The Manse

The Manse is a residential care home providing personal care to up to 21 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 21 people using the service.

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

People received their medicines as prescribed. However, some of the systems and processes used at the service, regarding the management of medicines, were not always effective in ensuring medicines were accurately recorded. The medicines audit was not effective. We were given assurances by the registered manager that this would be addressed.

The recruitment processes used at the service did not always ensure past employment dates were accurately recorded. We were given assurances by the registered manager that this would be addressed.

We toured the premises and found the service to be clean and decorated to a good standard. There were no malodours.

The provider had effective safeguarding systems in place and staff knew what actions to take to help ensure people were protected from harm or abuse.

The Manse was fully staffed. There were enough staff to meet people's needs and ensure their safety. Staff were happy and many had worked at The Manse for many years.

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.

Staff worked within the principles of the MCA and sought people's consent before providing personal care and assistance. Guidance in care plans guided staff to help build independence wherever possible.

Identified risks were assessed and monitored. Care plans contained guidance and direction for staff on how to meet people’s needs. However, where some people’s needs had changed this information was not always reflected in the care plans in a timely manner.

Food looked appetising and there were staff available to support people where needed.

The registered manager, deputy manager and the provider had oversight of the service. There was an audit programme to help identify any areas of the service that may require improvement. However, the medicines audit had not identified the concerns found at this inspection.

People, staff and relatives were asked for their views and experiences by the manager and the provider. Staff meetings were held to share information and seek their views. Relatives told us, “We are so pleased with The Manse. We are very happy”, “We have no complaints, and we visit regularly” and “The manager and staff are warm, they always let us know when things change. It is a lovely home like environment.”

The registered manager understood their responsibilities under the duty of candour. Relatives were kept informed of any changes in people’s needs or incidents that occurred.

The registered manager and staff worked closely with local health and social care professionals to meet people’s needs.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 10 December 2018.)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement

We have found a breach of regulations in relation to records at this inspection. Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service was clean and hygienic in all areas. There were satisfactory procedures to ensure that infection control risks were reduced. For example, in the communal areas the furniture was arranged to enable social distancing. Increased cleaning schedules ensured that all areas of the service were thoroughly cleaned regularly.

The service has good stocks of PPE and had a regular delivery to ensure there were consistent amounts available. Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19 and staff were provided regular updates to ensure they were following best practice recommendations. The training for staff regarding infection control had been updated to include guidance relating to COVID-19.

The registered manager, deputy manager and lead care staff routinely worked alongside care staff and ensured best infection control practices were followed. Regular discussions took place between staff and people to ensure they understood the reasons for safe distancing. People who had limited capacity were sensitively encouraged to safe distance by staff. The provider had a contingency plan to manage an outbreak of COVID-19 including segregating the home to keep people safe.

People and staff were being regularly tested in accordance with current guidelines. Appropriate admission procedures had been developed and everyone who moved into or returned to the service had received a negative test result on the day. If a positive test occurred people would be supported in their room in isolation. Signage and information posters were in evidence at the entrance to the home to inform visitors of the procedures to follow. There was additional signage in bathrooms to reinforce the need for regular hand washing.

The service was closed to visitors in line with government guidance. However, the service ensured people communicated with families and friends using phone calls and interactive technology where it could be used. The provider had installed a visiting room in the service garden with separate entrances for people and their visitors. A permanently installed clear wall minimised risks of infection. However, this facility was currently closed due to the peak of the pandemic. But this was being kept under review by the registered manager and it was hoped to be open in the near future.

The service is on two floors with access to the upper floors via stairs or chair lifts. All rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a conservatory, a dining room with seating areas, garden and patio seating at the side of the service.

There was a registered manager in post who was responsible for the day-to-day running 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.

The atmosphere in the service on the day of the inspection was relaxed, friendly and calm. Staff responded promptly when people asked for assistance and support was provided at a relaxed pace. Throughout our inspection we observed staff providing support with respect and kindness.

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were. Care plans had been updated so staff knew how to manage those risks.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, psychiatrists, GP’s and speech and language therapists (SALT).

People who used the service and their representatives were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people's choices and privacy and responded to requests for assistance. People and their representatives told us they felt safe when receiving care. People were involved in developing and reviewing their care plans.

Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on accidents and incidents, acted when required and reflected on incidents to mitigate risks.

Staff were sufficiently skilled to meet people’s needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

There was a system in place for receiving and investigating complaints.

People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

Auditing procedures took account of all areas of operation within the service to ensure systems were effective.

The Manse is a family run residential home that can accommodate up to 23 older people. On the day of our inspection 21 people were living at the service. The Manse is required to have a registered manager and there was one in post. 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.

Care plans contained risk assessments which identified when people were at risk, for example from falls. Guidance for staff contained detailed information on the action staff could take to minimise the risk.

Medicine Administration Records (MAR) were clear and accurate. This showed how much medicine people were receiving and whether the amount of medicine in stock tallied with the amounts recorded.

The registered manager had oversight of the service and people, relatives and staff told us they were available and approachable. Management was supported by a head of care and an effective staff team. In addition the staff team included kitchen staff, cleaning staff and a maintenance worker. There were clear lines of accountability and responsibility. There were sufficient numbers of staff to meet people's needs.

People and relatives told us they considered The Manse to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service in terms of its 'family' feel. Terms such as 'homely' and 'friendly' were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

Pre-employment checks such as disclosure and barring service (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people's needs.

Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made to the local authority appropriately. Training for the MCA and DoLS was included in the induction process and in the list of training requiring updating regularly. The registered manager and staff demonstrated an understanding of the principles underpinning the legislation. For example, staff ensured people consented before giving personal care. Mental capacity assessments had been completed as required.

The premises were clean and odour free. People were able to use two shared lounges or stay in their rooms as they chose. Improvements to parts of the building were planned. There was a garden available for people to use when the weather was suitable. Staff told us this was well used.

There were two part-time activity co-ordinators employed and people were supported and encouraged to take part in a range of activities organised in the service. There were also trips and activities planned outside the service. Visitors were made to feel welcome at the service and staff recognised the value of these relationships to people.

Is the service effective?

At the time of our inspection we found the service to be effective.

During our last inspection on 27 June 2014, we identified a number of instances where the provider had not followed their policy and procedure in relation to ensuring people who lived at The Manse, were adequately consulted and recorded as having given their consent to the care planning process undertaken by The Manse. The registered manager told us it had not always been possible for people to physically sign their care plan documents or to meet with relatives to gather their input and/or signature.

During the previous inspection, concerns were raised about the appropriate policy and procedure for recording people's' preferences as regards individuals' decisions about future resuscitation, should this be required.

During this follow-up inspection we were assured by the registered manager that steps had been put in place to improve the system in this area. The Manse had implemented new procedures and updated their policies regarding consent. On the day of inspection The Manse were operating effectively in this area.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, at the time of this inspection we judged the service was safe.

People we spoke with were positive about the staff who worked at The Manse. People told us staff were professional and supportive. For example, one person said ' staff are very nice, they are very good.' A relative of a person who lived at the Manse told us, 'All of the staff have been excellent with X. They are patient and kind'

We spoke with professionals who visited the home on the day of inspection. People told us, 'This is one of the better services of this type that I visit. There is a good culture. It always seems friendly and a happy place'.

The service had a well organised medication system. The system was well managed and regularly audited. Records were accurate and up to date.

Is the service effective?

At the time of this inspection we judged the service was not fully effective.

People all had individual care planning records, which set out their care and support needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their relatives' needs and responded promptly when they needed assistance. People told us and we saw in people's' records, that they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians.

However, we found the issue of ensuring appropriate consent was not following the home's own policy guidance concerning the Mental Capacity Act (2005) or local guidance.

Is the service caring?

Yes, at the time of this inspection, we judged the service was caring.

Relatives of people who used the service, and external professionals such as GPs and district nurses said they were happy with how the service supported people and found the staff to be professional and helpful. A relative told us 'it is very good. I have no concerns.'

From our conversations with people who had experience of the service and a review of the records we assessed, we judged that individual wishes and needs were taken into account and respected.

Is the service responsive?

Yes, at the time of this inspection, we judged the service was responsive.

Everyone we spoke with said the staff treated people with respect and dignity. People told us and we saw from records that people were able to be involved in activities including exercise classes, visits from a hairdressing service and sessions at the home with a local musician. From our conversations with relatives, and management, staff and other professionals we formed the view that the service were diligent about ensuring they could meet the changing social and support needs of each person supported.

Is the service well-led?

Yes, at the time of this inspection, we judged the service was well led.

Staff, relatives and external professionals were all positive about the management of the service. People told us management would listen to staff and also to any concerns raised by people who lived at The Manse and/or their relatives and were supportive.

The Manse had a system to check people were happy with the service. This included systems of survey and audit. There was also a system to monitor accidents and incidents. People's personal care records, and other records kept in the home, were accurate and complete.

This service was inspected in April 2013, and this inspection was in response to improvements identified as need at that time. People who used the service were protected from the risk of abuse, because staff were aware of the safeguarding process and had received training in this.

We saw privacy and dignity were respected during our visit, and we saw staff offering discreet help to people. Staff talked to people while offering them assistance. We saw people's wishes were respected. We observed people moving around the home without restriction, and where there were restrictions this had been properly documented and referred to other relevant agencies, for advice.

We found people's privacy, dignity and independence were respected and people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were not always protected from the risk of abuse, because staff were not confident in their knowledge of the safeguarding process.

People were protected from the risk of infection because appropriate guidance had been followed.

We found staff had started to receive appropriate professional development and accurate and appropriate records were maintained.

We saw privacy and dignity were mostly respected during our visit, although two people said 'not all the staff knocked before entering'. Staff talked to people and offered them assistance. We saw that people's wishes were respected. We observed people moving around the home without restriction.

We found people's privacy, dignity and independence were respected and people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were not always protected from the risk of abuse, and people were not always protected from the risk of infection because appropriate guidance had not been followed.

We found staff had not received appropriate professional development and accurate and appropriate records were not maintained.