality Commission. 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 commenced the registration process with CQC.

Although the provider was using a dependency tool to determine staffing levels required to support people who lived at the home, some people told us they thought more staff would be beneficial, especially during the evenings. We made a recommendation about this in the report.

Staff had been recruited following robust policies and procedures and people told us they felt safe living at the home.

People told us they were happy with the choice of meals provided at the home. People’s nutritional needs had been assessed and food and fluid intake was been monitored when this was an area of concern.

Care planning described the person and the level of support they required. Staff knew people well and were able to meet their individual care and support needs.

Staff were kind, caring and patient. They encouraged people to be as independent as possible and respected their privacy and dignity.

People were supported to have choice and control over their lives and staff supported them to make decisions when this was something they found difficult.

Activities were provided and people reported that the availability and variety of activities had improved.

Risks to people were assessed and reduced where possible. Staff received training on safeguarding adults from abuse. They were able to describe different types of abuse they may become aware of and the action they would take to protect people from harm.

People understood how to express any concerns or complaints and were encouraged to feedback their views of the service provided.

Staff told us they were well supported through supervision and staff meetings.

The Manor House is registered to provide accommodation and personal care for up to 38 older people and people who may be living with dementia. On the day of this inspection there were 29 people using the service. The service is located in the village of Little Weighton and it has its own grounds and parking area. There are individual bedrooms and several communal areas within the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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 our inspection we found that the recording and administration of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed. However, the registered provider had failed to notify us of the outcome of DoLS notifications for nine people, which was a breach of Regulation 18 of the Registration Regulations 2009 (Part 4).

We found that although people had access to sufficient meals and drinks, the dining experience and how people were supported with their choices in relation to food and drink was not always appropriate and required some improvement. We have made a recommendation on the subject of respecting people’s choices at mealtimes.

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

People told us that they felt safe living at The Manor House and we found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs. New staff had been employed following the service’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the service.

We saw that staff completed an induction process and had received training in a variety of topics and staff told us that they were happy with the training provided for them. There were systems in place to manage complaints if they were received and people told us they were treated with dignity and respect by staff.

People had their health and social care needs assessed and person centred plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health care professionals in the community.

Staff felt they received good support from the management and people who lived at the service and visitors told us that the service was well managed. Quality audits were undertaken of the systems within the service to help make sure people’s needs were safely met.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, observing interactions 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 that used the service were safe because the care they received from staff was in line with their assessed needs. Care was provided according to the action plans found in their care and health care plans. People had their personal, nutritional and mobility needs safely met.

People were cared for by staff that used appropriate equipment to aid peoples' mobility. Equipment was suitably stored and maintained to ensure its safe use. Staff were trained to handle equipment and assist people with their mobility needs.

Staff were safely recruited according to the regulation on 'requirements relating to workers'. The provider had not been compliant with this regulation at our last inspection but had taken appropriate action to address our concerns. The manager had a system in use to collate all relevant information for existing staff and to ensure it would be collated for all new recruits as well. There were recruitment and selection processes in place and information previously unknown had been obtained to show staff were safe and fit to provide care.

Is the service effective?

We saw that people were well cared for and their demeanour indicated they were interested in life and what it had to offer. Peoples' general welfare and wellbeing were well maintained and their needs for suitable nutrition and personal care were appropriately met. The care provided on a daily basis was effective at ensuring peoples' welfare.

The service had not fully considered the need for some people to be able to leave the property unaccompanied and so the practice, of always having a staff member go out with people that wanted to go out restricted them. The service did not place enough emphasis on providing people with dementia conditions with effective occupation and with an environment that was more suited to them. This meant people with dementia, while being cared for adequately, were not cared for in line with current research and recognised dementia approaches.

People were assisted with their mobility in an effective way, because there were no people requiring the use of lifting equipment, only their personal walking aids or wheelchairs. Should people have needed to use lifting aids, the staff were trained in their use.

The recruitment system which had been found to be lacking in effectiveness in February 2014 had been reviewed. A checklist had been followed since February and though this had been effective for collecting and recording existing staff details, its effectiveness had not yet been tested for recruiting new staff.

Is the service caring?

We found that the staff were thoughtful, caring and compassionate in their support to people that used the service. Staff questioned how they cared for people and considered their privacy and dignity. Staff were respectful towards people. People told us they were well treated by staff and only had to ask for help and it was given. They said, "We are treated well", "The staff are wonderful" and "I love it here".

We found that people or relatives had assisted staff with compiling their care plan and that it reflected the needs they were assessed for.

Is the service responsive?

We found that the service was responsive to peoples' personal care, mobility and nutritional needs, and to some level their social interactions and pastimes. The service enabled people to lead individual lifestyles in their rooms or in communal areas and met their individual needs by acknowledging people had diverse beliefs.

People told us they had not needed to complain but our discussions with the manager and staff revealed the service was open to approaches from people that used it. We saw the service's complaint records and the last complaint, having been made and recorded in early 2013, had been appropriately handled and satisfied.

Is the service well led?

There was a registered manager in post who ensured people had assessments of need and care plans in place, that were regularly reviewed. The manager led a team of senior staff, care staff and ancillary personnel. Care staff were supported to provide compassionate care, encouraged to seek improvements in peoples' health and welfare and expected to deliver high quality person centred care whenever possible.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed in the form of an action plan and actions carried out.

The system in place to monitor and audit the quality of the service provided was managed by a team of senior managers. Although the quality monitoring and auditing system in place had recorded the actions necessary to improve issues raised or identified, it did not have a mechanism to provide feedback to people. Had it done so then people and their relatives would have seen what had been done with the information they had given the provider in the annual surveys and with the information the provider had collated from the audits.

There was a suitable complaint system in operation to enable people to make their dissatisfaction known to the provider. People told us they had not needed to complain, but would speak directly with the manager if it proved to be necessary.

We observed that the interactions between staff and the people who lived in the home were very positive. One person told us 'I am happy living here. All the people are nice and I feel happy'. A relative told us 'I have been very satisfied with the support my relative receives. Everyone is very accommodating'.

We found that dietary needs and intake of food and drink was appropriately monitored. People who used the service spoke highly of the food that was available.

There were some issues with the consistency of checks and records that were in place for staff recruitment and induction. There were also some issues with the frequency of staff supervision and staff refresher training.

There were robust quality assurance systems in place and these were being used effectively.