Archived: Manor House Residential Home

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Manor House Residential Home provides accommodation and personal care for up to 33 people. People who used the service were over 65 years old and have physical and/or mental health diagnoses. At the time of the inspection there were 19 people using the service. The service had recently been placed into administration.

There was a new manager in post who was in the process of applying for their registration with us. The person named on our register as the manager of the service was not the manager and they were not the manager at the last inspection in August 2015. 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.

People were not always protected from the risks of harm and abuse because incidents of possible abuse were not reported as required and action was not taken to protect people.

Risks to people’s health and wellbeing were not always identified and managed by staff safely. We found there were not always enough staff available to deliver people’s planned care or keep people safe, particularly at night time.

We found that medicines were not administered, managed and monitored in a safe manner to ensure that people got their medicines as prescribed.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that issues with the quality of the care were not identified and rectified.

People, relatives and staff did not feel supported by the manager. Staff reported that the manager was unapproachable and they had little confidence that action was being taken in relation to issues raised with them.

People were not supported to make decisions in line with the Mental Capacity Act 2005 (MCA) which meant that their legal and human rights were not protected.

People were not always treated with kindness and compassion and their dignity was not always respected.

Care was not always provided in line with people's preferences and routines within the home were not flexible to meet people's needs and preferences.

Staff were not supported and trained to deliver effective care to people. People had access to healthcare professionals though this was not always sought in a timely manner and professional advice was not always followed.

People had enough to eat and drink and were offered some choices but risks in relation to people's eating and drinking were not always minimised.

People's care plans were not regularly reviewed to ensure they were up to date and reflected changes in people's needs. Staff told us they did not have enough time to read people's care plans.

There was a complaints procedure in place but concerns raised were not always acted upon.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were being protected against the risk of abuse. The provider had taken action to make sure that care staff had the knowledge and understanding of safeguarding issues and that they knew how to act on any concerns.

The home had changed the way it recorded and checked that people were having their medication. Records were being kept to confirm that people had creams and ointments applied to their skin. Regular audits had been introduced to check that people had received their medication as prescribed.

People were being supported by staff that were supervised and supported. Care staff had started to receive supervision with the manager. This meant that their performance was discussed and any training needs were identified.

Systems were in place to monitor and check the quality of care people received. Record keeping had improved. Records of care were up to date and accurate.

Every person we spoke with was pleased with the care they received. One person said: "Absolutely happy. No complaints". Another person told us: "They've done marvellous things".

People were receiving the personal care they needed although the care was not always fully documented in the records. Some activities were available but some people told us there was not much to do. People were supported to have sufficient to eat and drink. People had a choice of meals and drinks.

Improvements were needed in the way the home managed people's medication. No accurate records were kept to confirm that people were receiving prescribed creams and ointments.

Staff were trained in identifying abuse. There was evidence that safeguarding incidents were not referred appropriately to the local authority for investigation.

Care staff had the training to provide people with the care they needed but they were not receiving regular supervision.

The home did not have adequate systems in place to review and monitor the service. Regular audits were not being completed. The home had a complaints procedure and when issues were raised these were responded to.

We looked at the care planning documentation for five people using the service to see how their care was provided and managed. We talked with staff who were aware of and able to discuss people's care needs. We saw that some important information regarding the care and support needs of people was missing. We saw some staff working practices that were inconsistent and did not correspond with recognised standards of care and support.

People who used the service told us they would speak with the staff or their family member if they had any concerns. Staff told us they were aware of the procedures to report any concerns they may have.

We found that sufficient staff were on duty to meet people's needs in a timely manner. We saw that staff treated people compassionately; offering discreet assistance to those who required it. Visitors were complimentary about the service, the staff and the care and support provided to their relatives.

We saw the service had a system for monitoring the quality of the service, some improvements would be beneficial to ensure omissions of information were identified in a more timely way.