Manor Lodge

Manor Lodge is a care home that provides accommodation and personal care for sixteen older people some of whom are living with dementia. People's bedrooms are single occupancy. At the time of the inspection there were sixteen people using the service.

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

We saw positive engagement between staff and people. People told us that staff were kind and looked after them well.

Medicines were overall managed safely. We have made one recommendation about the management of some medicines.

Risks to people's safety in a range of areas including the COVID-19 pandemic were assessed and understood by staff. Systems were in place to ensure people were protected from abuse and treated with respect and dignity.

Suitable infection prevention and control measures and practices were in place to keep people safe and prevent people, staff and visitors catching and spreading infection.

Appropriate recruitment procedures helped to ensure only suitable staff were employed to provide people with personalised care and support.

Staffing levels and skill mix were determined by people’s dependency needs. People had the opportunity to take part in a range of social activities.

Staff received the training, guidance and support they needed to do their job well and to effectively meet people's needs.

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.

There were systems in place to effectively monitor and improve the service for people. People were asked for their feedback and action was taken to address issues raised.

The registered manager was approachable and provided staff with leadership, support and direction.

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

Rating at last inspection

The last rating for this service was good (published 01 May 2018).

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.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service good. At this inspection on the 15 March 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Arrangements were in place to keep people safe. Staff knew how to identify abuse and understood the safeguarding procedures they needed to follow to protect people from abuse.

Risks to people's health and well-being were identified, assessed and managed as part of their plan of care and support. Staff understood their responsibilities to deliver safe care and to report to the manager all concerns to do with people’s safety and any poor practise from staff.

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. Staff gained people's consent before providing personal care.

Medicines management systems were in place to ensure people’s medicines were stored and administered safely. People’s dietary needs and preferences were understood and supported by the service.

People received personalised care and staff were responsive to people’s needs. People's care plans included details about people’s individual preferences and information staff required to provide people with the care and support they needed in the way that they wanted. Care plans were reviewed regularly and were updated when people's needs changed.

Staff had a caring approach to their work and understood the importance of treating people with dignity and protecting people's privacy. People’s confidentiality was maintained.

People had the opportunity to take part in a range of activities. Staffing levels and skill mix provided people with the assistance and care that they needed. Appropriate recruitment procedures were in place to ensure that only suitable staff were employed to provide care.

Staff received the training and support that they needed carry out their roles and responsibilities including providing people with individualised care.

People and their relatives knew how to make a complaint and were confident their concerns would be addressed appropriately by the service.

There were systems in place to assess, monitor and improve the quality of the services provided for people. Improvements to the service and people’s care were made when needed.

People’s healthcare needs were assessed. The service worked with healthcare and social care agencies to ensure people’s needs and preferences were met.

We have made two recommendations. One about improving the access of the building for people using the service and visitors who have mobility needs, and another about developing the adaptation, design and decoration of premises to ensure that the environment always meets the needs of people using the service who were living with dementia.

Further information is in the detailed findings below.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on the 18 August 2016 to check they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Manor Lodge on our website at www.cqc.org.uk

Manor Lodge provides accommodation and personal care for up to 16 older people some of whom have dementia. There were 16 people living at the home at the time of our inspection.

At the time of our inspection the home had a registered manager. 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 our focused inspection on the18 August 2016, we found that the provider had followed their plan and legal requirements had been met. The provider had taken action to address our concerns about some aspects of the way medicines were managed by the service. The provider had made improvements to the storage of medicines. They had also carried out medicines competency assessments of staff who administered medicines and provided staff with additional medicines training.

Manor Lodge is registered to provide accommodation and personal care for 16 people. The home provides care for older people some of whom have dementia. The home is owned and managed by R.M.D. Enterprises Limited. On the day of our visit there were 16 people living in the home. Public transport and a range of shops are located within walking distance.

People informed us they were satisfied with the care and services provided and told us staff were kind. We saw people were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People’s privacy and dignity were respected.

People received the medicines they were prescribed. However we found there were aspects of the storage and management of medicines where improvements were needed.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm.

Care plans were personalised and reflected people’s current needs. They contained the information staff needed to provide people with the care and support they wanted and required. People had the opportunity to participate in some activities of their choice.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was maintained and promoted. People were supported to maintain links with their family and friends.

People were supported to maintain good health and their well-being was promoted. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed.

People were provided with food and refreshments which met their preferences and dietary needs. However, the menu did not indicate that people had choice during some meals.

Staff were appropriately recruited, trained and supported to provide people with individualised care and support. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

People had opportunities to feedback about the service. There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We found one breach of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found that the provider had taken proper steps to demonstrate compliance in all the areas where there had been concerns. These areas included Care and welfare, Management of medicines, Supporting workers and Assessing and monitoring the quality of service provision.

We spoke with six people who used the service, four visitors, four care staff, the registered manager and an owner of the care home. People who used the service told us that they were happy living in the home. They said the staff were kind and treated them well. Comments from people included 'its fine here,' 'The food is good,' and 'The staff are very nice.'

Relatives of people who used the service spoke highly of the care provided by the home and made positive comments about the registered manager. Comments from relatives of people who used the service included 'Nothing is too much trouble for the staff and the manager,' 'They are all very kind,' 'Staff are very good at what they do,' 'They are very kind and positive,' 'I feel involved and listened to,' and 'I have recommended the place to several people."

Written procedures that guided practice had not been amended to reflect up-to-date information. Staff were not provided with suitable information to protect service users against risks of receiving inappropriate or unsafe care.

Staff were able to describe their responsibilities in recognising potential abuse and reporting safeguarding concerns. Some relevant training had been provided and information about safeguarding was included in the induction programme for new staff.

People were not protected against the risks associated with medicines. Medicines were not kept securely. Up-to-date published information about medicines was not made available to staff. This meant people were at risk of receiving unsafe or ineffective medicines.

Not all staff received appropriate training, professional development, supervision and appraisal. Staff could not demonstrate their continued ability to meet required standards, or that training was planned and based on the needs of people using the service.

There were some systems in place to seek the views of people using the service, relatives, and staff. There were no clinical, or quality audits carried out to ensure that risks were identified and managed.

We also spoke with the relatives of people who use the service who were equally happy. One comment was, "I can relax 100%. The care here is fantastic". Another relative said, "all staff are nice. I've never seen anyone who isn't smiling". We spoke with one relative who stated that the home had helped her mother to walk again.

The staff we spoke with had been working at the service for many years. They had undertaken additional training courses to improve their skills and qualifications. Staff said "it's a good working atmosphere. We work like a team".

The service had person centred care plans in place and encouraged people to be independent. Dignity and privacy was respected and the home provided a safe environment. Although there were regular reviews of care plans and daily record sheets filled in for each person, the policies were several years old.