We carried out a review of the data available to us about The Manor House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Manor House, you can give feedback on this service.
At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to the area in which this home was located were commonly known as 'Tier Three Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.
We found the following examples of good practice:
We noted good practices in all of the areas we considered including the use of and disposal of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.
There were robust processes in place when approved visitors such as health care professionals visited the home. This minimised the risk to people, staff and visitors from catching and spreading infection.
There were comprehensive measures to prevent infections spreading within the home. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.
Where appropriate, and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions with infection outbreaks, these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.
We noted the provider and registered manager had developed a visiting area in a suitable location within the home. This incorporated shielding and isolation processes to ensure visitors and residents were protected. The registered manager said that this would only be used when guidance allowed and the current rules were relaxed.
Visiting rules and process were communicated effectively to people using the service and their relatives. People were also supported in contacting their friends and relatives by the use of social media and video messaging services. This assisted in promoting people's mental wellbeing.
Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The registered manager insisted people were tested before admission and consistent with guidance, new residents were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.
Staff had comprehensive knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.
Areas of the home could be segregated in the event of widespread infection so as to assist with appropriate isolation of people. The registered manager said separate staff members could be used to help in this situation.
Policies and infection control processes were regularly reviewed when guidance changed. We saw good examples of this that took into account guidance from a wide variety of sources. The provider kept abreast of developments and changes and we saw examples of where they had considered new guidance and provided this to management and staff in the home.
The home was clean and hygienic. The service had designated cleaners who were working during the inspection. All staff had received Covid-19 related supervision and the provider was proactive around ensuring staff and management had access to appropriate support to manage their wellbeing should it be required.
Further information is in the detailed findings below.
People's experience of using this service:
¿ The home had safeguarding policies and procedures in place and staff had a clear understanding of these procedures.
¿ Staff were recruited safely but we noted in some cases the need to improve some pre-recruitment checks. We have made a recommendation about this in the 'Safe' section of the report.
¿ There were enough staff available to meet people's care and support needs.
¿ Risks to people had been assessed and reviewed regularly to ensure people's needs were safely met.
¿ People were receiving their medicines as prescribed by health care professionals.
¿ The home had procedures in place to reduce the risk of the spread of infections.
¿ Care records were up to date and reflected people’s current health care needs.
¿ People told us they were happy with the care and support that was provided.
¿ Assessments of people's care and support needs were carried out before they moved into the home.
¿ Staff had received training and support relevant to people's needs.
¿ People were supported to maintain a balanced diet.
¿ 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 support this practice.
¿ There was a full range of activities for people to participate in that included health improving exercises and classes.
¿ Staff treated people in a caring and respectful manner.
¿ People and their relatives [where appropriate] had been consulted about their care and support needs.
¿ The home provided end of life care and support to people and their family members when required. Healthcare professionals and relatives were particularly complimentary about this.
¿ The home had a complaints procedure in place. People and their relatives told us they knew how to make a complaint if they were unhappy with the service.
¿ The registered manager had effective systems in place to assess and monitor the quality of the service.
¿ The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service.
¿ The provider took people and their relatives views into account through satisfaction surveys and meetings.
¿ Feedback from the surveys and meetings was used to improve the service.
¿ Staff at all levels enjoyed working at the home and said they received good support from the registered manager and provider's representative.
Rating at last inspection: Good (Report was published on 23 September 2016).
Why we inspected: This was a planned inspection based on previous rating.
The Manor House is registered to provide personal and nursing care for up to 50 people. The home is located in the centre of the village of Chatburn, close to all local amenities. Accommodation is provided in 50 bedrooms, 41 of which have an ensuite facility. There are two passenger lifts and one stair lift. At the time of the inspection there were 50 people accommodated in the home.
The service had a registered manager in post. 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.
This was the first inspection of the service following the registration of a new provider. During this inspection we found the service was meeting all the current regulations.
People living in the home said they felt safe and staff treated them well. There were enough staff on duty and deployed in the home to meet people's care and support needs. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. Risks associated with care were identified and assessed. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.
Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.
Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. People were encouraged to remain as independent as possible and supported to participate in a variety of daily activities.
Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care. Regular checks were undertaken on all aspects of care provision and actions were taken to continuously improve people's experience of care.