Archived: Urmston Manor RH

At our last inspection in June 2017 we rated the service as inadequate. We found five breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regard to safe care and treatment, person centred care, premises and equipment, recruitment, good governance staff supervision and training.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good.

This service has been in Special Measures since our last inspection in June 2017. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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

Urmston Manor RH is registered to provide care to up to 24 older people, including people who may be living with dementia. The home has been operating since 1984. Accommodation is based over three floors and there is a passenger lift between the floors. At the time of our inspection there were 23 people living at the home.

There was not a registered manager in post at the time of 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.

The current manager was in the process of purchasing the home from the provider. Their registration for this was being assessed by the Care Quality Commission at the time of our inspection and was due to be completed within the next two months. The current provider had no oversight of the home at the time of our inspection, with the current manager having taken on the responsibility for the home.

At this inspection we found improvements had been made in all areas; however there continued to be a breach in the regulation for good governance. The manger had introduced a system of audits at the service; however these were not detailed or robust enough to review and improve the quality of the service. The manager was aware of this and was working with staff to improve the quality of the audits and action plans. You can see what action we have told the provider to take at the back of the full version of this report.

People living at the service, their relatives, staff and visiting health professionals were all very positive about the changes made by the manager and the improvements made at the home. The manager had a clear vision and values for the home. Staff confirmed that they had received training on privacy and dignity and they were now more aware on how to support people in a dignified way. People and relatives were very complimentary about the staff and said they were supported with kindness, dignity and respect.

Building work had been completed to meet the fire regulations. A new fire alarm and call bell system had been installed. Evacuation plans were in place for each person and fire drills had been held. A business continuity plan was in place to identify the actions to be taken in the event of an emergency.

A legionella risk assessment had been completed by an external company and actions taken to reduce the risk of legionella disease at the home.

Risk assessments and care plans were up to date, reviewed monthly and reflected people’s care and support needs.

Medicines were administered as prescribed. Guidelines for when people may need an ‘as required’ medicine to be administered had been written. Recording sheets for the care staff to sign when they applied topical creams and added thickeners to drinks were introduced during our inspection. We have made a recommendation that medicine administration records are checked more frequently than after each four week medicines cycle so any issues are identified more quickly.

People said they felt safe living at Urmston Manor.

Staff received the training and support they needed to undertake their role. A safe recruitment system was in place to recruit staff who were suitable to work with vulnerable people. There were sufficient staff on duty to meet people’s assessed care and support needs.

Relative and staff surveys had been carried out. These showed a large improvement in the levels of satisfaction with the service and communication with the manager and staff team.

An activities co-ordinator was now in place who organised a series of activities both within the home and in the local community. People and relatives were very positive about the activities now available.

People were supported to maintain their health and nutrition. Visiting health professionals said staff now had the information they asked for and followed any guidance they were given. Referrals to health professionals, such as GPs and district nurses were appropriately made. Staff now supported people to attend appointments if their relatives were not able to do this. This meant appointments did not now need to be cancelled.

Dementia friendly signs had been purchased. Individualised posters had been made for people’s bedroom doors detailing a person’s favourite hobbies, food, drink and places. These would assist people living with dementia to orientate themselves around the home and provided staff with a prompt of topics of interest to the person when talking with them.

The service worked with social services and local hospitals for people assessed as medically fit to be discharged from hospital but needing an assessment of their care needs.

The service was working within the principles of the Mental Capacity Act (2005). People’s capacity to make decisions was assessed and applications made for Deprivation of Liberty Safeguards where applicable.

We last inspected Urmston Manor on 24 August 2016 when we rated the home Requires Improvement overall. At that inspection new found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care, recruitment, good governance and staff supervision and training. We issued three warning notices to the provider and former registered manager to formally inform them of the reasons they were in breach of the regulations and to tell them improvements must be made.

At this inspection we found that although there had been improvements to some aspects of the service, we identified ongoing concerns and continued breaches of the regulations. We found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care, good governance, recruitment, training and premises and equipment.

You can see what action we have told the provider to take at the back of the full version of this report. We are currently considering our options in relation to enforcement and will update this section once any enforcement action has concluded. As a result of our concerns, we requested and received an urgent action plan from the provider that detailed the immediate actions they would take ensure the safety of people living at the home.

We have made two recommendations. We have recommended the provider reviews their processes in relation to handling hazardous waste and that the provider reviews good practice guidance in relation to developing dementia friendly environments.

Urmston Manor RH is a residential care home registered to provide care to up to 24 older people, including people who may be living with dementia. The home has been operating since 1984. Accommodation is based over three floors and there is a passenger lift between the floors. At the time of our inspection there were 18 people living at the home.

There was not a registered manager in post at the time of 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. The former registered manager who is also one of the partners of partnership who run Urmston Manor left the role of registered manager in March 2017. The main partner told us the former registered manager no longer had any active involvement in the management of the home. There was an interim manager in post who was overseeing the day to day management of the service. They told us they did not intend to register to manage the service, but would stay in post until a new registered manager could be recruited.

Prior to our inspection the fire service made us aware of shortfalls they had found in relation to fire safety at the premises. The fire service found that concerns identified in a fire risk assessment completed in 2012 by a third party risk assessor had not been acted upon by the provider. These shortfalls were unknown to the current manager and main partner until the risk assessment was located when the fire service was recently called out to a small suspected fire in the home. The manager had taken a number of immediate steps to help reduce risks including increasing staffing at night and stopping any new admissions to the home whilst works were underway to make improvements to the structure of the building. The required works were agreed to be completed by September 2017.

During this inspection, we found other issues effecting the safety of the environment. The provider did not have a risk assessment in relation to legionella, and was not undertaking routine checks to help control the risks of legionella. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire’s disease that can be dangerous, particularly to more vulnerable people such as older adults. There was also no call bell system in place, and instead an intercom system was used. This system was not effective and also had a potential impact on people’s privacy.

Staff acted upon concerns to people’s health and wellbeing. However, the measures in place to reduce risks were not always clearly documented in risk assessments. There were no recorded checks of equipment such as bedrails taking place, and in one instance the use of bed rails had not been risk assessed. This would increase the risk that bedrails were not safe or suitable for use and that defects would not be recognised.

Medicines were stored safely, and staff kept accurate records of administration. However, we found one person had not received a pain relief medicine as prescribed as there had been delays in obtaining the medicine from the pharmacy. We also found accurate information on allergies was not always in place, and there was no evidence that staff had contacted a GP or pharmacist for advice when a person had repeatedly declined to take their medicines.

During our inspection we saw staff were attentive and responded to people who might need assistance in a timely way. There were sufficient numbers of staff on duty to provide people with the support they needed. We observed positive and caring interactions between staff and people living at the home. People were comfortable in the presence of staff and to request help if they needed it.

We saw limited activities taking place during the inspection and received mixed reports from people as to whether they had enough to keep them occupied. People told us trips out had increased since the new manager had started, although the manager acknowledged further work was required to develop the provision of activities.

The manager had introduced a new electronic care management system. All care plans had been transferred to this new system, which help with the organisation of records. Whilst staff were aware of people’s care needs, preferences and social histories, we found this was recorded to variable degrees of detail in the electronic care records. We also found records were not always up to date, and did not always reflect the care the person was currently receiving.

We received positive feedback from people about the food provided. Kitchen staff were aware of people’s dietary requirements, and they told us they devised menus based on what people had previously enjoyed.

The manager placed emphasis on the importance of supporting and training the staff team to build competence. Staff told us training had improved since the new manager had taken up post, although there were some continued gaps in training provision. The manager was providing regular supervision to staff, and was enthusiastic about ensuring supervision was used as an effective tool to drive long-term improvements in the service.

The manager listened to both staff and people using the service and had acted on feedback they provided. Staff told us the manager had introduced quality training, supervision and had bought new moving and handling equipment they needed. The manager had arranged for the library to provide large print books in response to feedback from people using the service, and had supported a person to move bedrooms as a result of their request.

We received consistently positive feedback from people using the service and staff for the current manager. The manager had a clear vision for the continued improvements they wanted to see in the service. They also talked about a range of improvements they had already put in place, and this was reflected in large improvements in local authority assessments of the service since they had been in post.

Despite these improvements, we identified on-going breaches of the regulations. There was no effective monitoring of the quality or safety of the service in place, and no routine audits were being undertaken at the time of the inspection. This increased the risk that staff would not identify or be able to act on any areas where improvements were required. The manager told us their focus had been on the immediate issues such as fire safety and staff supervision, and that audits would be introduced in the near future. The provider did not have effective oversight of the service, which had resulted in them failing to take effective action in relation to areas of known risk.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social c

The service was previously inspected 19 May 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Urmston Manor RH is a privately owned residential care home in the Urmston area of Trafford and has been operating since 1984. The home is registered to provide care to a maximum of 24 older people and accommodation is provided over three floors. The home provides care and support to older people, some of whom live with dementia. There were 21 people living at Urmston Manor RH on the day of our inspection.

At the time of the inspection there was a registered manager at Urmston Manor RH.

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.

During this inspection visit we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, recruitment processes, training and staff supervision, meeting people's social needs, and quality assurance and auditing systems. We will report on any further action we have taken regarding these when it has been

completed.

The manager was present during the first day of our inspection and engaged positively in the inspection process.

Feedback received from people using the service we spoke with was generally complimentary about the standard of care provided. People living at Urmston Manor told us the manager was approachable and supportive.

We found that risks assessments were updated when risks had been identified, however, care plans to mitigate the risks were not always put in place. The care plans we saw were generic and lacked detail.

An accident book was in place to record accidents and falls. The information captured did not provide any evidence of lessons learnt and actions taken to minimise the potential for reoccurrence.

We found the safeguarding procedures had not been established to help staff understood how to safeguard people they supported. However, staff had access to the local authorities safeguarding policy and knew how to recognise and respond to suspected abuse. We found the registered provider did not have systems in place that recorded how they dealt with safeguarding incidents. We saw the registered provider had reported safeguarding incidents appropriately when we contacted the local authority safeguarding team after the inspection.

Although most of the home was clean and tidy and the people using the service and their relatives told us the home was clean, we found two areas of the home that was malodourous and required new flooring.

Potential safety hazards were identified as we walked around the building. The owner of the home had already begun to address these issues after the inspection.

We found staff had not received regular supervision, and there were gaps in the provision of training, including training in dementia awareness, moving and handling, and MCA and DoLS. The registered manager explained the home has recently purchased new training booklets that will cover the majority of the key training subjects; this will be rolled out to staff in the near future.

Some staff and people told us that activities could be limited at times. People's social needs were not being met. People told us they were bored and activities did not occur regularly.

The service lacked governance systems to assess, monitor and improve the quality of the service. There were shortfalls identified during this inspection that had not been identified by the provider or registered manager.

Medicines were ordered, stored, administered and disposed of safely.

Consent to care and treatment was sought in line with legislation and guidance. Capacity assessments had been completed appropriately for people and were in their care records. Staff we spoke with understood the principles of the Mental Capacity Act 2005 which meant staff understood the importance of ensuring people's rights were protected.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and their relatives told us they would raise any concerns with the manager.

Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

Equipment checks were undertaken regularly and safety equipment, such as fire extinguishers and alarms, were also checked regularly. However, we viewed the fire drills documentation and noted the no evidence of fires drill being coordinated for night staff at the home. We recommend the registered provider reviews the latest fire safety guidance for care homes.

The registered provider failed to notify CQC concerning safeguarding incidents. We have signposted the registered manager to the CQC statutory notification guidance for providers.

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?

We walked around the building and saw all areas were clean and tidy and there were no unpleasant odours present. We saw a there was a cleaning schedule in place to maintain cleanliness and hygiene in the home. Staff had access to personal protective equipment (PPE) such as gloves and aprons.

Risk assessments were in place in relation to fire safety, nutrition, falls and moving and handling. Equipment was maintained and serviced regularly to ensure people were not placed at unnecessary risk.

Safeguarding and whistleblowing procedures were in place and staff were aware of their responsibilities to report poor practice.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. No applications had been made to deprive people living in the home of their liberty.

Is the service effective?

We saw staff demonstrated a good awareness of people's care and support needs. We spoke with four people who lived at the home who told us staff asked them what they wanted. Comments included: 'They ask me what I want to do.' 'They talk to me.' We spoke with a visitor who told us they were involved with planning their relatives care. 'They asked about preferences and what (my relative) liked.'

The people we spoke with told us they saw the manager daily and felt able to express their views and opinions about the service they received. It was clear from our observations people who lived at the home had a good rapport with the manager and staff.

Is the service caring?

Care plans contained each person's preferences for how their care and support needs should be met. During our inspection we saw staff offering people choices, such as where they would like to sit and what they would like to eat and drink. Staff approached people with respect and were patient and courteous. Where people needed assistance staff were patient and support was provided in a sensitive manner.

Staff were attentive and took time to sit and talk with people. The people we spoke with told us: 'They are fantastic.' 'The staff are really very good.' 'I am very satisfied.' "I can't speak highly enough about them, they are angels" 'I am very happy here.'

Is the service responsive?

We spoke with a visitor who told us they were able to speak to the manager to discuss their relatives care and support. Comments included: 'The manager is always here and she will always have time to talk.' 'If I have any concerns they are dealt with immediately.' 'There is always someone around to speak to and any issues are dealt with.'

The people we spoke with knew who to speak to if they had any concerns and people felt they would be listened to.

Is the service well led?

The people we spoke with during our visit told us the home was well managed. One person's relative told us: "I looked at a lot of homes before making a decision on this one. It is much better than the other homes I looked at.' 'The staff are lovely with (my relative) and they know what she wants.' 'The manager is always around and I can talk to her and ask how (my relative) is doing.' 'I like it here because it is like your own home the staff are all friendly and nice with people.'

There was a system of audits in place although an infection control audit had not been carried out. The manager told us the local infection prevention and control team had planned to visit the home to carry out an inspection.

We looked at three care plans; all three plans were comprehensive and provided a summary of care and support needs, alongside detailed assessments, outcomes people planned to achieve and personal profiles.

We asked staff how they ensured the care and welfare of the people living in the home, they told us: 'It's all about dignity and respect, I talk to people and treat people how I would like to be treated.' 'Different people have different needs, we know all the people individually and ensure we meet peoples individual needs. '

The manager told us the chef plans the menu on people's personal preference, the kitchen is in the heart of the home and the chef engages with the residents on a daily basis. When new people move into the home the chef spends time with people discussing their preferences and looking what foods they like.

There were effective systems in place to reduce the risk and spread of infection. The cleaner told us: 'I am the first line of defence, if I notice anything or have any concerns I report it straight away.'