CQC report explained · a nursing home
What the CQC found at London and Manchester Healthcare Limited
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Inspectors found that risks were assessed, equipment was maintained, staffing and recruitment were safe, and infection control arrangements were satisfactory. However, medicines instructions and records were not always complete, and medicine intervals were not always followed.
- Effective?
- Good
- This key question was not inspected during this visit. The report says ratings for key questions not inspected were taken from the last inspection.
- Caring?
- Good
- This key question was not inspected during this visit. Inspectors did observe caring and patient support, and people appeared comfortable with staff.
- Responsive?
- Good
- This key question was not inspected during this visit. The report says care plans were person centred and reflected people's choices and needs.
- Well-led?
- Good
- The home had regular audits, supportive management and systems for learning from incidents and previous inspections. Relatives and staff spoke positively about communication and the atmosphere in the home.
What inspectors found, April 2023
Rated Good overall; inspectors found caring support and better management, but medicines records and administration were not always safe.
Inspectors made an unannounced visit on 23 March 2023. They spoke with people living in the home, visitors and staff, and reviewed care records, medicine records, recruitment files and management documents.
The home had improved since its previous inspection. Medicines were managed more safely and the home was no longer breaching the regulation about safe care and treatment. However, inspectors still found several medicines problems, including missing instructions, incomplete records and doses not always being given at the correct intervals.
People were supported by staff who were described as kind, patient and caring. Care plans and risk assessments were detailed and regularly reviewed. The home was clean, staff recruitment was safe, and there were enough staff on duty during the visit.
The overall rating was Good. Safe was rated Requires Improvement and Well-led was rated Good. The inspection focused on these areas, so other key-question ratings were carried over from the previous inspection.
Person-centred care
Care plans and risk assessments contained detailed information about people's needs, wishes and risks. They were reviewed and updated when needed.
“Care plans and risk assessments were person centred and detailed how people wished and needed to be cared for; these were regularly reviewed and updated as required.” from the report
Kind and patient support
Inspectors saw staff supporting people in a caring and patient way. People appeared comfortable with staff and positive relationships had developed.
“We observed support being provided in the home and saw this was done in a caring, responsive, and patient manner.” from the report
Improved leadership
Management had improved services since the previous inspection. Audits and lessons learned were used to identify and address problems.
“The provider and registered manager had used the findings from previous inspections to build and improve on the quality of care.” from the report
Clean and well-maintained home
Inspectors were assured that infection prevention arrangements were effective. Visitors described the home as clean, tidy and free from unpleasant smells.
“All visitors we spoke with could not praise the home enough on cleanliness, that there were no odours and was very well maintained.” from the report
Incomplete medicine instructions
seriousInstructions were not always up to date for medicines crushed for covert administration or given through a tube. Instructions for some medicines given when needed did not explain clearly when or why to give them.
“Where medicines needed to be crushed prior to administration to be given covertly in food or drink or to be administered via a tube, (PEG), there was not always up to date instructions” from the report
Medicine records and timing
seriousStaff did not always record when thickened fluids were given to people at risk of choking and aspiration. Some medicines that needed an interval between doses were not always given with that interval.
“Staff were not always consistently recording when thickened fluids were being given to people at risk of choking and aspiration.” from the report
- 01What has the home done to update instructions for medicines given covertly, through a PEG tube or when needed?
- 02How does the home check that thickened fluids are recorded every time for people at risk of choking or aspiration?
- 03How does the home make sure medicines needing an interval between doses are given at the correct times?
- 04How are staff checked as competent in medicines administration, and how often are their records audited?
- 05Which ratings are from this inspection and which ratings have been carried over from the previous inspection?
This was a focused, unannounced inspection of Safe and Well-led; the other key-question ratings were not inspected and were carried over from the previous inspection. This explanation was written from the published report of 13 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2021
Requires Improvement; inspectors found safer infection control and staffing, but medicines management remained unsafe and the home was still in breach.
This was an unannounced follow-up inspection on 17 November 2021. Inspectors reviewed care and medicines records, staff recruitment files, management records and infection control. They also spoke with people living in the home, relatives, staff and health and social care professionals.
The home had improved since its previous inspection, which was rated Inadequate. Infection control, risk assessments, staffing and management oversight had improved. However, medicines were not always stored, recorded or administered safely. Records of people's food, fluids and health monitoring also had gaps.
The overall rating is Requires Improvement. The home is no longer rated Inadequate or in Special Measures, but inspectors found an increased risk that people could be harmed and required further improvements.
Improved infection control
Inspectors were assured that infection prevention arrangements had improved. This included the use of protective equipment, testing, cleaning and visiting arrangements.
“We were assured that the provider was using PPE effectively and safely.” from the report
Enough staff
Recruitment records contained the required checks, and inspectors saw an appropriate number of staff on duty.
“During the inspection we saw that there appeared to be an appropriate number of staff on duty.” from the report
Improved leadership
A new management team was in place. Staff and the local authority gave positive feedback about the culture and support from managers.
“the culture at the home was one of positivity and that the management team were supportive and approachable.” from the report
Better care information
Care files contained appropriate information about people's health needs, and risk assessments had been updated.
“Each care file we looked at now held appropriate information about people's health needs.” from the report
Medicines were not always safe
seriousReturned medicines were not always stored securely. Fridge monitoring, medicine administration records, new admissions checks and some instructions for hidden medicines were not reliable.
“Not enough improvement had been made at this inspection and the provider was still in breach of regulation 12 in regard to safe management of medicines.” from the report
Health monitoring records had gaps
needs fixingSome nutrition and fluid charts were incomplete. Inspectors also found that professional advice about a person's thickener had not been followed, creating a choking risk.
“There continued to be gaps in people's monitoring information for example nutrition and fluid intake charts.” from the report
Changes in staff and managers
minorFamilies expressed some concern that changes to managers and staff had affected continuity of care.
“comments we received from families indicated that there was a slight concern regarding the changes to the management team and staff and how this impacted continuity of care.” from the report
- 01How have you fixed the problems with secure storage and monitoring of returned medicines and medicine fridges?
- 02How do you now check that Medicine Administration Records are signed correctly and that medicines have been given safely?
- 03How are medicines checked when a new person comes into the home?
- 04How do you check that nutrition and fluid charts are complete and that health professionals' advice is followed?
- 05What steps have you taken to improve continuity of care after changes to the management team and staff?
This was a follow-up inspection focused on Safe and Well-led, with infection control also checked; the other key-question ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 3 December 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of London and Manchester Healthcare Limited
5 rated inspections over 8 years: the service has held its Good rating throughout.
- April 2023Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at London and Manchester Healthcare Limited →
- December 2021Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at London and Manchester Healthcare Limited →
- May 2021Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- March 2018Goodstayed GoodSafe: GoodWell-led: Good
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- August 2011
Registered with the Care Quality Commission on 3 August 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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