About the service: Manton Heights is a care home that is registered to provide nursing and personal care. It supports to up to 91 older people, some of whom are living with dementia, and adults of all ages with an acquired brain injury. Although registered to provide it, Manton Heights was not providing nursing care. The service is provided across four units, one just for people with an acquired brain injury, a second for people living with dementia and two units for people who have residential care needs.

People’s experience of using this service:

We found significant improvements had been made to the service since our last inspection. The registered manager, with the support of a new deputy manager, had worked very hard to address the issues identified at the last inspection. They had put measures in place to embed good practice within the culture of the service. A staffing restructure, including the appointment of several new staff had supported this process. The provider had started work with a leading dementia care expert to drive a new dementia care strategy across the whole organisation. This showed the provider was committed to developing the service in line with recognised good practice guidance.

At the last inspection, the unit for people living with an acquired brain injury was not running yet. At this inspection the unit was now running having opened in November 2018.

People told us they felt the care and support they received at Manton Heights was safe. Risks to people were identified and monitored. Clear guidance was in place for staff on how to support people with these risks.

Staff understood their responsibilities to safeguard people from harm and how to report their concerns internally and externally to local safeguarding authorities.

Staff treated people kindly. There was a significant improvement in the way staff spoke with people. People`s personal information was kept confidential and their dignity and privacy was promoted and respected by staff.

Care plans had been fully updated and significantly improved since the last inspection. They were detailed and personalised to give guidance to staff on how to support people effectively. Where people displayed behaviour that might be perceived as challenging, clear guidance was in place to support staff to work positively with the person.

Medicines, including ‘as required’ medicines. were managed safely and people worked with other healthcare professionals to meet people’s health related needs.

People were encouraged to eat a healthy balanced diet and to have enough to drink.

People and their relatives were involved in discussions about their care.

Staff encouraged people to maintain their interests and take part in activities, and most people felt they had enough to do.

There were enough staff to meet people`s needs. Staff had regular supervision and training in subjects considered essential by the provider to develop their skills and knowledge. Staff had additional training in relation to people’s specific support needs, such as dementia.

The provider`s governance systems and processes had improved and the registered manager had a clear plan in place to continue to develop these systems to support ongoing improvements.

Rating at last inspection:

At the last inspection in June 2018 the service was rated ‘Requires Improvement’ with one domain (caring) rated as inadequate. We found several breaches of regulations. Improvements were needed in the care of people living with dementia, particularly where people displayed behaviour perceived as challenging, the way staff treated people, the management of ‘as required’ medicines, the way incidents were managed, how staff training was embedded and the management oversight of the service. We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made improvements and there were no breaches.

Why we inspect

We carried out an unannounced comprehensive inspection on 06 June 2018. During our last comprehensive inspection in September 2015 we rated the service as ‘Good’. During this inspection the rating changed to ‘Requires Improvement’. This is because we identified some improvements were required to ensure the service provided a good quality service to people who lived there. This is the first time the service has been rated Requires Improvement.

Manton Heights is a ‘care home without nursing’. 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.

Manton Heights accommodates up to 79 people in one purpose built premises across three separate units. There is a fourth unit which is currently not in use. One unit is primarily for people with needs related to living with dementia and the other two units support people with residential needs. At the time of the inspection there were 64 people living at the home.

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.

The provider had effective recruitment processes in place. Although we identified some gaps in the employment history for some staff, administrative staff were aware of this and work was underway to address this. There were sufficient numbers of staff to support people but some lacked the skills and knowledge to do this safely and effectively.

Staff understanding of their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) required improvement. Staff did not always gain people’s consent before they provided care or support to them.

Risk assessments were in place that gave guidance to staff on how risks to people could be minimised without compromising people’s independence. However, these lacked detail in some instances and were not always regularly reviewed.

Staff supervision was provided regularly. However, training to enable staff to support people well was not up to date and some staff lacked skills in relation to people’s specific needs.

Staff engagement with people was varied; some staff spoke kindly and were respectful to people whereas others were task orientated and were not respectful in all their communications with people.

Care plans took account of people’s individual needs, preferences, and choices but lacked sufficient detail to ensure staff were able to meet people’s needs well in all areas.

The provider’s values were not known or understood by all staff and the culture was task oriented and did not put people at the heart of the service. The registered manager aimed to promote a person-centred culture within the service but a clear strategy for how this would be achieved was required.

The provider had quality monitoring processes in place to ensure they were meeting the required standards of care, but although many of the issues identified at this inspection had been identified, action towards achieving the necessary improvements was not clearly in evidence.

People were supported to pursue their interests.

The provider had a formal process for handling complaints and concerns.

Medicines were administered safely and people were supported to access health and social care services when required.

We carried out an unannounced comprehensive inspection of this service on 21 and 22 September 2015. After that inspection we received information about concerns in relation to the service. We had identified that the incidents of falls people experienced within the service had increased. Concerns had been raised about this, in conjunction with the numbers of staff deployed within communal areas of the service. As a result we undertook a focused inspection on 8 November 2016 to look into those concerns.

Manton Heights Care Centre is a purpose built care home with accommodation provided from three units over two floors. The home currently provides residential care for older people and people with dementia care needs. On the day of our visit, they were providing care and support to 71 people.

The service had 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 that risks to people’s safety had been assessed, with plans in place to mitigate these, particularly in respect of falls. Staff had taken into account the risks to which people were exposed and had worked hard to ensure areas were free from obstacles and that equipment was well maintained. People had risk assessments which identified the hazards they may face and which provided guidance to staff on how to manage any risk of harm.

Accidents and incidents were recorded and the causes of these overviewed and analysed, so that preventative action could be taken to reduce the number of occurrences.

There were appropriate numbers of staff on duty, at day and night, to ensure that people’s needs were met in a safe and timely manner.

We inspected Manton Heights Care Centre in April 2014; following concerns raised through our website and by the local authority. We found them to be non-compliant in care and welfare, safeguarding, medication management, staffing and quality assurance. During our follow up inspection in June 2014, to determine if compliance had been achieved, we found further non-compliance in infection control and nutrition and issued enforcement action against the provider so that action would be taken to address these concerns.

We re-inspected in August 2014 and found that the provider had achieved compliance in care and welfare, medicines management, infection control, nutrition and quality monitoring. In order to ensure that action had been taken to address the remaining outstanding non-compliance, that we did not check in August 2014, we inspected the service again in September 2014, to review the management of safeguarding and staffing at Manton Heights Care Centre.

The inspection was conducted by two inspectors. At the time of our inspection, there was no registered manager but the service had employed a new manager who was due to commence employment in October 2014. We spoke with the deputy manager, six care workers, two ancillary staff, two people who lived in the home and one relative. We looked at staff rotas, safeguarding records and policies and procedures.

During this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer our key questions that were relevant to the outcomes we looked at; Is the service safe? Is the service effective? Is the service caring? Is the service responsive?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Care staff had been trained in the safeguarding of vulnerable adults and were aware of the processes they should follow should they have safeguarding concerns. We found that risk assessments had been undertaken for staff and people with particular needs and requirements to ensure they remained safe.

Emergencies measures were in place and the people who lived in the home had personal evacuation plans.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered and had noticed an improvement over recent weeks.

Is the service caring?

We found that the people who lived at the home were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. Requests for assistance were responded to promptly.

Is the service responsive?

We found that the numbers of staff on duty enabled them to provide timely support for people and to meet people’s needs effectively. Staff told us that the home was much calmer and that they now had time to spend with people and “do everything we need to.”

We considered all the evidence we had gathered under the outcomes we inspected during our inspection at Manton Heights Care Centre. 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 to people's needs?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

All of the people we spoke with told us they felt safe living at Manton Heights Care Centre. One person said, “The staff have time for us now.” A visitor told us that the service was calmer and they felt more attention was given to their relative. We observed that plans of care included risk assessments to promote people’s safety, such as assessments for malnutrition, the risk of falls and moving and handling assessments. We also observed staff used safe moving and handling techniques.

Staff understood infection control processes and demonstrated how they would reduce the spread of infection.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DOLs). We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. They had sought appropriate advice from the local authority following the recent changes in guidelines.

Is the service effective?

Steps were taken to involve people in making decisions about their care and support by involving them in their care planning. It was clear that people had stated their preferences, particularly in relation to their food likes and dislikes and their preferred name.

Staff we spoke with had a good understanding of people’s needs and knew how they preferred to be supported. This meant people were supported appropriately in relation to their needs

Is the service caring?

Staff now spent time interacting with the people who used the service and were able to provide a range of activities to stimulate them. This was particularly noticeable in the area of the home where people lived with dementia.

We saw evidence that staff sought the support of care professionals, for example a G.P. correctly.

Is the service responsive?

The staff team had received updates of their training to ensure they had the experience and qualifications to meet people's needs. This had been achieved in part by moving people with high needs to more suitable accommodation, following the last inspection.

During our inspection we observed that call bells were answered in a timely fashion and any requests from people were responded to. This meant that there was minimal delay in people receiving the attention they needed.

Activities were planned to help stimulate people and people told us these were varied and catered for all interests. One person said, "I don't know what scrabble is and I can learn."

Is the service well- led?

The service did not have a registered manager. However, recently a new manager had been employed and was committed to remaining until a registered manager was in post.

Quality assurance procedures were in place, however, they had not been in place long enough to prove their effectiveness and will be tested during future inspections.

During our visit to Manton Heights Care Centre on 12 September 2013, we observed a friendly environment, with positive interactions between staff and residents. People looked relaxed and well cared for, and we saw staff took time to talk with people.

At the time of our visit, 53 people were living in the home. We spoke with 11 people, and used a number of methods to help us understand the experiences of those people who could not talk to us, including observation and talking with people's relatives and care staff.

Two people's relatives said they were happy with the care provided. People who were able to speak with us told us they felt cared for and supported by staff. Two people said the care was "wonderful", and one person said, "I really like the staff here; they are so kind and caring.”

We noted there was a policy for the management of medication and saw staff had received training before administering medication.

Staff said they felt well supported at work and that the home manager was approachable. They also said they received some planned supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust quality assurance process. Both staff and people told us they would feel able to raise any concerns or issues that they had.

We observed evidence of effective record keeping and were given free access to all information we required as part of this inspection.

We visited Manton Heights Care Centre on 14 January 2013 to review improvements within the home following the enforcement action we took against the provider in October 2012. A new management team had been employed since our last inspection and a number of staff changes had occurred.

During this inspection we found a very different environment which was welcoming, relaxed and friendly. We observed positive engagement and interactions between staff and residents. The home had been divided into two units, one for people with residential needs, and one for people with dementia needs. Previously all people had been in one area and staff had not been able to meet their needs.

We spoke with eight of the 13 people using the service who told us they were happy with the care and support. One person said “the staff are much more caring, and really understand our needs; it wasn’t like that before”. Another person said “they’ve made good improvements; I feel as if staff now like looking after us”.

We spoke with two people’s relatives who said they had noticed improvements in the home. One person said “It’s such a relief to feel you can trust the care now given.”

We also spoke with all staff on duty, some of who had been employed recently, others who had worked in the home at the time of our last inspection. Staff told us they were happy working there, the atmosphere was relaxed and staff got on well together. Three staff independently told us they “loved coming to work.”

When we visited Manton Heights on 17 July 2012 we spent time talking with people and observing the care given to them.

We spoke with four out of the eleven people currently living at the home.

People said the staff were helpful and took their time when assisting them. We were informed by people that they were happy living at the home.

People told us the food in the home was very nice and they always had a choice.

We were told that food and drink was plentiful and you could have snacks and drinks when you wanted.

We were informed by people that they felt safe in the home and if they were unhappy they would talk to one of the staff or the manager.

Manton Heights Care Centre is a purpose built care home with accommodation provided from three units over two floors. The home currently provides residential care for older people and people with dementia care needs. On the day of our visit, there were 62 people living in the home.

The inspection was unannounced and took place on 21 and 22 September 2015.

The service did not have a registered manager although the manager, who was new in post, had submitted their application to the Care Quality Commission (CQC) to become 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 felt safe in the service and confirmed that staff kept them secure and free from harm.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse.

Risks to people were identified and plans put into place to enable people to live as safely and independently as possible.

Accidents and incidents were recorded and the causes of these were analysed so that preventative action could be taken to reduce the number of occurrences.

Robust checks took place in order to establish that staff were safe to work with people before they commenced employment.

There were sufficient numbers of staff available to meet people’s care and support needs.

There were effective systems and processes in place to manage people’s medicines.

Staff understood their roles and responsibilities in relation to the provision of care for people. They were supported by the manager to maintain and develop their skills and knowledge through on-going supervision and regular training.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People had choice of good, nutritious food that they enjoyed. We found that people’s weight was monitored, with appropriate referrals made to the dietician when concerns were identified.

Referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being.

Staff cared for people with warmth and compassion.

Relatives were involved in the review of people’s care needs and were kept informed of any changes to a person’s health or well-being.

There were regular meetings for staff which gave them an opportunity to share ideas, and give information about possible areas for improvements to the manager.

People and their relatives knew who to speak to if they wanted to raise a concern. There were appropriate systems in place for responding to complaints.

The service was led by a manager who was well supported by a robust management structure.

The manager and staff told us that they wanted to provide good quality care for people. As a result, quality monitoring systems and processes were used effectively to drive future improvement and identify where action needed to be taken.