Manswick Care Home

About the service

Manswick Care Home is a residential care home for people with learning disabilities and/ or autism, providing personal care to up to 4 people in 1 adapted building. At the time of the inspection there were 3 people using the service.

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

Right Culture:

There was limited input from the provider to ensure people received good outcomes of care and all parts of the regulated activity were delivered well and safely. There were systems in place to monitor the quality of the service but these were not always effective as they had failed to identify where improvements were needed.

Staff told us they felt supported by the registered manager and told us they believed improvements in the service were being made

Right Support:

People were supported by enough staff to meet their care needs. People had a choice about their living environment and were able to personalise their rooms. The service had enough staff, including for one-to-one support for people to take part in activities.

People were supported to maintain contact with their relatives and staff encouraged people to take part in community-based activities and hobbies.

People's prescribed medicines were managed appropriately. 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.

Right Care:

People told us they liked the staff who supported them. Staff protected and respected people's rights and choices.

People's healthcare and nutritional needs were met. People were supported to access healthcare professionals and to attend health appointments as needed.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 04 August 2022). 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 however, we found the provider remained in breach of regulation.

This service has been in Special Measures since 04 August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 28 June 2022. Breach of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, consent to care, safe care and treatment, good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manswick Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Manswick Care Home is a residential care home for people with learning disabilities and/ or autism, providing personal care to up to four people in one adapted building. At the time of the inspection there were three people using the service.

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

Right Support

People were at risk of and had experienced abuse from others because staff did not know how to protect people from poor care and abuse. We saw recorded incidents between people where one person verbally abused another. The registered manager and staff had not reported this to the local authority safeguarding team and had not notified CQC.

Staff did everything they could to avoid restraining people, however staff had not always completed appropriate records when they restrained people. At times, staff used an unauthorised method to control the movement of one person. The registered manager and staff had not always learned from those incidents and how they could be avoided or reduced in the future. The registered manager had not reviewed recorded incidents. This meant support plans and risk assessments were not always up to date to reflect recent incidents.

People had plans for when they experienced periods of distress, however we found support plans had disorganised information, often this information was repeated in other support plans. This meant that important information about risks to people, staff or others was not always clearly recorded and there was a risk it could be missed.

Governance systems and processes were ineffective. Improvements had not been made since our last inspection. Some improvements had been made to the management of medicines; however further improvements were needed.

People were supported in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to take part in activities and pursue their interests. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

Staff had not always fully understood the complexity of people’s needs and associated risks. We saw some interactions between staff and one person which were not appropriate.

People’s care, treatment and support plans had not always reflected their range of needs in clear and transparent ways.

People were supported to have maximum choice and control of their lives and staff, however the policies and systems in the service did not support this practice because appropriate assessments and best interest were not always completed.

Staff protected and respected people’s privacy and dignity. People could take part in activities and pursue interests that were tailored to them. Staff offered people opportunities to try new activities that enhanced their lives.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

People were not always supported by management and staff who fully understood the holistic needs of supporting people with a learning disability and autism.

People told us they received good quality care, support and treatment because staff could meet their needs and wishes.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 October 2021).

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manswick Care Home on our website at www.cqc.org.uk.

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 identified breaches in relation to person centred care, assessing the risk, safeguarding, need for consent, staffing and governance.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Manswick Care Home is a residential care home for people with learning disabilities and/ or autism, providing personal care to up to four people in one adapted building. At the time of the inspection there were three people using the service.

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

The provider's quality assurance systems were not always robust enough to ensure the quality of the service.

People were not always safe from harm due to risks not being managed and recorded safely. Guidance for staff about people’s behaviour and how to manage those was not always in place. Records of people's care were not always individualised and had not always reflected people’s needs and preferences. We made recommendation to the provider to review and update peoples care plans.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. There were enough staff to support people. Recruitment and criminal records checks had been undertaken on staff to make sure they were suitable to support people. The home was clean and tidy and infection control practices minimised the risks of infections spreading.

Staff received the training and support they needed to meet people's needs. People were supported to maintain their health and to maintain contact with professionals involved in their care. People received food and drink of their choice

Staff were kind and caring and respected people's rights to privacy and to be treated with dignity. People were supported to be as independent as they could be with daily living tasks

Staff and relatives told us the management team were approachable and would address concerns.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were supported to stay healthy and well. Staff helped people eat and drink enough to meet their needs and to take their prescribed medicines. People were treated as individuals and staff promoted people's dignity, privacy and human rights. Staff and management were passionate about supporting people to achieve good outcomes.

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

Rating at last inspection

This service was registered with us on 23 December 2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We have found evidence that the provider needs to make improvements across the service. However, the manager provided us with some immediate assurances of the actions they have taken to improve the service following our feedback.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing, monitoring and managing risks to people and overall governance of the service at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.