Manchester House 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. Manchester House is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability. There were 65 people accommodated at the time of the inspection.

This was an unannounced inspection which took place over two days on 25 and 26 June 2018.

The last comprehensive inspection was carried out in May 2017 when we found some breaches of regulations relating to safe care and treatment and Governance of the service. We followed up in November 2017 and found improvements had been made and the breaches of regulations were met. We rated the services as ‘Requires improvement’ because we needed to ensure the service could maintain consistent standards over a more prolonged period of time.

At this inspection we found improvements had been sustained. The service accommodates people with a wide range of diverse and complex care needs. Although we highlighted some areas for improvement we found that people living at Manchester House were receiving safe care which also enhanced their quality of life. The management and leadership of the service was more established and consistent.

There was a registered manager 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.

We found the management structure supported the service with clear lines of accountability and responsibility. The auditing and monitoring systems in place had been developed over a period of time and were now fully embedded. This level of monitoring helped identify and reduce risks around safe care and treatment.

At the last inspection in November 2017 we made a recommendation for improvement because we found people were not always being supported in good time with their personal care needs; people told us they had to wait for extended periods of time when using their call bells to call for support. At this inspection we found some improvements had been made but feedback from people remained mixed and we saw that some people continued to present challenges for staff with respect to supporting their personal care needs.

We found people’s risks regarding their health was assessed and monitored. There was improved clinical leadership in the service and there was evidence of effective referral and liaison with supporting health care professionals. Feedback from a visiting health care professional was positive about staff approach and competence in relation to wound care and pressure ulcer monitoring.

We found people were protected against the risks associated with medicines because the provider’s arrangements to manage medicines were consistently followed.

We found the home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). People were being supported to make key decisions regarding their care and treatment. The supporting care plans and assessments evidenced people being consulted and involved in their care. Care plans we saw were clearly written, agreed by people and were being regularly reviewed.

There were ten people who were being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom and ensures that any restrictions are appropriate and in the person’s best interests. We found these were being monitored by the registered manager of the home.

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Manchester House is located near Southport town centre and is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability.

Manchester House 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.

There were 61 people accommodated at the time of the inspection.

We undertook an unannounced focused inspection of Manchester House 28 November and 4 December 2017.The inspection was done to check that improvements to meet legal requirements planned by the provider after our last comprehensive inspection in May 2017 had been made. -The team inspected the service against three of the five questions we ask about services: Is the service well-led; Is the service safe and Is the service caring. This is because the service was not meeting some legal requirements under ‘Safe and ‘Well led’. There were some good practice recommendations made at the last inspection and these were also reviewed and reported under ‘Caring’ and ‘Well led’. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Manchester House Nursing Home’ on our website at www.cqc.org.uk.

This inspection was carried out by two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

At the last inspection in May 2017 the service had been in breach of two regulations. These were with respect to risks regarding people’s health care not being adequately assessed and monitored; this was particularly in relation to wound care, pressure ulcer monitoring and following up on medical recommendations. Also the overall management and governance was ineffective; there was no registered manager in post to provide a lead for the home. There had been changes to the leadership and management of the home which had caused instability for staff and people living there. The action plan submitted by the provider following the previous inspection had not been fully realised and there remained failings in some areas.

On this inspection we found ongoing improvements with management of people’s clinical risk and found the service more ‘settled’ with respect to the governance arrangements by the provider; both of these breaches of regulations had now been met.

There remained an ongoing concern that staff were not responding in a timely manner to people when they called for assistance. This had also been raised at the previous inspection.

Overall, we found the service to be rated as ‘Requires improvement’. This is the second consecutive time the service has been rated Requires Improvement. Prior to this the service had been rated ‘inadequate’ following an inspection in November 2016.

At the previous inspection in May 2017 we found the provider in breach of regulations with respect to assessing people’s risks regarding their clinical care. There had been a number of concerns reported as safeguarding concerns. On this inspection we found the nursing care to have improved with particular reference to management of people with challenging behaviour, pressure ulcer care, people with specific clinical interventions such as nasogastric tube feeding and care of specific medical conditions. We found no outstanding issues of concern regarding people’s clinical care at this inspection. The breach had been met.

At the previous inspection we foun

Located near Southport town centre, Manchester House is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability. Seven of the places beds] at Manchester House were commissioned by the local Clinical Commissioning Group [CCG] to provide short stay enablement and support for people being discharged from hospital.

There were 57 people accommodated at the time of the inspection.

This was an unannounced inspection which took place over three days on 30, 31 May and 1 June 2017. The service was last inspected in October and November 2016 April 2016 when we found five breaches of regulations. The service was rated as ‘inadequate’ and was placed in ‘Special measures’ at that time. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

At this inspection we found improvements overall to the service. Staffing of the home was more settled and three of the previous five breaches had been met. Because of the improvements the overall quality rating has been raised to ‘requires improvement’ and the home has been removed from special measures.

During the inspection we found two continued breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and governance.

We found that some people’s risks regarding their health care were still not being adequately assessed and monitored. This was in relation to wound care, pressure ulcer monitoring and following up on medical recommendations. The provider remains in breach of this regulation.

At the last inspection we found the management structure was not clear and did not support the home with clear Ines of accountability and responsibility. The auditing and monitoring systems in place had been fractured, underdeveloped and not consistently applied. On the inspection we found improvements in these areas but the provider had not fully met their action plan to meet all of the outstanding breaches. There had also been four changes to the management of the home since October 2016 and at the time of our inspection there was no registered manager in place. This did not support effective monitoring of standards in the home. The provider remains in breach of this regulation.

Although still in breach of these two regulations, we found the overall risk reduced from our last inspection.

You can see what action we took with the provider at the back of the full version of the report.

At our last inspection in October / November 2016, we had found the home in breach of regulations relating to safe administration of medicines because people were not always protected by the medication administration systems in place. At this inspection we found improvements had been made. People protected against the risks associated with medicines because the provider’s arrangements to manage medicines were now consistently followed. The breach had been met.

At Our last inspection we had found that the home was not fully operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Although there were examples indicating good practice we found some hesitancy and misunderstanding in particular around the use of the ‘two stage mental capacity assessment’ and when this should be used as part of making ‘best interest’ decisions for people. On this inspection we found improvements had been made. Staff evidenced a better understanding of the principals involved, including an understanding of the need to assess individual decisions relating to c

Located near Southport town centre, Manchester House is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability. Shared areas include two dining rooms and three lounges on the ground floor. A lift is available for access to the upper floor. There is an enclosed garden to the front and rear of the building. A call system operates throughout the home. The home is situated opposite Hesketh Park and is within easy reach of Southport promenade.

This was an unannounced inspection which took place over four days on 24 to 25 October and 28 and 29 November 2016. The service was last inspected in April 2016 when we found four breaches of regulations. The service was rated as ‘Requires Improvement’.

During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, person centred care, consent to care and treatment and good governance. Two of these, person centred care and consent to treatment, where continued breaches of regulations from the last inspection in April 2016.

Following the first two days of the inspection we found the seriousness of the breaches of regulations to pose a ‘high’ risk to people living at Manchester House. We used our enforcement procedures and served an urgent notice telling the provider to take action to put things right. The notice also told the provider to not admit any more people to the home until the areas of risk we identified had been addressed. We visited again on 28 and 29 November 2016 to complete a full inspection and check to ensure people were safe.

We found that the provider had made improvements to reduce the risk to people living at the home. This report and outcome is based on the evidence we found over the four days of the inspection.

There was a registered manager 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.

We found not all medicines were administered safely. We found concerns around the way some medicines such as creams, medicines for pain relief and thickeners added to drinks were administered and recorded which placed people at risk.

We found that some people’s risks regarding their health care were not being adequately assessed and monitored. This was in relation to wound care, pressure ulcer monitoring, accident recording and following up on medical recommendations.

We found people’s written care plans did not contain accurate, up to date information and had not been reviewed in good time. This had been a breach at our last inspection and was still not met.

We found that when people were unable to consent, the principles of the Mental Capacity Act 2005 were not always followed.

Some of the systems for auditing the quality of the service needed further development and did not provide adequate monitoring of standards in the home.

We found the management structure was not clear and did not support the home with clear Iines of accountability and responsibility.

Although these findings were addressed in the short term following the Notice we served and the risk to people reduced, we continue to have concerns regarding the sustainability of standards and will therefore continue to monitor the service closely.

You can see what action we took with the provider at the back of the full version of the report.

We found there was not always enough staff on duty at all times to help ensure people’s care needs were consistently met. This was in relation to nurse cover during the evenings. The provider listened to our concerns and allocated nurse cover for this period. When we asked people about the staffing in the home they told u

This inspection took place on 6 and 7 April 2016 and was unannounced.

Located near Southport town centre, Manchester House is registered to provide accommodation and nursing care for up to 67 older people and younger adults with a physical disability. Shared areas include two dining rooms and three lounges on the ground floor. A lift is available for access to the upper floors. There is an enclosed garden to the rear of the building. A call system operates throughout the home. The home is situated Hesketh park and is within easy reach of Southport promenade.

During the inspection, there were 65 people living in the home. A contract was in place with the local health service to provide short term intermediate care for up to seven people.

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.

People told us they felt safe living in Manchester House and staff we spoke with had a good understanding of how to recognise signs of potential abuse and how to report concerns to help ensure people’s safety.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. People’s emergency evacuation plans did not always provide adequate information to ensure people could be safely evacuated from the home.

We found that medicines were managed safely and staff received training and yearly checks to ensure they remained competent. People told us they received their medines when they needed them.

We looked at how the home was staffed and asked people their views on staffing levels and the feedback we received was mixed. Staff and relatives told us there were usually adequate numbers of staff, and most people living in the home agreed. Some people however, did tell us they did not feel there were always enough staff and they sometimes had to wait short periods of time for support. Our observations showed us that people received support in a timely way during the inspection.

We looked at how staff were recruited within the home and found that checks were made to ensure staff were suitable to work with vulnerable people. These was not always completed fully as risk assessments were not documented when checks identified a potential risk, though the registered manager was aware of the issue and had discussed this with the relevant staff.

We found that consent was not always sought in line with the requirements of the 2005 Mental Capacity Act (MCA). Deprivation of liberty safeguards (DoLS) had been applied for appropriately and people told us they were asked for their consent to care. When people were unable to provide consent, mental capacity assessments were completed, however this process was not implemented consistently and not all capacity assessments we viewed accurately reflected people’s ability to make decisions.

Staff told us they were well supported and were able to raise any issues with the manager when required. Staff received an induction to their role, regular training and supervision to support them to meet people’s needs, but annual appraisals were not always completed.

We found that people’s nutritional needs were met as the home catered for people’s specific dietary requirements and staff provided support to people with nutritional intake when required. Feedback regarding meals was positive; people told us they had choice from a well balanced menu and were able to request alternatives when necessary.

The registered manager told us there were no restrictions in visiting, encouraging relationships to be maintained.

People living at the home told us staff were kind and caring and treated them with respect and relatives we spoke with agreed. We ob

We considered all the evidence we gathered under the outcome we inspected. We used the information to answer the five 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?

Below is a summary of what we found –

Is the service safe?

We found that the provider had an effective process in place to determine the numbers of staff required. The Registered Manager set the staff rotas. They took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met. We saw staff rotas for the current month which evidenced this.

We spoke with six people who lived in the home to gather their views and opinions. Their comments included: “I have no problem getting help. I can go to bed at any time. The staff are on hand. They’re very professional”, “Staff come when I need help, they’re very friendly”, “Staff are very good at answering the buzzer, I don’t have to wait” and “The staff are really good, I get excellent care. I have no concerns at all.”

We spoke with six members of staff. Care staff we spoke with told us the numbers of each shift could fluctuate between four and six staff, but they always managed. A staff member told us they had enough time to do the work they needed to; they usually managed to get a break.

We found the nursing staff spent long periods of time administering medication. One nurse told us in order to ensure people received their morning medication they had to wake them up.

We saw evidence new staff had received an induction and training to support them in their job.

Is the service effective?

This was a responsive inspection to concerning information and we did not look specifically at this area.

Is the service caring?

This was a responsive inspection to concerning information and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to concerning information and we did not look specifically at this area.

Is the service well led?

This was a responsive inspection to concerning information and we did not look specifically at this area.

We considered our inspection findings to answer 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.

Is the service safe?

The people we spoke with told us staff were caring and treated them with kindness and respect.

The home was clean, hygienic and odour free. Measures were in place to ensure the environment was safe and suitable for the people who were living there.

Although a busy home, both people who were living there and staff told us there was enough staff on duty to ensure people’s safety. The manager set the staff rotas; they took people's care needs into account when making decisions about the numbers of staff required. This helped to ensure that people's needs were always met. People we spoke with confirmed this.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection there were no Deprivation of Liberty Safeguards (DoLS) in place. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People’s health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People’s care plans reflected their current needs.

Where specialist support was needed, for example, with a person’s nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people’s health, well-being and independence.

Is the service caring?

People told us they were supported by kind and attentive staff. We observed staff supporting people in a caring, friendly and respectful way. A person living there said, “It’s very, very good here; I am happy here.” Another person told us, “I have everything I need.”

Staff were knowledgeable about people’s preferences, interests and diverse needs so care and support was provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint or raise a concern if they were dissatisfied with something.

From our discussions with staff and looking at a number of care records we could see that people’s plan of care was revised to meet any change in need, for example, deterioration in a person’s medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

In this report the name of a Registered Manager appears who was not in post and not managing the regulatory activities at the location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. We informed the new home manager of the importance of being registered with the Care Quality Commission [CQC]. They informed us they had recently submitted an application to us for this position.

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

Staff we spoke with said they received good quality training. Staff were currently attending mandatory training courses to update their knowledge. They had all received one supervision session in January and February 2014 since the new provider took over in December 2013. This helped to ensure that people received a good quality service at all times.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.