Background to this inspection
Updated
21 February 2020
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.
Inspection team
This inspection was completed by two inspectors and a specialist advisor registered nurse over two days. The nurse’s specialism was dementia care and medication management.
Service and service type
The Manor Care 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 had a manager registered with the Care Quality Commission. This means that they and the provider are 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 inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection-
We spoke with eight people who used the service and four relatives about their experience of the care provided. We spoke with 12 members of staff including the registered manager, clinical care manager, the chef, trainer, care staff and registered nurses. We used the Short Observational Framework for Inspection (SOFI) during the lunchtime service. The SOFI is a way of observing care to help us understand the experience of people who could not talk with us. In addition, we made observations throughout the day.
We reviewed a range of records. This included nine people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. 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 two professionals who regularly visit the service.
Updated
21 February 2020
About the service
The Manor Care Home is a residential care home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 65 people.
The service operates over three floors that provide a secure setting for people who are living with dementia and associated needs. Each floor is keypad secured, preventing people from walking independently within the service. Staff support people should they wish to move between the floors. Each bedroom has an en-suite, that the person is able to use, in addition to communal bathrooms. Dining facilities and lounges are available on each floor. People can access the large communal gardens through the ground floor. An elevator enables access to all floors for people who have mobility issues. The ‘Sun lounge’ offers sensory stimulation to people and is accessible on the first floor.
People’s experience of using this service and what we found
The care and treatment of people was not always appropriate and did not always meet their specific needs. Care plans did not evidence that people were being involved to the maximum extent possible in their care or that their preferences were always being taken into consideration. We found that next of kin were making decisions for people without having the legal authority to do so, and without evidence of best interest meetings take place.
People were at risk of potential harm because the registered person had failed to ensure the proper and safe management of medicines.
People were at risk of potential harm because risks were not appropriately mitigated, or actions identified where a risk was prevalent. The service had removed call bells from peoples’ rooms without giving consideration on how they would seek support should the need arise.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Systems to ensure compliance with legal obligations and the regulations were not effective. Audits although completed, did not assess, monitor and improve the quality and safety of the service provided. The lack of robust quality audits meant people were at risk of receiving poor quality care and, should a decline in standards occur, the systems would potentially not pick up issues effectively. The registered manager did not have a thorough overview of the service.
People had their healthcare needs identified and were able to access healthcare professionals such as the GP, optician when needed. The service worked well with other professionals to provide effective health care to people.
Activities were offered to people and their families to improve wellbeing. Staff engaged well with people focusing on prompting communication and reducing social isolation. Sufficient staff were deployed to support people.
Staff were compassionate and kind when speaking with and supporting people. We observed good examples of care being delivered to people, with staff taking their time when engaging and completing tasks.
People’s nutritional and hydration needs were well met. Staff ensured people were well supported to eat and drink. Meals were nutritious and met people’s specific health needs.
The environment was clean and appropriate for the service type. Signage could help improve people’s experience when living with dementia. For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 07 June 2017).
Why we inspected
The inspection was prompted in part due to concerns received about unsafe medicine management, poor practice and support for people and insufficient staffing. A decision was made for us to inspect and examine these risks in depth, as part of the scheduled inspection.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report to identify areas where improvement is required. You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Manor Care Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to regulation 9 (person centred care), 11 (need for consent), 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Care provided was not always person-centred; people did not always receive safe care and treatment and were not always protected from the risks of harm; staff and management did not have a comprehensive understanding of capacity and the MCA and effective systems were not in place to ensure the service met the required fundamental standards of care.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.