Manton House

Updated 1 September 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Manton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had an acting manager who is not yet registered with the Care Quality Commission. This means that the provider is solely legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and used this as part of our planning. We also contacted the local authority for their feedback. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We carried out observations throughout the day of our visit, spoke with the manager, the area manager and three staff, which included a senior, deputy manager, and cook. We also briefly spoke with care staff about their interactions with people. We spoke with six people using the service.

We reviewed a range of records. This included three people’s care records and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one health care professional, four further staff and four relatives. We also spoke with the provider.

Updated 1 September 2021

About the service

Manton House is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people. The building has been extended and adapted over time and provides both single and double accommodation on both ground floor and first floor levels with a passenger lift.

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

Our inspection was brought forward due to changes in the providers registration and a number of concerns received about the service and the care people were receiving. During our inspection we were met by the manager who had been in post for approximately four months. They had been employed without delay following the departure of the previous manager. They had started to implement a lot of changes within the service to improve the quality of care people receive and had faced some challenge by specific members of staff who were resistant to change. At the time of our inspection these changes and processes were not firmly embedded within the service and we were not assured of the confidence and competence of the senior team some new to their role.

Although the manager demonstrated a person centred approach to care we found the service was not consistently proving individualised care to people. In our decision making processes when deciding a rating for this service we took into account the history of the service and the role of the provider in ensuring people received continuity of care which met good standards. Safeguarding incidents and incidents were recorded in different places and did not include clear outcomes, or lessons learnt to ensure improvements in care.

During our inspection we were not provided with all the information requested and therefore relied on information provided. An action plan had been implemented and provided but this did not give timescales for each action, or how each action would be clearly achieved and embedded within the service.

New staff had been employed, some at senior level, with no previous experience in care. Although all staff were supported through induction and shadowing existing members of staff, not all staff had the necessary skills in line with their job role. Some staff spoken with had weak knowledge and did not know where to find the relevant support and guidance. Staff training in using electronic recording systems for people’s notes was not fully embedded on the day of inspection.

People’s health care and behavioural needs were not fully understood by staff. This was in part due to the inexperience of some staff and the uptake of training in relation to people’s specific health care needs and impact. Concerns had been raised by other agencies in terms of people's care and this was being addressed.

People’s health care needs were recorded but not always clearly escalated when there was a change or unmet need. For example, staff were unclear how much an average person should be drinking or what signs to consider should a person become dehydrated and the impact this might have on other aspects of the person’s health. We have made a recommendation about this.

Medicines were administered by trained staff who had been assessed as competent. We have made a recommendation about using a tool to assess people’s pain threshold where people might not be able to verbalise this.

We observed some positive engagement from staff which was appropriate and meaningful but not inclusive of everyone. Some people were observed as having regular engagement with staff whilst the activity levels for other was minimal. People’s lunchtime experience could have been significantly enhanced if staff had sat with people and supported and encouraged them to eat and drink.

Two relatives spoken with did not feel the service was inclusive or had kept them in touch with changes in the service. However, the provider had kept families informed of the situation regarding visits during COVID -19. The provider’s quality assurance systems which involved seeking independent annual feedback from people and their families had not happened for two years which meant relatives and health care professionals had not had an opportunity to have their say or influence what the service improvements and priorities should be. The next survey was to be issued in August 2021 and had not taken place before because of the impact of COVID-19.

Environmentally lots of positive changes had been made and any issues identified at the time of inspection were rectified immediately.

We were not fully assured that 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 did not fully support this practice.

Rating at last inspection

Since the last inspection there has been a change to the provider’s registration from a partnership to a limited company. This is the first inspection under their new registration.

The last rating for the service under the previous provider was requires improvement (published on 16/04/2019).

Why we inspected

The inspection was prompted in part due to concerns received about a wide range of issues affecting the health and safety of people using the service. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manton House 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 have identified a breach in regard to the management and overall governance and safety of this service. These concerns relate to the management and oversight of this service.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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 request an action plan. We will work with the 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.