Newhey Manor Residential Care Home

Newhey Manor is a purpose built residential care home situated in Newhey, Rochdale. It has 24 single rooms, all of which have sinks and two have en-suite toilets. There was a large communal lounge and a separate dining room. The home had access to a large playing field at the rear of the building. At the time of our inspection there were 21 people living at the home.

The service had a registered manager who was present during the inspection. 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.

During the last inspection of Newhey Manor in March 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care records were not clear and accurate, and systems to monitor the quality of the service did not ensure people were not at risk of harm or injury. Following that inspection the provider sent us an action plan informing us that they had taken action to ensure the regulations had been met. During this inspection we found the provider had complied with the previously breached regulations and the service was no longer in breach. We found that all other regulations were being met. However we made a recommendation that the service reviews and takes steps to improve daily recordings, as we found that daily care notes were poorly stored and were sometimes written in a subjective and derogatory manner.

We found the home was safe and secure, and staff understood their responsibilities to keep people safe. Procedures were in place to protect vulnerable people from abuse, and attention was paid to ensuring risks were assessed and monitored to minimise the danger of harm. Care plans showed attention to detail where a risk was identified.

There were adequate staff on duty at the time of our inspection and this was reflected in the rotas we looked at. However, at busy times such as lunchtime, staff were not always able to give a timely response to the needs of the people they supported.

Medicines were well managed, and there were good systems in place to allow for covert medicines and as required medicines to be administered safely.

The service was willing to listen to positive criticism and act on any advice provided. We saw that the service saw mistakes as an opportunity for improvement and to learn from errors.

There was good oversight and supervision of care staff who were well trained and knew the people they supported, and how they liked their needs to be met. Staff worked well together and shared tasks equally.

People told us they liked the food provided at Newhey Manor, and that they were consulted when planning the menu. Attention was paid to their dietary needs, and there was evidence of work in collaboration with health and social care professionals such as doctors, district nurses and speech and language therapists.

Staff we spoke with understood issues around capacity, and the service met the requirements of the Mental Capacity Act 2005. People told us that staff always sought their consent before providing them with support and care.

We were told that staff were caring and we saw that people were well cared for; throughout our inspection people commented on the kindness of the staff. We saw people treated with dignity, kindness and patience. Care plans were comprehensive, showing a good understanding of people’s individual and diverse needs, with attention to cultural and religious requirements. We saw that when people were approaching the end of their life, care plans reflected their needs and wishes, and people told us that the service supported people well as they approached the end of their life.

When we reviewed the complaints and compliments file we saw that the former was vastly outnumbered by the latter, and people told us that they were happy with the service and the support they were given. We saw that staff interacted well with all the people they supported and where they did not wish to join in with arranged activities their needs for social stimulation were not ignored. Visitors were always welcomed, and the service presented a homely feel with a caring ethos.

There was evidence that people supported at Newhey Manor were consulted about the service, and audits were undertaken regularly to monitor service provision. The manager demonstrated a good oversight of the service and ensured people were content and well cared for.

Newhey Manor Residential Care Home is a purpose built residential care home situated in Newhey, Rochdale. There are 24 single rooms, two of which have en-suite toilets. There are several communal areas such as a lounge, dining room and access to large playing fields at the rear of the house. At the time of the inspection there were 19 people living at the home.

The service has a registered manager. They were supported in their role by two deputy managers. 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 this inspection we identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Risk assessments and the monitoring of health needs were not always completed so that people’s health and well-being was protected.

Suitable arrangements were in place to ensure the premises and equipment used by people was safe. However action was required with regards to the mains electric circuit check, contingency plan and individual emergency evacuation plans so that people were protected from harm or injury.

Systems to monitor, review and improve the quality of service provided needing improving to help ensure people were protected from the risks of unsafe or inappropriate care and support.

The overall system in place for managing people’s oral medicines was safe. We have made a recommendation about maintaining clear and accurate records about people’s medicines.

People and their visitors were complimentary about the staff and the standard of care and support offered. From our observations we saw staff speak with people in a polite and respectful manner and responded to people’s requests promptly.

People told us they felt safe and received the care they needed. Staff had received training in safeguarding adults and were aware of what action they must take to take if they thought someone was at risk.

Where people were being deprived of their liberty the registered manager had taken the necessary action to ensure relevant authorisation was in place. As much as possible people were involved and consulted with about their care and support.

Relevant information and checks were completed when recruiting new staff. This helps to protect people who use the service by ensuring that the people they employ are fit to do their job.

Opportunities for staff training, development and support were provided. Staff spoken with confirmed they had completed relevant areas of training and felt supported by the registered manager.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being had been assessed as at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Hygiene standards were maintained to help minimise the risks of cross infection. The premises and equipment were adequately maintained and regular checks were undertaken with regards to fire safety; this helped to keep people safe. We found some areas of the home appeared ‘tired’. Maintenance and redecoration of some areas was taking place.

Care files contained sufficient information to guide staff in the delivery of people’s care. Information about people was easily accessible to staff and held securely so that confidentiality was maintained.

Activities and opportunities were offered to people to help promote their health and wellbeing as well as maintain community links.

Suitable arrangements were in place for the recording and responding to any complaints or concerns. People and their Visitors said they would not hesitate in speaking with the registered manager or staff and felt confident their concerns would be listened to and acted upon.

Newhey Manor provides accommodation for up to 24 older people who require support with personal care. There were 21 people living at the service at the time of this inspection.

The service had a registered manager in place who was also the provider of the service. 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 this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because the provider had not taken proper steps to ensure people always received safe care and treatment. The provider had also not taken the necessary action to ensure people who used the service were not unlawfully deprived of their liberty. You can see what action we have told the provider to take at the back of the full version of the report.

Risk assessments needed to be more detailed to ensure people were protected from the risk of unsafe care. Although systems were in place to monitor the nutritional intake and weight of people who used the service, these records were not always fully completed. This meant there was risk people’s nutritional needs would not be met.

People who used the service told us they felt safe in Newhey Manor. Visitors we spoke with told us they had no concerns regarding the safety of their family member or friends in the service. Staff had received training in safeguarding adults and knew the correct action to take should they witness or suspect abuse. However we noted an incident in which a person had sustained bruising following poor moving and handling practice had not been reported to the local authority as required. All the staff we spoke with told us they were confident they would be listened to and taken seriously should they raise any concerns about poor practice in the home.

Staff we spoke with demonstrated limited understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS); these are legal safeguards for people who may not be able to make their own decisions. The registered manager had also failed to recognise the requirement to submit DoLS applications to the local authority for people who were unable to consent to their care in Newhey Manor.

Staff had been safely recruited. People who used the service told us staff generally responded promptly to their needs. Our observations during the inspection showed staff provided support and assistance to people in a timely manner.

Staff told us they received an induction when they started work at the service. Systems were in place to record the training staff had completed and any supervision sessions they had attended. New staff were supported to achieve the Care Certificate; this is the minimum standards that care staff are expected to meet.

Records we reviewed showed a number of staff had completed training in end of life care. Four staff, including the registered manager were in the process of completing further training delivered by the local hospice.

People we spoke with told us that the staff at Newhey Manor were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff who had worked at the service for some time showed they had a good understanding of the needs of people who used the service. They told us they always promoted people’s independence and choice when providing care.

Systems to ensure the safe management of medicines were mostly effective. Records we reviewed showed that people had received their medicines as prescribed. One person’s medication administration record (MAR) chart had not been countersigned to ensure the handwritten record was accurate.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care such as utility failures. Personal evacuation plans (PEEPS) had been completed for people who used the service. These provided staff with information about the level of support people would require in the event of an emergency. Records we reviewed showed staff regularly discussed fire evacuation procedures during staff meetings.

People told us they generally enjoyed the food in Newhey Manor. Staff made the necessary referrals to help ensure people’s health needs were met; these included referrals to the dietician, optician and GPs.

People who used the service and their relatives had opportunities to comment on the care provided in Newhey Manor. Systems were in place to record and investigate any complaints received in the service.

A programme of activities was in place to help maintain the well-being of people who used the service; this included activity sessions delivered by a local organisation aimed at people living with dementia.

Staff told us they enjoyed working in the service and received good support from both the registered manager. Regular staff meetings provided a forum for staff development and discussions regarding how the service could be improved. Staff also had access to policies and best practice guidance; these documents helped to support staff to carry out their roles safely and effectively.

There were a number of quality assurance processes in place. The registered manager had developed action plans to address any shortfalls identified during the audits in order to continue to improve the service provided.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

The manager told us, and we saw evidence that staff members underwent medication competency assessments every six months. These assessments were conducted by a qualified assessor. This helped ensure on-going safe practice and that staff members were up to date with requirements.

Procedures were in place at Newhey Manor which helped staff members to learn from any accidents, incidents or complaints. This minimised the risk of unnecessary accidents to people and helped the service to continually improve.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. At the time of our inspection, no people at the care home were subject to a DoLS.

Is the service effective?

Before people were admitted to the care home, they had their care needs assessed with them. This helped ensure they were involved in creating their care plans and support was provided in accordance with their identified choices and preferences.

We spoke with two family members who were visiting and they told us they were able to visit at any time. One told us, "I am always made welcome. The staff are very nice."

Is the service caring?

We spent time in communal areas and observed staff members providing care and support in a caring and unhurried manner. People who used the service were encouraged to be independent when possible but were supported if necessary by attentive staff members.

People who used the service and their family members were involved in regular meetings and surveys. We saw a high level of satisfaction had been achieved by the provider. This meant people were involved in how care and support was provided at the care home.

Is the service responsive?

During our inspection, we saw people taking part in different activities. We saw a schedule for activities displayed on the wall. The manager told us, "We have a church service here every two weeks." This was aimed at people from all denominations and meant their religious needs were being met.

People we spoke with told us they knew how to make a complaint if necessary. The complaints procedure was displayed on the walls of the care home and was also present in people`s rooms and care plans.

Is the service well led?

The provider had policies and procedures in place that monitored the quality of service being provided to people who used the service. This helped ensure the quality of service continued to improve.

The care home worked well with other agencies which included GPs, community nurses, and dieticians. This meant people received appropriate care and support when they needed it.

Following our visit we received a brief improvement plan from the provider advising us of the action to be taken to make the necessary improvements needed.

During this inspection we looked to see what improvements had been made. We spoke with the provider, three care staff and a visitor to the home.

The appointment of a new housekeeper had helped to improve hygiene standards within the home. New flooring had been fitted in the communal toilets, new mattresses had been purchased, and systems to help minimise the risk of cross infection had been put in place.

Sufficient staffing levels were provided to meet the individual needs of people. We found that the staff roster accurately reflected the shifts completed by staff. Care staff that we spoke with said, “I’m a lot happier”, “The new housekeeper has taken the pressure off carers, it make such a difference” and “We are not as rushed and are able to spend time with people”.

Individual care records were in place to guide staff in the support people needed. Records could have been enhanced further with more personal information about people’s likes, dislikes and personal preferences.

During our visit we spoke with two people who lived at the home, three visitors, four staff and a visiting health care professional. People spoke positively about the care and support provided. People told us, “They [the staff] are lovely” and “We have some fun”. A relative also told us, “If my relative is happy then I am happy” and “My mother would tell me if she had any concerns about her care but she is very happy”.

Hygiene standards within the home needed improving so that people were not placed at risk of harm or injury.

Staffing levels did not provide staff with sufficient time to support people in a more dignified and unhurried way, ensuring their needs were met.

Opportunities for staff training and development were being provided.

We also looked at the individual care records for people. Whilst information had been regularly reviewed, some of the records did not clearly direct staff in the safe delivery of care.

The provider had not kept CQC informed of events that had taken place within the home to show that relevant action had been taken ensuring people were kept safe.

The two people who lived at the home told us they were happy with the environment but felt that there was a lack of activities taking place at the home. The visitor told us they felt their relative was often bored as staff were not always able to spend time to perform dedicated activities with their relative.

The visitor told us they had never complained formally but on occasion’s had spoken with the Registered Manager who had dealt with any issues swiftly.