The Manor House Nursing Home

The Manor House Nursing Home is a nursing home providing personal and nursing care to up to 125 people across three adapted buildings. The service provides support to people with physical and mental health needs, some of whom were living with dementia. At the time of our inspection there were 81 people using the service.

People’s experience of using this service and what we found

People were supported by trained staff and felt able to raise any concerns around their care and support. People were supported by enough staff to meet their needs in a timely way. People were supported by staff who understood and were following best practice infection control guidance. People had comprehensive risk assessments in place which supported staff to meet their needs. People were supported to receive their medicines as prescribed.

People were supported by safely recruited staff. People were supported to eat and drink in line with their needs and wishes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported in a clean and homely environment. People had access to health and social care professionals as they required them. People were supported by kind and caring staff who knew them well. People's dignity, privacy and independence was supported.

People had end of life care plans in place. People's preferences were included within their care planning and staff provided support in line with these. People had access to information in a range of formats in line with their communication needs.

People knew who the manager was and were encouraged to give feedback about their care and support. Staff had access to regular supervisions and felt supported. The registered manager completed quality assurance tools to ensure any improvements were identified and action was taken to make these improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 August 2021). At this inspection the service had been rated as good.

Why we inspected

This inspection was prompted by a review of the information we held about this service and feedback shared by the Local Authority.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have made recommendations around the variety of activities.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Manor House Nursing Home is a residential care home providing personal and nursing care to 38 people aged 65 and over at the time of the inspection. The Manor House Nursing Home can support up to 125 people in three adapted buildings. One building accommodates people with general nursing needs. The second building accommodates people living with dementia and mental health needs across three separate floors, each of which has adapted facilities. The third building accommodates people who have recently been discharged from hospital and require assessment of their longer-term needs over two separate floors.

People’s experience of using this service and what we found

People were not always safe as some staff members working practices increased the potential for harm.

The provider had improved their quality monitoring systems however, they could not evidence consistent good practice over time. We will check this during our next planned comprehensive inspection.

People were protected from the risks of ill-treatment and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do if they suspected wrongdoing.

The provider had assessed the risks to people with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

People received safe support with their medicines by staff members who had been trained and assessed as competent. The provider had systems in place to complete an investigation, should a medicine error occur, to ensure the person was safe and lessons were learnt to minimise the risk of reoccurrence.

Staff members followed effective infection prevention and control procedures when supporting people.

People, relatives and staff found the management team to be approachable, supportive and their opinions valued.

The provider had kept the CQC informed about significant events at The Manor House Nursing Home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (Published 29 April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 29 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Manor House Nursing Home is a residential care home providing personal and nursing care to 70 people aged 65 and over at the time of the inspection. The Manor House Nursing Home can support up to 125 people in three adapted buildings. One building accommodates people with general nursing needs. The second building accommodates people living with dementia and mental health needs across three separate floors, each of which has adapted facilities. The third building accommodates people who have recently been discharged from hospital and require assessment of their longer-term needs over two separate floors.

People’s experience of using this service and what we found

People were not protected from the risk of abuse. Incidents were not reported to the safeguarding team. People were exposed to risks from COVID-19 as staff were not following the government guidance. Risks to people’s safety were not assessed and mitigated which exposed them to the risk of harm. Medicines were not given as prescribed and the guidance for staff was not effective leaving people at risk of their health deteriorating. Where people had accidents or incidents occurred there were no actions taken to prevent reoccurrence and people were left at risk of harm

We found significant concerns about the management of the home. The systems were either not in place or not effective to assess, monitor and improve the quality and safety of the service. The system had failed to ensure risks were assessed and mitigated. When things went wrong the provider had failed to analyse incidents and take action to prevent reoccurrence. The systems had failed to ensure people were safeguarded from abuse.

The systems to check on the quality of the care people received had failed to identify the concerns we found which are summarised above.

People were supported by enough staff. However, agency staff were in use which meant people were experiencing inconsistent care. There were improvements needed to how people, relatives and staff could feedback about the service. The provider needed to improve how they engaged with other professionals.

Rating at last inspection

The last rating for this service was requires improvement (published 21 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received about whether people were receiving safe and effective care including a number of allegations raised about people being neglected. We received concerns about the management of risks to people and clinical oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from abuse, managing risks to people’s safety and governance and oversight of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Manor House Nursing Home is a residential care home providing personal and nursing care to 80 people aged 65 and over at the time of the inspection. The Manor House Nursing Home can support up to 85 people in two adapted buildings. One building accommodates people with general nursing needs. The other building accommodates people living with dementia and mental health needs across three separate floors, each of which has adapted facilities.

People’s experience of using this service and what we found

Audit systems were not always sufficiently robust to check the quality of the service or ensure that documentation was consistently personalised to guide staff regarding each person’s individual needs. Accident and incident recording was inconsistent across the units and we could not always see whether trends had been identified so action could be taken to reduce the risk of reoccurrence.

Care planning documentation used did not always promote person centred care and people’s diverse needs were not always documented. Care plans were not always detailed enough to ensure people received personalised support to meet their individual needs. Activity co-ordinators undertook activities with people but not all people were consistently provided with opportunities to access activities of their choice.

People were safe. Systems were in place to keep people safe and staff understood how to keep them safe. People’s risks were assessed and staff understood how to manage risk to people. Staff were supported by a sufficient number of safely recruited staff. Medicines were stored and administered safely. People lived in a clean environment and staff understood how to prevent the spread of infection. Where things went wrong, lessons were learnt and action was taken immediately to reduce the risk of reoccurrence.

People’s needs were assessed and care was delivered in line with their assessments. People were involved in the assessment process. People were supported by knowledgeable and well trained staff who had the skills to meet their needs. People were supported to eat and drink in line with their dietary requirements. People were supported to access healthcare professionals where needed and staff worked together to provide consistent care to people. People’s rooms were personalised with their own belongings.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by kind and caring staff who respected them. People were encouraged to express their views and make decisions about their care. People were supported by staff who respected their privacy and dignity. Staff promoted people’s independence and supported them to do what they could for themselves.

Staff knew people well and understood how to meet people’s communication needs. Complaints were investigated and action was taken to address any concerns. People’s end of life wishes and preferences were discussed with them and advanced care plans were in place.

The provider and registered manager were open and honest with people when things went wrong. People, their relatives and staff were encouraged to feedback regarding the service and were given the opportunity to put forward their views. The registered manager was proactive in learning and encouraged staff to improve their learning in order to provide better quality care to people. The provider worked closely with health and social care professionals to improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated good. At this inspection we found the service remained good.

People receive support from staff that understood how to safeguard them from abuse and help them manage risks to their safety. There were sufficient safely recruited staff to meet people’s needs and maintain their safety. People received their medicines as prescribed and medicines were administered by trained staff that had their competency assessed.

People were supported by staff that understood their needs and had the required skills to meet them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had a choice of food and drinks and support to meet their nutritional needs and preferences. People were supported to maintain their health and wellbeing.

People felt they had good relationships with staff and they told us they felt staff observed their rights to privacy and treated them with dignity and respect. People were given choices and were supported to maintain their independence.

People had their needs met in the way they preferred and were able to spend time doing things they enjoyed. People and their relatives understood how to make a complaint and we found complaints were managed in line with the provider’s complaints policy.

People, relatives and staff all told us the registered managers were approachable and they felt able to raise any concerns and make suggestions about the service. Staff said they received support in their role from the management team. The provider took opportunities to enhance the quality of the service people received through training and development for staff. We found there were systems in place to ensure people received good quality care.

At the time of our inspection 78 people were living in the home. We spoke with staff, visitors and people that used the service who were able to tell us about their experiences. One person who used the service told us: "The staff are very attentive to our needs".

Some people were unable to speak with us either because of frailty or personal preference. We spent time in the units to observe the activity and interactions between staff and people who used the service.

We looked at the care and support records of nine people who were accommodated in different units within the home. We spoke with staff and they told us how they provided care for people each day. The information recorded in the plans corresponded with what staff had told us.

Staff told us their understanding of safeguarding vulnerable people and confirmed they had received training in this. People who used the service told us they did not have any concerns but if they did they would speak with the manager, senior staff or their family.

We saw staff were attentive and prompt when people required help and support. Staff told us that they had received training to help them understand how to meet the needs of people in their care. We saw people took part in a variety of activity that had been arranged during the day.

We saw that records included the care and support needs for the people who used the service.

We spoke with staff about the care and support they provided each day, they offered an explanation of people's individual needs. We looked at a selection of care records to check the care being given to people. We saw some inconsistencies in the recording of people's care needs, some records had not been reviewed or updated within the specified timeframe. People we spoke with told us the care they received was good, they had no concerns. Visitors told us the care provided to their relative was "excellent".

We spoke with staff about their understanding of safeguarding vulnerable adults, they told us what they would do if they had any suspicions of wrong doings. People told us they would speak with staff or a family member if they had any concerns about the care they received.

We saw that staff were present in all areas of the home, they were quick to offer help and support to people when it was needed. People who used the service told us that the staff were very good and helpful. Visitors told us they were fully satisfied with the staff and the way in which the care was provided to their relative.

We saw the service had an effective system for monitoring the quality of the service.