Manor View Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found concerns around staffing, infection prevention and control and learning from incidents. The systems in place to learn from accidents and incidents required improvement. We found 1 breach of regulation in relation to staffing. The registered manager and provider could not demonstrate that appropriate numbers of staff were available to meet people’s need. Staff were not always deployed effectively.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt care and support was carried out safely however; most people we spoke with told us they were not involved in their daily care and only 2 relatives said they were involved in care planning arrangements.

Staff and leaders were aware of the high number of falls which had previously occurred at the home and were looking at ways to reduce future falls. However, staff felt obliged to assist people back to their chair when they stood up to walk around, this limited peoples ability to move freely within the home.

There was a system in place to record and monitor falls and other accidents and incidents within the home. However, the analysis of these tools was not always effective. For example, the accident and incident log recorded accidents and what had occurred, and injuries sustained. However, there was a lack of evidence to show what actions had been taken to mitigate future risks. The providers fall audit identified the number and location of the falls, but the analysis and action taken to minimise future falls was missing. Following our inspection the registered manager updated these tools to improve their efficacy, however, they required embedding into practice. The registered manager understood their duty of candour and demonstrated that letters had been sent to relatives following incidents.

People had access to healthcare services and staff followed their advice to ensure care was delivered in line with people's needs.

The registered manager explained that a check sheet was completed to assist with new admissions to the home. Staff also confirmed information was easily accessible via the electronic care planning system and used to assist with hospital admissions.

At the time of our assessment the home was working closely with the local authority to address concerns which had been identified as a result of commissioner’s visits. The local authority felt the home was improving but still had lots of outstanding issues to address such as staff raising concerns with the management team, activities being uninteresting and care plans needed to reflect care delivery.

The registered manager had introduced a new admissions check list to support staff when people moved in to the home. The registered manager also completed an audit listing people who had been admitted to hospital and returned home. There was also an admission document checklist detailing the documents to accompany the person to hospital such as medication administration sheets, body map, weight, baseline observations, sling make, model and loop configuration, and a care needs summary. This gave other professionals an awareness of the persons care needs.

Most people and their relatives felt they received safe care. For example, people told us they received their medicines safely, but nobody knew what medication had been prescribed or why they were taking it. One person said, "My medicines get given [to me], but I have no idea what they are.” People told us they had access to necessary equipment, such as hoists and slings to help people to transfer safely. One relative said, "The whole set up here is about good care and safety. If [relative] wasn’t safe I would move her." One person said, "Yes, it is safe, and we are looked after but it is boring here." People told us they would speak with care staff if they had any safety concerns. Although people responded positively and did raise any concerns in respect of safeguarding, we were not assured people's experience reflected our observations.

Staff were aware of safeguarding process and said they had received training. The registered manager confirmed staff had received regular training in safeguarding and were supported to raise concerns.

When people stood up to walk staff were quick to guide them to sit back down again. There had been several falls and although staff were ensuring people were not falling, they were restricting their freedoms. People did not have easy access to the garden area as it was not safe to access without a staff member. We observed staff interacting with people in a caring way and when using equipment, they did so in a safe way and in line with people’s care plans. Sensor mats were in place where required, to alert staff of people standing.

The provider had a safeguarding policy and procedure. The registered manager kept a record of safeguarding concerns and their outcome. The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

Most people told us they were not involved in their daily care and only 2 relatives said they were involved in care planning arrangements. People told us they had access to necessary equipment, such as hoists and slings to help people to transfer safely. One relative said, "The whole set up here is about good care and safety. If [relative] wasn’t safe I would move her." One person said, "Yes, it is safe, and we are looked after but it is boring here." People told us they would speak with care staff if they had any safety concerns.

Staff were aware of risks associated with people’s care and were able to explain how they managed risks safely. However, some staff required to cover in Church View, had no knowledge of people who lived there as they were used to working in Manor View. The catering team had information regarding people's diets and food preferences and were aware of any special diets.

When people stood up to walk staff were quick to guide them to sit back down again. There had been several falls and although staff were ensuring people were not falling, they were restricting their freedoms. People did not have easy access to the garden area as it was not safe to access without a staff member. We observed staff interacting with people in a caring way and when using equipment, they did so in a safe way and in line with people’s care plans. Sensor mats were in place where required, to alert staff of people standing.

Risks associated with people’s care were identified and managed to keep people safe. For example, where people were at risk of falls, sensor cushions and senor mats were in place to alert staff that people were moving. Risk assessments gave clear instructions where people required the use of a hoist and sling to assist them to transfer. Loop configurations and size and type pf sling to be used were documented along with the serial number.

People did not have easy access to outside space and garden areas due to risks this would pose. The home was tired and worn and required attention. Some equipment was in need of repair, for example, a hot trolley used to transport food, had a wheel falling off making the process difficult.

Staff explained they had been told not to use the dishwasher in Church View as it was expensive to run. Consequently, all the dishes were being washed in a full sink of soap suds. We were also informed that the “hot trolley” that comes from the main kitchen in Manor View has wheels that fall off making the transition of food difficult. The registered manager told us the outside environment was not safe and a refurbishment plan was in place to address issues.

Some areas of the home required attention, for example, we found someone’s wardrobe was not securely attached to the wall, radiators very hot creating an uncomfortable environment due to the weather also being hot, general décor was worn, tiles missing in bathroom and people have very limited access to outside space. The door to the maintenance store was not secured properly giving access to equipment that could cause harm or injury.

The home had a refurbishment plan in place but there were no timescales for completion and no priority order. The maintenance team ensured appropriate checks were carried out such as electrical testing. Equipment such as slings and hoists were serviced in line with requirements.

People and their relatives gave mixed views regarding staffing. Some people didn’t raise any concerns, whilst others did. One person said, “If I wanted to say just one thing it is that the home is understaffed and the carers work so, so hard. It is not their fault that sometimes there are not 2 carers to support people. The weekend is the worst.” Another person said, “I know [relative] is safe, all the staff keep a good watch over [relative].”

A dependency tool was used in Manor View, but there was a poor understanding of dependency and identification of needs. The registered manager told us there had been a high number of falls between January 2024 and March 2024 and felt there were not enough staff. The registered manager told us there was no dependency tool used to calculate the number of staff required in Church View. Staff told us they were unable to assist people in the garden as a member of staff was required as a safety measure.

Staff were not always deployed effectively and there were occasions where people could not access the garden due to no staff member being available. People in the main lounge in Manor View were sat most of the day. No activities took place and there was only the radio to occupy people. We observed lunch being served in Church View and found people were eating lunch from over bed tables which had been purchased by the provider to use instead of low coffee tables. Meals were covered when taken to bedrooms. Staff sat with people and interacted with them in the lounge area. Staff told us people were given options prior to meals being served. However, there was no menu displayed and no show plates were used to support people living with dementia to make choices.

The system in place to calculate the numbers of staff required, was not effective as it was based on numbers of people and not people’s assessed needs. The registered manager also explained that the tool was not used to plan the number of staff required as it was completed at the end of the week. The registered manager did not have any method in place to effectively calculate the numbers of staff required in Church View. Staff were not deployed effectively and could not provider person centred care. For example, when people stood up to walk, they were assisted to sit down as they staff didn’t have the time to assist them to walk. There was a safe recruitment procedure in place which assisted the management team to recruit appropriate staff. Pre-employment checks were evidenced in recruitment files.

People and relatives, we spoke with felt the home was clean and did not raise any concerns about infection prevention and control. People and relatives felt the home required decorating. However, we found some armchairs which were stained, and some areas of the home had a malodour.

The registered manager told us the local authority had found infection control concerns and had offered guidance and support to improve these standards. At their last visit they found some improvements in regard to infection prevention and control and were happy with the progress.

We carried out a tour of the home and found areas which were not cleaned effectively. For example, one store had a hoist sling which had a malodor, some armchairs were stained and required cleaning.

The registered manager had an audit in place to assess the quality of infection prevention and control in the home. We carried out a tour of the home and found the audit had not always been effective. For example, on the audit action plan dated April 2024 an odour was identified in wheelchair store. During our assessment we also found an odour in the same area. The odour was from a hoist sling which had not been laundered. This showed the audit had not been effective in identifying and continually improving the service.

Most people and their relatives felt they received safe care. For example, people told us they received their medicines safely, but nobody knew what medication had been prescribed or why they were taking it. One person said, "My medicines get given [to me], but I have no idea what they are.”

Staff told us they received training prior to administering medicines. Staff also confirmed they had their competencies assessed regularly to ensure they understood how to safely administer medicines.

We observed senior staff and nurses administering medicines and found they did so safely. However, medicine trollies were not always taken back to the storerooms following medicine administration. One medicines store was very tiny, and staff found difficulty in fitting the medicine trolly in there. This room also had a lock which was not operating effectively, which increased the risk of medicines not being accessible.