Mansion House Residential Home

We found the following examples of good practice.

People's wellbeing was being supported by contact with family and friends. A visitors pod had been put in place and had been well used. The benefits of these visits helped people’s mental health.

Staff employed at the service had received training on infection prevention and the correct use of personal protective equipment (PPE).

Staff were well supported by the management team and had access to support services.

There were clear arrangements at the entrance to the building and at other key areas to minimise the risk of infection.

PPE was available and accessible. The service was well maintained and visibly clean. Schedules were in place to show that regular cleaning was undertaken. Audits and observations of practice were completed to show the service was following good practice guidance.

The provider was following the government guidance on whole home testing for people and staff.

We rated the service as ‘Requires improvement’ for the key questions of Safe and Well led and ‘Good’ in Effective, Caring and Responsive. We asked the provider to complete an action plan as to how they would improve the service. The provider wrote to us showing the actions they had taken since our last inspection.

We carried out this unannounced inspection on 10 April 2018 to see if the provider had made the necessary improvements to the service. We saw that improvements had been made to ensure people had their medicines in a safe and timely way and robust monitoring audits about the quality of the service and the recruitment of staff had been improved. All of the key questions were rated as ‘Good’ and the service received a rating of 'Good' overall.

Mansion House Residential Home 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 accommodates up to 37 older people. Care is provided over two floors. At the time of our inspection there were 27 people living at the service. Mansion House Residential Home also provides a personal care service within the community called Mansion Care which provided care to five people with three staff supporting them.

A registered manager was in post at 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.

There were systems in place to safeguard people from avoidable harm and staff knew how to report any concerns. The risk assessments undertaken provided staff with the necessary information and guidance on how risks to people could be minimised. The service regularly reviewed their staffing arrangements to ensure there were sufficient staff available to support people safely.

Recruitment procedures had been improved for the safe employment of staff. Improvements had also been made to the way in which medicines were managed and administered. Infection control procedures were followed in order to keep people safe and well. Systems were in place to learn from incidents and accidents and to improve the service as a result.

An organised programme of induction, training, supervision and appraisals for staff were in place. Staff had the knowledge and skills to care for people effectively. They understood their roles and responsibilities to seek people’s consent prior to care being provided.

People were supported to have a choice of food and drink and to have a balanced and varied diet. The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals to implement care and support plans.

The service had been adapted from a manor house into a care home. The design and decoration of the premises met people’s needs.

Systems were in place to ensure that people’s rights were respected and protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people did not have capacity to consent to their care or make decisions about their lives, this was managed in line with the requirements of the MCA.

Staff were respectful and compassionate towards people ensuring their privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles and responsibilities. People's independence and choice were encouraged and promoted by staff.

People received personalised care that was responsive to their needs. Care plans were individual and detailed people’s history, preferences and wishes. An effective complaints procedure was in place and had been implemented appropriately by the registered manager. People and their families were well supported by caring staff at the end of their life.

There was a positive, open and inclusive culture at the service. The service was well led and managed. Resources were available to support and develop the service and people, their families and staff were actively involved. Systems were in place to monitor all aspects of the quality of the service. There were opportunities to learn and develop new and innovative ideas in partnership with other agencies.

Mansion House Residential Home provides accommodation with care for up to 37 older people. Care is provided over two floors. At the time of our inspection there were 30 people living at the service. Mansion House Residential Home also provides a personal care service within the community called Mansion Care.

A registered manager was in post at 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.

Medicines were not given to people in a safe and appropriate way. Staff did not carry out effective medicine administration and were not clear about the service’s policy and procedures. People had not been given their medicines as prescribed.

The service did not have in place a process for the safe recruitment of staff. Staff were being recruited without the necessary employment checks in place to ensure they were able to work with people in a social care setting.

The quality assurance audits were not sufficiently robust to ensure that people received a service which met their needs and protected their safety.

There were sufficient numbers of staff to care for people at Mansion House and in Mansion Care. The staff team had a range of skills, experience and knowledge to provide care and support to people.

People’s health and emotional needs were assessed, monitored and met in order for them to live well. The service worked closely with relevant health care professionals. People received the support they needed to have a healthy diet that met their individual needs.

People were treated with kindness, respect and dignity by staff who knew them well. People were able to raise concerns and give their views and opinions and these were listened to and acted upon.

Care plans and risk assessments provided information about people’s needs and wishes so that staff could meet their needs.

The management team worked well together and were visible in the service. People were well cared for by staff who were supported. The views of people were taken into account to make improvements and develop the service.

The purpose of this follow up inspection was to check if improvements had been made to people's care and welfare and medication. We had also received some information of concern which we followed up as part of the inspection.

During our inspection we were accompanied by a specialist advisor with nursing and wound management experience. We spoke with five people who used the service. We also spoke with two managers and seven staff.

Mansion House Residential Home provided accommodation with personal care for up to 34 people. At the time of our visit, 25 people were resident and two people were in hospital. The service also provided domiciliary care to people in their own homes.

Some people who used the service were not able to tell us verbally about their views and experiences so we used observation and interaction to gain an understanding of their care and support.

We looked at the care records for six people who used the service as well as the administration of medication to see if the necessary improvements had been made.

We considered our inspection findings to answer questions we always ask; 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 service had ensured that staff were provided with the knowledge and skills to keep people safe and protect them from harm in relation to their care and welfare and in receiving their medication.

The monitoring of people's care through the reviews of care plans, risk assessments and daily records confirmed that people were provided with care and support that ensured their welfare and safety.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. People were fully involved, where possible, in choices and decisions about their lives. This made their care more effective as it enhanced their wellbeing and independence.

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully; they were considerate, courteous and kind. Staff had a good knowledge of people's likes and dislikes. This showed that people were cared for by staff who were respectful and caring.

Is the service responsive?

We saw from the records viewed that the service liaised and worked well with other agencies. A range of health, mental health and social care professionals from the community were involved in people's care. This showed that people received their care in a joined up way.

Is the service well-led?

Regular care reviews and recording of information about people's health and wellbeing were in place. The management of the service was well organised and efficient.

One person said: "I feel unbelievably fortunate to have a garden room. The carers are very good, even the young girls. I'm surprised by them, they're good at what they're doing".

Care plans and risk assessments in the home were not detailed, although staff were knowledgeable about the people we spoke about.

Medication in the home was not recorded or audited sufficiently to ensure people were safe.

Equipment was available in the home and in people's homes that was suitable and properly maintained.

People were unsure about the complaints system in the home but said they did not have need of it and would just talk to staff or the management team. People we spoke with in their own homes said they had the information they needed in the file but had no complaints about the service.

One person we spoke with who used the domiciliary care agency said: "I'm very pleased (with the service). The staff are very helpful and efficient".

People were involved and able to make choices about their care arrangements. A range of activities were offered and people could get involved as much as they wanted. People liked the food and the choices available. One person said: "We get different meals every day, they are very nice and I always enjoy my food.'

Mansion House had all the necessary policy and procedures, quality assurance and monitoring systems in place for the safeguarding and protection of people who lived at the home. Staff carried out their responsibilities in a professional and caring way.

One person told us: 'I have a good life here, all what I need.'