The Care Quality Commission
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Archived: The Manor House Residential Home

Overall: Requires improvement read more about inspection ratings

The Manor House, Wakefield Road, Lightcliffe, Halifax, West Yorkshire, HX3 8TH (01422) 202603

Provided and run by:
The Manor House (Halifax) Limited

Important: The provider of this service changed - see old profile

All Inspections

8 October 2015

During a routine inspection

This inspection took place on 8 October 2015 and was unannounced. At the last inspection on 14 May 2015 we found three breaches in regulations which related to staffing, person centred care and good governance. The provider sent us an action plan which told us improvements had been made. At this inspection we found some improvements had been made.

The Manor House Residential Home provides accommodation and personal care for up to 30 older people, some of whom may be living with dementia. There were 18 people living in the home on the day of inspection. Accommodation is provided over two floors and there is a passenger lift available to assist people with mobility problems. There are lounges on both floors and a dining room and kitchen on the ground floor as well as communal toilets and bathroom facilities. A laundry is located on the lower ground floor.

The home had a registered manager. 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 home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible.

At the last inspection we were concerned that there was not always sufficient staff on duty to meet people’s needs and that staff did not always receive the training and support they required to carry out their roles effectively. On this inspection we found the provider had increased the number of staff on night duty and placed more emphasis on staff training and supervision. However, we have recommended that the registered manager kept staffing levels under review to ensure they are adequate to meet people’s needs.

There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) that included steps staff should take to comply with legal requirements. The registered manager also told us they were working with the local authority to make sure they were working in line with guidelines. This legislation is used to protect people who might not be able to make informed decisions on their own.

The staff we spoke with had a general understanding of the MCA and DolS and how they impacted on the care and treatment they provided. However, the training matrix showed not all staff had yet completed training on the subject.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists. We also saw since the last inspection the care documentation in place was more person centred and provided staff with accurate and up to date information.

We found that although people received their medicines as prescribed there were no protocols in place for medicines prescribed “as and when required” (PRN). Therefore there was no guidance in place to inform staff on under what circumstances they should administer the medication.

People told us they found the staff caring, and said they liked living at the home. Relatives gave us positive feedback about the care and support their family members received. Throughout the inspection we saw staff were kind, caring and patient in their approach and had a good rapport with people.

Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect. We saw information relating to people’s care and treatment was treated confidentially and personal records were stored securely.

We saw the complaints policy had been available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

Staff told us communication within the home was good and staff were confident senior management would deal with any concerns relating to poor practice or safeguarding issues appropriately.

However, we found that although the quality assurance monitoring systems in place had been improved since the last inspection further work was required to evidence the service was consistently being managed effectively and in people’s best interest.

We have made recommendations about staffing and where to seek guidance on they way the premises could be adapted in a way that helps people living with dementia manage their surroundings, retain their independence, and reduce feelings of confusion and anxiety.

14 May 2015

During a routine inspection

This inspection took place on 14 May 2015 and was unannounced. At the last inspection on 18 June 2014 we found six breaches in regulations which related to respecting and involving people, consent, medicines, staffing, complaints and quality assurance. The provider sent us an action plan which told us improvements had been made. At this inspection we found some improvements had been made.

The Manor House Residential Home provides accommodation and personal care for up to 30 older people, some of whom may be living with dementia. There were 19 people living in the home when we visited.

Accommodation is provided over two floors with lift access between the floors. There are lounges on both floors and a dining room and kitchen on the ground floor as well as toilets and bathroom facilities. A laundry is located on the lower ground floor.

The home has a registered manager. 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 and relatives we spoke with were unanimous in their praise of the service. They praised the staff who they described as kind and compassionate and expressed satisfaction with the care they received. They told us they felt safe in the home and enjoyed participating in the activities that took place.

People told us the food was good and knew how to raise a complaint if they had any concerns. We saw people had access to health care services when they needed them and a healthcare professional we met confirmed staff acted upon the advice they were given. We saw people received their medicines when they needed them.

The home is family run and we saw the providers and registered manager were well known to people and had a visible presence in the home.

However, we found the home lacked formal recording systems and processes to underpin and consolidate the quality of care and service provided. This included a lack of established quality assurance processes to ensure continuous improvement. This had been raised at the previous inspection in August 2014 and had not improved. We found although people’s views were obtained, there was no evidence to show how this influenced the running of the service.

People’s care needs were not fully assessed and recorded, which meant people were at risk of receiving inconsistent care as staff relied on verbal communication and care records were not used effectively to plan and deliver care. We found some care practices were task orientated and not tailored to meet people’s individual preferences.

Staffing levels were determined by occupancy levels and people’s dependencies and the layout of the building were not taken into consideration. We considered staffing to be at a minimal level and found some staff were working excessive hours amounting to 60 hours a week.

We found staff were not receiving the induction and training they needed to give them the knowledge and skills to fulfil their roles.

We identified three breaches in regulations which related to regulation 18 (staffing), regulation 9 (person-centred care) and regulation 17 (quality assurance). You can see what action we told the provider to take at the back of the full version of the report.

26 August 2014

During an inspection in response to concerns

The inspection visit was carried out by two inspectors and an expert by experience. Before the visit we spoke with a community matron, community psychiatric nurse and social worker about care at the home. We also reviewed the report from most recent contracts performance and quality site visit.

During the inspection, the inspection team spoke with the registered manager, assistant manager, three care workers, one domestic assistant, eleven people who lived at the home and five relatives. The inspectors also looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 27 people living at the home on the day of the visit, two of whom were receiving respite care.

At the last inspection in April 2013 the home was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about people's care and support not being properly planned, a lack of involvement of people and their relatives in care planning, people not giving consent to their care and treatment, the home being short of staff (especially at night) and complaints not being investigated properly.

We looked at these areas during our visit and found some evidence to support the information we had received.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was not safe.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff employed at the home had the skills and experience needed to carry out their roles and support the people who lived there. However, we found staffing levels were insufficient to meet people's needs, especially at night.

People were cared for in an environment that was safe and secure. However, we found areas of the home that were not clean, hygienic or well maintained.

We also found records, including people's care records, were not securely stored.

Is the service effective?

The service was not always effective.

The provider did not have suitable arrangements in place to assess people's capacity to consent and did not ensure people gave consent to the care and treatment they received. Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We found people who lived at the home had their movements restricted in various ways. The home was not compliant with the requirements of the Deprivation of Liberty Safeguards.

People generally told us they were happy with the care provided at the home and their care, treatment and support needs were generally being met.

From our observations and from speaking with staff, people who lived at the home and their relatives we found staff were aware of people's care and support needs.

Is the service caring?

The service was not always caring.

People's privacy, dignity and independence were not always respected.

People who lived at the home were generally supported by kind and attentive staff. Some staff interactions we observed were helpful and caring and we saw and heard care staff being patient and encouraging when supporting people. This showed us staff generally treated people with compassion, kindness, dignity and respect.

However, some people told us of examples where staff had not been respectful to them and two people told us some staff working at the home shouted at them.

People's views and experiences were not taken into account in the way the service was provided and delivered. Staff did not know about people life histories and care and support was not always provided in accordance with peoples' wishes. This was because people's preferences, interests and diverse needs were not recorded or taken into consideration.

Is the service responsive?

The service was not responsive.

Complaints were not fully investigated and responded to appropriately and there was no system in place for capturing complaints or concerns raised verbally. This meant there was no evidence to show whether concerns or issues people raised about their care at the home were dealt with appropriately.

Some activities were available at the home and we saw the care staff encouraging people to join in with them. People who lived at the home were supported to maintain their religious interests. All but one of the people we spoke with knew who the manager or management team were. People who knew them told us they were very visible and approachable.

Is the service well-led?

The service was not well-led.

There was no evidence to show there were effective systems in place at the home for monitoring and assessing the quality of the service people who lived there received. There were no audits or audit schedule in place. The assistant manager told us actions were taken to address issues, but there was no documented evidence to confirm this. This showed us the leadership and management at the home did not have any systems in place to assure the delivery of high quality care.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Accidents and incidents were documented but trends were not monitored and analysed.This meant people who lived at the home may be put at risk of harm.

The home did not promote a fair and open culture where staff felt they were well-led and supported. Staff and healthcare professionals told us management at the home were often resistant to suggestions about improvements and were set in their ways. This showed us the leadership and management at the home did not promote an open and fair culture.

The registered manager at the home was planning to hand over the registered manager role to their son, who also worked at the home as the assistant manager. The registered manager's son told us they had recently applied to the CQC to become the registered manager, and had submitted all the relevant paperwork a week prior to our visit.

16 April 2013

During a routine inspection

During our inspection visit we were able to speak with eight people living at the home and two relatives. These are some of the things they told us.

"In general the home is very good and it is always clean and tidy."

"It's comfortable living here the food is excellent with a good choice."

"It's fantastic living here."

"When you go to breakfast and come back your room is clean and tidy."

"The home totally look after my relative it's lovely here I would recommend it to anyone."

We observed positive interactions between care workers and people using the service and staff spoke with people in a polite and respectful manner.

The three members of staff we spoke with told us they felt well supported by the registered manager and management team. They said they felt confident about raising any personal or work-related issues with them.