Manor Field

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.

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.

Caring – this means we looked for evidence that people are always treated with kindness, empathy and compassion. At our last inspection we rated this key question Good. During our assessment of this key question, the provider failed to ensure people were always treated with dignity and respect. This resulted in a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We assessed 2 quality statements in the caring key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. People were not supported following ‘Right support, right care, right culture’ guidance. People could not always go out when they wanted to. Staff did not always treat people in a dignified way or used undignified language when they referred to people. Staff told us they did always feel supported by the management team. Relatives told us staff encouraged people to engage in activities, however they wished their loved ones went out and about more.

Responsive – this means we looked at evidence that people were always at the centre of how care is planned and delivered. At our last inspection we rated this key question Good. During out assessment of this key question, we assessed 2 quality statements in the responsive key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good.

People were not supported following ‘Right Support, Right Care, Right Culture’ guidance. People were not always supported in a person centred way. Sometimes peoples plans for the day were rescheduled if staff (who could drive) were not available. People did not always have the opportunity to take part in activities outside of the care home during the evenings. The provider worked in partnership with other health professionals to meet people’s goals.

Relatives told us staff supported people to maintain relationships. Staff understood people’s communication needs and used other forms of communication to understand people’s wishes and needs.

Well-led – this means we looked for evidence that the service has an inclusive and positive culture of continuous learning and improvement. At our last inspection we rated this key question Good. During our assessment of this key question, the provider failed to ensure quality assurance processes were effective and the governance and leadership in the service had been inconsistent. This resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A senior manager acknowledged the shortfalls and told us of their plans to make the necessary improvements to ensure people received safe and compassionate care that met their needs and preferences. A new manager had just started at Manor Field and told us they wanted to improve the service for the people living there.

We assessed 4 quality statements in the well-led key question and found areas of concern. The provider had a governance structure in place to monitor the quality of their services. However, this had not always been effective in identifying the shortfalls found at this inspection and improvements were needed. People were not supported following ‘Right support, right care, right culture’ guidance. Systems were in place for staff to raise concerns, however staff told us they had felt that actions from the provider and managers had not always been carried out in a timely manner in response to their concerns. Managers did acknowledge that divisions amongst the staff team still remained at the service and that they continued to work to resolve and improve working relationships. Staff worked in partnership with external services to ensure people were in the best of health. Relatives were positive about their loved ones care and felt staff engaged with them about their loved ones care.