Archived: Manor Lodge Care Home

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

Since the last inspection widespread changes had been made. A new framework of audits had led to improved monitoring which had led to improvements in the quality and safety of the service. Continuous learning was a clear focus and it was acknowledged that the service was embedding new systems and ways of working.

People told us they felt safe and happy. Safeguarding concerns were reported and responded to appropriately and in a timely manner. Improvements had been made to the environment including the maintenance of the heating and hot water system. Measures to minimise the risks of COVID-19 were in place. Some staff told us they were not wearing PPE appropriately. The registered manager and provider took immediate measures to ensure staff were following the current guidance. Risks were assessed and mitigated where possible. A new electronic support planning system was being rolled out. We have made a recommendation about the review and audit of the content of risk assessments and support plans.

Staff said they felt there were enough of them to meet people’s needs at present. Improvements had been made to the staffing structure and allocation of staff in the kitchen. Staff said they felt well supported and opportunities for training and learning had improved. They described their job role and what was expected of them.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, effective and well-led the service was able to demonstrate how they were embedding the underpinning principles of Right support, right care, right culture.

Right support:

• People were supported to access the community.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights

Right culture:

• Improvements had been made to the culture of the home to promote inclusion and involvement in decision making.

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 April 2021) 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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced focused inspection of this service during 2 to 9 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve god governance, safe care and treatment, staffing and safeguarding.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Manor Lodge Care Home on our website at www.cqc.org.uk.

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.

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

An effective and robust system to assess, monitor and improve the quality of the service was not in place. Staff morale was low, and they told us they did not feel supported. Residents meetings had taken place however; the tone of the minutes was not supportive, or person centred.

Safeguarding concerns had not been responded to in a timely manner. Risks had been identified but had not always been assessed or managed. Records had not been kept up to date in response to changing needs. A formal way of assessing the numbers of staff needed was not in place. There were gaps in the registered manager’s knowledge in relation to current COVID-19 guidance.

Medicines were administered safely however; we have made a recommendation about ‘as and when required’ medicines.

Safe recruitment practices were in place.

In relation to the COVID-19 pandemic people were not always supported to have maximum choice and control of their lives. It was not always documented that people were supported in the least restrictive way possible and in their best interests; the systems in the service did not always support staff to follow the principles of the Mental Capacity Act. We have made a recommendation about restrictions incurred during the pandemic.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, Right Care, Right Culture. Access to the community had not been fully assessed in line with COVID-19 guidance. We did not fully explore 'Right support, right care, right culture' at this inspection, this will be reported upon at our next inspection.

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 (report published 2 July 2019).

Why we inspected

We received concerns in relation to safeguarding and the management of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found there was a concern with staff support so we widened the scope of the inspection to include the key questions of effective.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from the risk of abuse and improper treatment, safe care and treatment, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Manor Lodge is a residential care home providing accommodation and personal care to 21 adults in one adapted building. At the time of this inspection, the home was full. People who live at Manor Lodge have varied health and social care needs, such as mental health, physical, learning disabilities and dementia.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People had seen an improvement to the environment they lived in. The provider had invested in the home with new furniture, flooring and decoration. The maintenance work required after our last inspection was completed. Plans were in place to further enhance the communal areas.

Staffing levels had increased. People were cared for by staff who were well supported by the management team to provide high quality, person-centred care. Staff recruitment continued to be safe and staff training was up to date. Competency checks were carried out to ensure staff remained suitable for their role.

People’s care needs were assessed and risks to their health, safety and well-being were identified and reduced. Staff gave support which met people’s current needs. Records were well maintained to reflect this. Accidents and incidents were recorded and reported as required.

People felt safe living at Manor Lodge, with support from caring and friendly staff who knew them well. People’s privacy and dignity were protected, and staff were respectful. Independence was encouraged, and people were involved in developing their care plans and making decisions.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Staff supported people to engage in social activities and pursue their hobbies and interests. This helped to reduce loneliness and promote socialisation and community involvement.

The management team strove to achieve high standards through continuous improvement and development. The quality and safety of the service was monitored through checks and audits.

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 23 June 2018). We identified two breaches of regulations related to the premises and staffing. 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 Manor Lodge until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected Manor Lodge in February 2017. At that inspection we found the service was in breach of its legal requirements with regard to Regulations 12, 9 and 17 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These related to safe care and treatment, person-centred care and governance. This was because systems were not all in place to keep people safe. Records did not provide an accurate account of the care people received. Robust quality assurance systems were not in place.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

We found improvements had been made so the service was no longer in breach of its legal requirements from the findings at the last inspection. However, during this inspection we found breaches of Regulations 18 staffing and regulation15 premises and equipment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Manor Lodge is a care home. People in care homes receive accommodation and 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.

Manor Lodge accommodates a maximum of 22 people. Nursing care is not provided. Care is provided to people who have mental health needs, learning disabilities and/or a physical disability. At the time of inspection 16 people were using the service.

A registered manager was in place. 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.

People said they felt safe and they could speak to staff as they were approachable. We had concerns however, that there were not enough staff on duty to provide safe and effective care to people.

Although a programme of refurbishment was taking place around the home. We considered more timely action was required in some areas to ensure it was safe and fit for purpose.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interests decision making, when people were unable to make decisions themselves. People were involved in decisions about their care. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

Staff knew the people they were supporting well. Records reflected the care provided by staff. Staff had developed good relationships with people, were caring in their approach and treated people with respect. Care was provided with patience and kindness. People were positive about the care provided and a camaraderie was observed between people and staff.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. There was a good standard of record keeping and records reflected the care provided by staff.

People had food and drink to meet their needs. Menus were varied and staff were aware of people’s likes and dislikes. People were provided with opportunities to follow their interests and hobbies. They were supported to contribute and to be part of the local community.

A range of systems were in place to monitor and review the quality and effectiveness of the service. People had the opportunity to give their views about the service. There was regular consultation with people.

At our last comprehensive inspection of the service, in June 2015, we found four breaches of legal requirements which related to person centred care, safeguarding, safe care and treatment and good governance. We returned to the service in January 2016 and found the provider had made improvements to meet legal requirements.

A registered manager was 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.

At this inspection we found medicines were not managed safely. Two people had not received their medicines as prescribed as they were out of stock. In one case the medicine was a pain relief patch, which they had not received for three days. Whilst staff had contacted the pharmacy team to reorder the medicine, they had not sought medical advice about what steps they should take to ensure the person's pain needs were met whilst waiting for their regular medicine to be delivered.

Medicines were not always disposed of safely. Where people had not taken individual tablets these discarded medicines had been stored in a sharps box. There were no records as to what medicines were in the box, or when and how they would be disposed properly. Medicines records were not always accurate.

Staff had received training in safeguarding people from abuse, however, where one person made frequent allegations the process had not always been followed.

Accidents and incidents had been recorded, but were not monitored and analysed. Risks had been assessed and where possible, action had been taken to reduce the likelihood of the risks occurring again.

There were enough staff to meet people's needs. Staffing had recently been increased, whilst the home recruited additional staff they relied on agency staff. Robust recruitment procedures had been followed.

Staff training was up to date. The manager monitored essential training to ensure any refresher courses were booked before training expired. There were no formal assessments of staff competency. Whilst the training element of the care certificate had been taken into account for new staff inductions, the provider had not yet incorporated the assessment, feedback and reflective practice elements. Supervisions sessions were planned for staff to discuss their training needs and performance. We saw these were not always regular. One staff member had not received any supervision since September 2016.

The Care Quality Commission (CQC) is required by law to monitor the application of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

The registered manager and staff understood the principles of the MCA. The registered manager told us that everyone who used the service was able to make their own decisions. Whilst we saw people were offered choice, and their decisions were respected, we saw one entry within care records which did not promote their rights.

Where restrictions on people's liberty were in place to keep them safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards in line with legal requirements.

People were very positive about the food on offer within the home. Most foods were home-made by the cook, who was knowledgeable about people's nutritional needs. A choice of food was available at every meal and food was on offer throughout the day.

People spoke highly of the staff team. Through our observations we saw staff were friendly and treated people with respect.

Care records contained a good level of detail about people's life histories so staff had an understanding of what was important to people.

Information was provided in a way which met people's communication needs.

Whilst information within care records was specific and detailed, it was not always up to date. Some people's needs had not been planned for. Staff had not been provided with information about how to respond to one person who frequently wanted to telephone for an ambulance. Where people's needs had changed care plans and assessments had not always been updated to reflect this.

Complaints records had not been well maintained. We saw one formal complaint had been received in the previous year, but we were unable to determine what action had been taken in response or whether the complaint had been substantiated.

Activities were on offer within the home, and the provider was purchasing transport to enable people to visit the wider community more frequently.

The provider did not have a robust system in place to monitor the quality of the service provided. The registered manager told us that checks were undertaken by them and the provider, however these were informal and there were no records of them. The provider's internal checks had not identified or addressed the shortfalls in medicines management and care planning which our inspection highlighted.

People, staff and health professionals were positive about the leadership in the home. They described the improvements they had seen in the service in recent months.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person-centred care and good governance. You can see the action we have told the provider to take at the back of the full version of this report.

After the comprehensive inspection, the provider wrote to us to say what action they would take to meet legal requirements in relation to the breaches. We undertook a focused inspection on 26 and 27 January 2016, which was unannounced, to check that they had followed their plan and to confirm that they now met legal requirements.

You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for ‘Gailey Lodge Care Home’ on our website at www.cqc.org.uk

Gailey Lodge is the only location owned by Renal Health Limited and is based in Whitley Bay. The provider owns a sister home nearby, operated through a separate registered company. Gailey Lodge provides accommodation for up to 22 people with physical disabilities and/or mental health issues, who require assistance with personal care and support. At the time of the inspection there were 19 people using the service.

At the time of the inspection the home did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. We had written to the provider and requested they take action to ensure a manager was formally registered with the Commission as soon as possible and an application was in progress. The home’s acting manager and the provider’s operations manager were present during, and assisted us with, the inspection.

At the previous inspection we had noted a small number of windows at the home did not have appropriate window restrictors fitted. At this inspection we found there were still windows without restrictors. The operations manager told us this had been an oversight. He contacted us the day after the inspection to advise us that this work had now been completed. Wider safety checks on equipment and safety systems were in place. Broken bulbs in rooms and corridors had been replaced and small electrical items had been tested to ensure they were safe.

At the last inspection we had raised issues about the cleanliness of the home and infection control. The home had worked extensively with the local infection control team to improve cleanliness and infection management. Toilets and bathrooms had been upgraded and refurbished. Carpets had been cleaned and in some places flooring had been replaced.

We had also raised concerns about the safe management of people’s finances at the previous inspection. Appropriate systems were now in place to ensure that people were protected against financial abuse and, where necessary, appropriate applications to the Court of Protection were being considered. People told us they felt safe living at the home and staff confirmed that they had received training in relation to safeguarding vulnerable adults.

People told us there were enough staff to support them with their care. Extra staff had been scheduled to work in the evenings. Additional domestic time, kitchen staff and handyman hours had also been sanctioned by the provider. Proper employment processes were in place to ensure the safe recruitment of staff and proper checks were in place. Medicines at the home were stored safely and staff administered them appropriately. Medicine records were up to date.

At the last inspection we found that appropriate systems regarding the application to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards were not in place. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. The manager confirmed that no one living at the home was under any restrictions as defined by DoLS. Records showed that consent was sought from people and that their capacity to consent is considered and the Mental Capacity Act (2005) (MCA) was applied appropriately.

The operations manager told us a new training system had been purchased to support staff development. Staff told us they were able to access a range of training and had recently participated in a specific event regarding infection control and supporting people with alcohol issues. Staff said, and records confirmed that they had regular supervision. The manager told us that annual appraisals were still to be arranged.

People were supported to maintain their health and wellbeing. People were able to attend doctors’ and other health appointments. There was evidence of staff from the home consulting with specialists about people’s needs and health requirements.

People told us there was sufficient food and drink provided at the home. They told us they had access to a kitchen so they could prepare their own hot and cold drinks. People with special diets were catered for and supported by staff, as necessary.

Partial redecoration of the home had taken place with some corridors and the lounge areas repainted. The manager told us further work was planned to continue to upgrade the home, but this needed to be planned to work around people living at the home.

At our previous inspection we had found that people were not always involved in reviewing their care. At this inspection we saw people’s care records had been rewritten. People indicated that staff had spoken to them about their care reviews and that they had been involved in setting their care plans. People told us they were happy with the care provided and said they now had a key worker to work with, which they found helpful. We observed there were good relationships between staff and people who lived at the home. People told us staff treated with dignity and respect.

People had individualised care plans that included risk assessments and identified people’s care needs. Care records had been fully rewritten and reviews of these new plans had taken place. Staff also regularly reviewed people’s activities and significant events on a monthly basis.

People told us there were activities at the home, although some people said they would like more to be made available. Other people told us they liked to manage their own time and could do what the wished. People were free to go out when they wished. The manager said staff would support people to access the community.

People knew how to make a complaint and said they would tell the staff or the manager if they had a complaint. The provider had a complaints policy which was available throughout the home. There was now a system to record concerns as well as formal complaints. There had been no formal complaints since the last inspection.

A number of checking systems had been put in place, but the manager told us she was still looking at developing a wider audit system. The majority of people and staff were positive about the management of the home and the changes that had been made. There were regular meetings with staff and people who used the service. Both people and staff at the home had been asked to complete questionnaires to ascertain their views and experiences at the home.

The manager and the provider told us they felt that good progress had been made, but recognised there was still work to do to further improve the home.