Manor Field

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective - this means we looked for evidence that people have the best possible outcomes because their needs are assessed. At our last inspection we rated this key question Good. Although areas of concern were found until we have assessed more quality statements the rating for this key question remains the same. People were not always supported following ‘Right support, right care, right culture’ guidance. Staff were not always following the principles of the Mental Capacity Act 2005. Staff did not always understand their role and recording how decisions were made when people did not have capacity to do so. People’s needs had not always been reviewed and their care plans updated. The manager responded to our feedback and agreed to review the areas of concern with the appropriate people. People had access to healthcare services and were supported to live healthier lives. The care home worked in partnership with health and social professionals to ensure people were in the best of health.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they felt involved in the care people received. One relative said, “We have daily contact”. We saw some staff engaging positively with people.

Staff knew people well and told us about their risks without referring to documentation. However, staff were not always sure about people’s food and drink requirements. Staff were concerned over the lack of consistency at Manor Field amongst the staff team with regards to who gave people food and drinks and who did not. The regional manager responded to our feedback and acknowledged that instructions for staff were not clear and that these would be reviewed given the risks involved for some and all of the people living at Manor Field. Staff told us people’s care needs were discussed in team meetings and handovers. Multiple staff told us that there were no real activities in the afternoon at Manor Field and that, everyone ‘chills’. Staff also told us there was also no regular option for evening activities for people, unless planed in advance, due to the start time of staff. The interim manager told us that peoples preferences were considered. Some of the language we saw staff use was not person centred. For example, talking about people being dangerous or a risk as the rationale for the high level of restrictions at Manor Field. We shared this feedback to the interim manager and regional manager, who said they would speak to staff at the next team meeting to check their understanding.

People’s care plans and assessments were personalised. We reviewed the care plan documents for each person. We identified that functional assessments of behaviour for each person had not been carried out. Functional assessment requires examination of the behaviours that are demonstrated and the circumstances in which they occur, and uses the information to develop hypotheses about the functions of the behaviour for the person. The plan that is then developed from this understanding, seeks to support the person in using more appropriate methods of communicating their needs, changing the environment in a way that makes the occurrence of the behaviours less likely and improves the person’s skills, access to opportunities and an improved quality of life. The regional manager told us they not carried out functional assessments for the people since they had moved into the service, but instead staff carried out reviews with people regularly to ensure they received support in accordance with their current circumstances. The reviews checked people’s preferences, where possible and if any new activities were to take place, these were fully planned and assessed. Not assessing peoples functional skills, increased the risk of staff becoming confused regarding the current assessed care and support required by people.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

People's care needs were monitored consistently to improve outcomes. Relatives had no concerns about the care people received. Relatives confirmed they were involved in regular reviews to ensure their family members health and wellbeing needs were being met.

Staff told us that peoples outcomes were mainly positive and consistent, and that they meet both clinical expectations and the expectations of people themselves. However, multiple staff also told us that there are no real activities in the afternoon at Manor Field and that due to the start time of the night staff, there was no regular option for evening activities to take place, unless these had been planed in advance for people. Staff told us they had concerns as some staff allowed people to have certain food and drinks, whilst other staff denied people their choices. Staff also voiced some concerns, about the high levels of restrictions at the service and they told us they worried how this impacted everyone, as people had different needs. The provider informed us that although the kitchen at the service was locked, this had been risk assessed and documented in peoples care plans. Staff were able to give examples of whereby they have supported people to make improvements in their lives since moving to Manor Field. For example – one person was able to go out locally and use public transport with support. The interim manager told us people’s outcomes were monitored through daily observations and reviews. During reviews, care needs were discussed to improve outcomes.

Systems were in place to monitor and improve outcomes. People’s care plans set out strategies to enhance independence, and demonstrated evidence of planning and consideration of the longer-term goals. However, we found some people’s care plans were not always accurate. In particular, with regards to the food and drinks people could have and how often. For example – all the diet and nutrition management plans for people had not been reviewed in line with the provider’s policy. The providers audits had not identified this issue prior to our inspection. Care plans listed planned outcomes for people and how staff are to achieve these under each specific care plan.

People were empowered to make their own decisions about their care and support. We observed staff seeking consent before supporting individuals. Relatives confirmed they had been involved in best interest decisions in relation to their loved ones support.

Staff spoken with understood the principles of the Mental Capacity Act 2005. Staff understood the importance of ensuring that people fully understood what they are consenting to and the importance of obtaining consent before they delivered care or treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests (BI) and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Systems were in place to obtain consent from people to provide care and support, however improvements were needed were needed with regards to how this was documented and how staff followed this. MCA policy was in place, however improvements were needed to ensure that staff followed the providers policies. Staff had been trained on the MCA, however it would be advisable to review staff understanding when it came to people making unhealthy choices, balanced with any clinical guidance. People were able to make day to day decisions about their lives, however improvements were needed to ensure staff were consistent with people. Where people did not have capacity to consent to care and treatment, then MCA assessments had been carried out and best interest decision process was followed. Records had been completed in full to include who attended the meeting and date of meeting. DoLS applications had been made to deprive peoples of their liberty lawfully for the