Manordene

We found the following examples of good practice.

¿ There were procedures in place to support safe visiting, including appointments, temperature checks on arrival, provision of masks and aprons and use of a designated room. Due to the outbreak of COVID-19 the service was closed to visitors in accordance with Government guidelines.

¿ The layout of the service and large communal areas were suitable to support social distancing. The premises looked clean and hygienic and there were enhanced cleaning schedules in place and adequate ventilation. A laundry rota ensured that clothing wasn’t mixed and there was an off-site arrangement for the laundering of bedding and towels.

¿ Staff had been trained in infection control practices and posters were displayed throughout the home to reinforce procedures. Staff were using personal protective equipment appropriately and disposal was safe.

¿ The manager had joined a forum set up by the local Clinical Commissioning Group (CCG) which provided support and advice through regular virtual meetings. There was an opportunity to seek professional guidance and exchange views and the forum encouraged communication with other managers and health care professionals.

Further information is in the detailed findings below.

We found the following examples of good practice

• Staff used an NHS tablet to enable safe communication between NHS professionals and people using the service.

• Staff used a tablet to support people to communicate with family and friends through video calls.

• Family members and regular visitors had been informed of updated visiting procedures and could book times to see their relatives.

• The provider had arranged for a specialist laundry company to clean people’s bedding. The registered manager told us this would reduce the risk of cross contamination in the laundry and provided staff with more time to perform the enhanced cleaning regime.

Manordene is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 22 people in one purpose-built building.

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

People received nursing care in a safe, caring and homely environment by caring and competent staff. People told us they were happy living there, and with the food and the activities provided. People had all their healthcare needs met and their independence was promoted. All feedback was positive from people, relatives and staff for all parts of the service.

There were enough safely recruited and suitable staff to meet people’s needs. People felt safe and all risks to people were managed. People were protected from abuse and avoidable harm. Medicines were managed safely and in line with good practice. Lessons were learnt from accidents and incidents and used to make improvements.

People were treated with dignity and respect. Care was person centred, met people’s needs and achieved good outcomes. People were cared for at the end of their life in line with their wishes. People and relatives knew how to make a complaint if they needed to and were confident they would be listened to. People and their loved ones were involved in their care.

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.

The quality and safety of the service was ensured by the provider. The manager had made improvements to the service since being in post and had been supported by the provider to do so. Care workers told us it was a good place to work and they were well supported. There was a positive, high quality and caring culture of continuous learning.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 14 December 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Manordene 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 is registered to accommodate up to 22 people. At this inspection, 21 people were living at the service.

There was a registered manager in post who was present during the inspection. 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.

At our last inspection in August 2017, the service was rated requires improvement. Six breaches of the Health and Social Care Act 2008 (Regulated Activities) were identified. We issued requirement notices relating to person centred care, good governance and staffing. We asked the provider to take action and they completed an action plan to show what they would do and by when. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

At this inspection, while some improvement had been made, two of the original breaches had not been met and two additional breaches were found. These related to person centred care, good governance, staffing and consent. We have made recommendations about the environment, accessible information and end of life care. You can see the action we have told the provider to take at the back of the full version of the report.

The overall rating for the service remains at requires improvement. This is the second time the service has been rated as requires improvement.

Assessments had been carried out to identify people's health and welfare needs but they had not been continuously reviewed and there was a lack of detailed guidance for staff to mitigate risks. Checks had been completed on the environment and equipment used by staff to keep people safe. People had personal emergency evacuation plans (PEEPS) but these did not contain detailed information about how to support them in an emergency.

The principles of the Mental Capacity Act 2005 were not always followed as Deprivation of Liberty Safeguards (DoLS) applications had not been made for people who required them.

Equipment to reduce the risk of people developing pressure wounds had not been checked to confirm the correct settings for each person.

The building had been adapted to meet people's physical needs and but there was no signage in place appropriate to help people living with dementia to understand. For example where their room was or where the toilets were.

People could not access the garden without staff as this was not safe. All doors to the outside space were locked. Action was being taken by the provider to make the outside space safe for people to access.

The activities co-ordinator worked four days a week for five hours each day which resulted in limited time for people to be supported to follow their interests and take part in social activities of their choice. We observed that in the afternoon there were not always enough staff on duty to support people’s needs. Some people told us there were not always enough staff on duty

People were safeguarded from the risk of abuse because staff had received training and knew how to recognise and report abuse. Staff told us that they were confident that any concerns they raised would be taken seriously by the registered manager.

People living in the service were not always supported in a manner that upheld their dignity. During our inspection we observed people without covers on in their bedrooms with the doors open.

Staff were receiving training, supervision and appraisals. However, the registered manager had not received formal supervision from the provider, or an appraisal to identify their training and development needs to enable them to continuously develop their skills and competencies.

People were offered a choice of meals and snacks, however, there was no picture menus for people who needed them. When people needed a special diet and assistance to eat their meals this was provided.

Peoples end of life wishes were not always recorded to ensure that their expressed needs were met during this time. Staff had received training to support people at the end of their life and keep them comfortable. Nurses in the service had received training around end of life medicines and competencies had been checked.

At the previous inspection medicines had not always been managed safely. At this inspection we found that medicines were now managed safely and there had been no errors in administration. People received their medicines when they needed them and their medicines were stored and administered safely. Staff and nurse competency had been checked.

People told us they knew how to complain. All complaints had been investigated in line with the providers policy and resolved.

There was an open and transparent culture within the service. The provider held resident and staff meetings, however, these were not always well attended.

The registered manager and provider wanted the service to be homely and for people to feel that it was their home from home. Staff shared this vision and felt it was important that people should be surrounded by things that made them feel at home. We saw peoples’ bedrooms had been personalised.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC checks that appropriate action had been taken. The registered provider had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

The service had a registered manager 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.

On the first day of our inspection staff appeared rushed. On the second day of our inspection when an extra staff member was shadowing a shift staff appeared to have more time to support people. Some call bells were not answered in a timely fashion and the provider did not have a dependency tool to determine staffing levels.

Care records were not consistently maintained. We found some records relating to fluid intake and output had not been completed meaning peoples could be at risk of dehydration.

Quality audits had not consistently identified shortfalls in service delivery highlighted in our inspection. Other audits had been completed and had led to improvements being made.

Care plans did not always contain accurate information about people to enable staff to care for the person. One person had a skin condition that required treatment that was being provided but had not been addressed in their care plan.

People were not always kept safe at Manordene. Medicines were not being stored at the recommended temperature and fluid thickener that poses a choking risk to people was left out unattended. We have made a recommendation about this in our report.

Activities did not always take in to account people’s interests past and hobbies and were not always meaningful. We have made a recommendation about this in our report.

People were kept safe from abuse at Manordene. Staff told us they understood the importance of people's safety and knew how to report any concerns. Risks to people's health, safety and wellbeing had been assessed and plans were in place, which instructed staff how to minimise any identified risks to keep people safe from harm or injury.

People received their medicines when they needed them. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

The registered provider had effective and safe recruitment procedures in place and staff told us that they had the training they needed to carry out their roles.

Staff treated people dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. People’s privacy was respected by staff who valued people’s unique characters.

Staff were kind and caring good interactions were seen throughout our inspection, such as staff sitting and talking with people as equals and treating them with dignity and respect. People could have visits from family and friends whenever they wanted.

Complaints were used as a means of improving the service. People felt confident that they could make a complaint and that any concerns would be taken seriously.

There was an open, transparent culture and good communication within the staff team. The management team offered effective leadership to the service.

The registered manager took an active role within the service and led by example. There were clear lines of accountability and staff were clear about their roles and responsibilities.

The registered manager had notified us of events that had occurred within the service so that we could have awareness and oversight of these to ensure that appropriate actions had been taken.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service safe?

People told us that they felt safe at the service. There was an organisational safeguarding vulnerable adult's procedure in place. Staff we spoke with demonstrated that they understood when to raise a concern about a person's safety and who to report it to.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff received Mental Capacity Act and DoLs training to help them understand how to support people who did not have capacity to make decisions.

There were systems in place to make sure that any accidents or incidents were recorded and tracked in order to identify any trends. We saw that effective measures were put into place when necessary as a result.

Staff told us that they were concerned that there were not always sufficient staff on duty to make sure people were kept safe.

There were no personal emergency evacuation plans in place for people to give staff guidance about the support that each person needed in the event of fire at the service.

Is the service effective?

People's needs had been assessed before they moved into the service. People and relatives were involved in the process. Information about people was updated if their needs had changed. However, we found concerns in respect of some aspects of record keeping, which included care plans. People told us that staff understood their individual needs and supported them in the ways that they preferred.

The service liaised with health and social care professionals to make sure that people received the support and health care they needed.

Is the service caring?

Staff were patient and attentive towards the people who used the service and we observed good interactions between people and staff. We saw that staff encouraged people's independence. People told us that staff were 'Very caring', 'Lovely girls' and staff were 'Pretty quick' at answering call bells'.

Is the service responsive?

We observed that staff were quick to respond if people requested assistance and made sure that they knew if people's needs had changed.

We found that the provider had not responded to the need to reassess the staffing levels in line with the number of people who were using the service. We spoke with staff in different roles who all told us they felt stretched and had concerns about staffing levels.

We found that systems for gaining people's views about the service were in place and that the provider made checks on the safety and quality of the service.

Is the service well led?

We found that people were well cared for and told us they were happy with the service overall.

Staff told us they felt well supported by the registered manager and they liked working at the service. Staff received regular supervision and told us they 'Helped each other out' and 'Worked well as a team'.

The provider wrote to us on 23 January 2014 and told us about the action they were taking to address the non- compliance. At this inspection we found that the provider had taken action to address these matters.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not always able to tell us about their experiences. We spoke with four people who used the service, three relatives and four members of staff.

At this inspection we found that that staff treated people with dignity and respect. Staff used respectful language when they addressed people, and supported them with eating in a dignified way.

We found that a system was in place to check that people's care records were sufficiently detailed to reflect the care and support they required from staff, and that identified risks to people's safety had been assessed and recorded.

We found that systems for monitoring and assessing the quality of the service had improved, and that the provider was making regular checks on the service.

People told us that overall they were satisfied with the service. They said that staff were kind and caring and that they treated them respectfully. One person told us that 'staff always have a laugh with me' and another person said 'the care is good'.

Relatives told us that their relative was well cared for and their health had improved since they had lived at the service.

Mostly people told us they were satisfied with the service, they told us that staff were kind and caring and that they were able to make choices about their lives and their care and support. However, we found that people were not always treated respectfully and did not always receive care and support in the ways they preferred.

People told us that 'staff are very, very nice' and 'the nurses are top drawer '. A relative told us they were happy with the care provided and that 'they have looked after (x) very well'. However, we found that there were not always enough staff on duty to meet people's assessed needs safely and effectively.

Staff demonstrated that they had an understanding of what action to take if they suspected that a person may have been subject to abuse. However, the service's safeguarding procedure did not always give information or guidance for staff.

The provider did not have adequate systems in place to regularly assess and monitor the quality of the service provided.