Manor Field

On this page

• 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

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. We found the standard of care had deteriorated. People were not supported following ‘Right support, right care, right culture’ guidance. People’s human rights had not always been protected and we could not be assured that people were always supported in the least restrictive way possible. Accidents and incidents had not always been reported to safeguarding when required placing people at risk. Care plans were in place, although some care plans contained not accurate information, which meant there was a risk staff might not be clear on what information to follow. The provider acknowledged our feedback. Staff were deployed safely, however we found that one member of staff regularly worked long hours, which we brought to the providers attention. Systems were in place to minimise the risk of infections. Medicines were being managed safely. Safety checks had been carried out to ensure the environment was safe to live in. Staff had completed training to perform their role effectively, which included training on learning disabilities and autism, however we did signpost the provider to new guidance in relation to the different levels of training staff should have if they are supporting autistic people and people with learning disabilities every day. Relatives told us they felt their loved ones were safe with the people who supported them.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The inspection was prompted due to allegations CQC had received about staff at the service and regulations not always being followed. Although relatives told us they were happy with the care their loved ones received and they felt they were safe. One relative said, “Staff do as much as possible and understand [our relatives] needs. Our [relative] is always happy to go back to [Manor Field] after a visit.” Another relative said, “Our [relative] is the happiest [they] have ever been.” People appeared comfortable in the presence of staff and staff knew people well. Staff supported people to live their lives incorporating their interests.

The provider promotes a culture of safety and learning, however recent management changes at the service had impacted staff feeling confident in this area and staff had raised some concerns, which they felt had not been fully addressed by the provider. The inspection was prompted due to allegations being made about staff, and regulations not always being followed. In part, some of these allegations were investigated by the local council’s safeguarding team, following the providers internal investigation. These were dealt with by managers as an opportunity to put things right, learn and improve. For example, managers had increased the out of hours spot checks on staff at the service and they acknowledged more work was need to improve teamwork at the service. Managers had not identified the issues inspectors found at the service during this inspection. Repeated incidents of distressed behaviour had not been reported by to the local safeguarding team or the Care Quality Commission for external review. We were not assured that all the staff members understood what caused people to become frustrated, or that they always recognised the impact of changes on people’s lives with regards to their emotional wellbeing. Staff told us they were transparent with relatives and multi-disciplinary teams as and when appropriate to do so. Relatives felt safe to raise concerns with the service.

The provider had robust polices and systems to document and report accidents and incidents, analysing any emerging themes and trends at Manor Field. Incidents had been recorded, however how these incidents were categorised and the language used to describe, in particular incidents when people had become distressed was not dignified. The lessons learnt section did not always clearly identify what lessons had been learnt and what action staff should take to reduce the risk of events happening again. The providers overarching quality and safety team identified serious incidents requiring closer examination and managed them at the provider level, offering necessary team support. Staff practices were guided by established policies and procedures. Supervisions and team meetings offered additional opportunities for learning. The provider understands and acts on the duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong. Relatives told us staff had been open and transparent following, for example a safety incident or issue that had occurred.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us they were happy with the care their loved ones received and they felt they were safe. One relative said, “Staff do as much as possible and understand [our relatives] needs. Our [relative] is always happy to go back to [Manor Field] after a visit.” Another relative said, “Our [relative] is the happiest [they] have ever been.” People appeared comfortable in the presence of staff and staff knew people well. Staff supported people to live their lives incorporating their interests.

Staff had been trained in safeguarding and the staff we spoke to understood the main principles of safeguarding and the action they should take if they had concerns about people’s care or safety. Although the management team understood their responsibilities to safeguard people, this was not always consistent to ensure the process of reporting, monitoring and learning lessons took place by all staff and managers at Manor Field.

Throughout the time we spent time observing staff interacting with people. We saw that staff treated people with kindness, understanding and offered appropriate support.

The provider had safeguarding policies and processes in place to protect people from the risk of abuse, however we identified that incidents of repeated self-injurious behaviour were not investigated in full to safeguard people from abuse. We signposted the management team to guidance from their local safeguarding team. Staff were not always supported to work in line with the principles of the Mental Capacity Act (MCA) and we could not be assured that people were always supported in the least restrictive way possible, and supported to make day to day choices and decisions about their care. We were not always assured from the records shared from the service that people’s MCA assessments’ and Best interest decisions had been consistently reviewed, checked and updated where necessary in line with the provider's policy. In addition further development of MCA assessments and best interests needed to be more decision specific in relation to the food and drinks people wanted to have, verses any up to date clinical advice that had been given to individuals. The regional director confirmed work would begin to ensure people were supported to understand their rights and ensure staff practice would be consistent going forward making sure people were respected. Where people were subject to Deprivation of Liberty Safeguards (DoLS) these were adhered to at Manor Field, however you did not ensure that notifications were submitted by staff to CQC. You must notify CQC if the outcome of the application is to deprive a person of their liberty.

Staff supported people to be involved in the support they received. Relatives told us they felt involved. Comments included, “[Staff] phone me with information when needed” and “The staff really look after [our relative]”. The service supported people to remain independent and safe whilst enabling them to do the things that mattered to them.

Staff and the management team knew people well and were aware of people's risks and the support they needed to remain safe, however staff reported some concerns. Staff told us, some of their colleagues at Manor Field did not always respect people’s choices or decisions, in particular around food and drink choices. Staff said they understood they had to follow clinical guidelines; however, they did not fully understand the reasons behind this or why some staff responded to people differently. The regional manager acknowledged improvements needed to be made with regards to instructions for staff to follow and reviews would take place to understand the concerns further.

We observed staff responding well to people who were communicating a need, expressing feelings or an emotional reaction during our visits. However, inspectors found that the provider, management team and staff had not considered one person’s privacy, as they had an observational window on their bedroom door. Staff told us this was due to the risks involved in with the person’s health condition and that observations were only ever made for a very short periods of time. Following our feedback as part of this inspection, the management team took action to amend the door to protect this person’s privacy going forward. Inspectors also found this had not been documented in the persons care plan. Inspectors also observed staff saying no to people when they repeatedly asked for food or drinks. However, when we reviewed the care records for these people, instructions for staff were not consistent or up to date, or detailing the clinical guidance they were to follow.

We reviewed peoples care plans, staff daily notes and incident records from the service. The daily notes and incident information reviewed, which had been written by staff had not included any reference to people’s needs or reasons for behaving a certain way. The regional manager told us this was because staff were limited due to the categories and text box. However, the categorization and language used to describe people was negative and derogatory. Inspectors identified functional assessments of people’s behaviours had not been completed at Manor Field. This was against national guidance. The National Institute for Health and Care Excellence (NICE) Guidance on behaviour that challenges recommends that assessment of behaviour should include assessment of the functions of the behaviour for the person, and that this should be the basis for a behaviour support plan. Department of Health guidelines outline a number of key actions, including putting behaviour support plans in place for all people in services who are at risk of being subject to restrictive interventions. The lack of staff understanding of people's individual needs and how they use behaviour to communicate meant that people's needs were not being considered in an individual or holistic way. People were subject to a high number of restrictions at the service. People had restrictive practice reduction plans in place, however inspectors found that the annual review dates of these plans had expired. The regional manager told us these were with the provider’s Positive Behaviour Team to be reviewed. The plans did not demonstrate what restrictions had been reviewed at the service and what measures were in place to monitor and reduce them. It was also noted that people or their family had not had their views detailed on the restrictive practice reduction plans at the service.

The one relative who visited the service regularly felt the environment was safe, suitable and well maintained. However, we found managers had not taken every action to ensure the environment was safe for every person living at Manor Field.

Staff felt safe in the working environment. They told us they had the required skills to keep themselves and people safe.

People’s care was provided in an environment which was mostly well maintained. Some people’s bedrooms were personalised, others were quite sparse, as was the communal area; it was unclear whether this was by choice. Staff and managers completed health and safety checks. However, we were not assured these were robust. During our visit, we found one person at Manor Field had an observational window on their door into their flat. This was not respecting their privacy or dignity, as you could see into their lounge and bedroom. The use of observational widows in a care home setting is not the least restrictive option and is not person centered.

Premises and fire safety checks had been carried out to ensure the premises was safe to live in. Processes were in place to keep the service clean and free from any hazards. People had access to individual garden areas if people wanted to go outside. The provider had a comprehensive suite of policies to ensure staff are working consistently and in accordance with legislation and best practice. The policies were accessible and kept up to date.

People received care from staff they knew. People appeared comfortable with staff. There was enough staff to support people safely. Relatives were complimentary about the service. Comments included, “Staff are brilliant” and “I want them to be part of an extended family”. Relatives told us there were enough staff to meet people’s needs.

Some staff told us that their concerns about staff practice at Manor Field had not been fully addressed by managers or the provider. Staff made several disclosures to inspectors as part of this inspection. Due to the nature of the allegations made, the management team carried out an investigation and took immediate action. The regional manager acknowledged improvements were needed at the service. The interim manager had stepped up into the role whilst the provider recruited to the registered managers role. A new manager was about to start during the time of the inspection and a series of meetings were to take place with staff around the importance of raising concerns at the earliest possible opportunity, in line with the providers policy.

We observed that there were appropriate number of staffing to meet people’s needs and staff supported people safely and knew them well. However one person’s planned family leave day had to be changed due to lack of staff drivers availability at the weekend.

Staff rotas confirmed there were enough staff to support people safely. Staff had completed mandatory training. However, we signposted the provider to ensure that staff training was at the level appropriate to their role at Manor Field with regards to interacting appropriately with people with a learning disability and autistic people. It was also not indicated on the staff training matrix shared with the CQC that the provider was assessing the knowledge and competence of their staff at least annually. Regular supervisions and appraisals had been carried out and records confirmed this. Safe recruitment processes were followed at the service. You told us in order to ensure that recruitment is unbiased at Manor Field, job applications did not include protected characteristic such as age, religious beliefs and sexual orientation. You also told us that staff recruitment and retention had a big impact on the service.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received their medicines as prescribed. People’s behaviour was not excessively controlled by medicines. People’s relatives did not raise any concerns around support people received with their medicines. They were complimentary around overall standard of care and treatment provided to their loved ones at Manor Field. Staff were observed to be caring. The medicines room was locked, clean and well organised. Medicine counts matched with medicines charts.

Staff told us they received training to manage medicines and had their competency checked to ensure they were safe. Training records were provided to evidence this. The interim manager explained people’s behaviours were not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (Stopping The Over-Medication of People with a learning disability, autistic or both).

The provider and staff had ensured that medicines and treatments were safe and met people’s needs. Medicines incidents were recorded, analysed, and learnt from. There was a safety culture that encouraged staff to report these. Audits identified where staff had made medicines errors, and these staff were re-trained and their competencies checked. Risk assessments had been done to make sure this was safe and appropriate. People’s care plans were person-centred and up to date. ‘When required’ PRN medicine protocols had recently been updated and were in place to help staff give these medicines correctly.