Ealing Manor Nursing Home

Ealing Manor Nursing Home is a care home for up to 33 older people with nursing needs. At the time of our inspection, 30 people were living at the service. Some people were living with the experience of dementia.

The care home was owned and managed by a private partnership, and this was their only care home.

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

People using the service were happy and well cared for. They had been involved in planning their care and staff understood their needs and supported them well. People had access to healthcare services and the staff monitored changes in their conditions and needs. They had enough to eat and drink and took part in a range of different social activities.

Staff assessed risks to people's safety and wellbeing and planned for these. They provided support for people to have their medicines as prescribed and monitored any accidents or incidents to make sure people were safely cared for.

People were cared for by enough staff and did not have to wait for care. Staff were well trained and supported. Procedures for recruiting staff made sure they were appropriately qualified and had the right attitude and skills.

The registered manager and provider had a good understanding of the service and their regulatory requirements. They had systems for monitoring quality and for investigating complaints and safeguarding alerts. People using the service, staff and visitors felt the management team were approachable and responsive.

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.

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 7 March 2020). 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.

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.

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.

Ealing Manor Nursing home is a care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

Medicines were not always well managed which meant some people did not always get their medicines as prescribed.

The home had a safeguarding policy however it had not been updated since 2011 which meant the registered manager had not always kept up to date with national guidance on safeguarding adults. We made a recommendation to the provider about this.

There were not always adequate numbers of staff deployed to provide appropriate care and support to people. Sometimes people had to wait to be supported to eat and people's dignity was not always maintained.

The home was undergoing a schedule of works to modernise the building however the provider had not ensured the design was dementia friendly despite many of the people living with dementia. We made a recommendation to the provider about this. The induction process of new staff did not clearly state what training they had completed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s end of life wishes were recorded but the information was at times not very clear to make sure staff had all the information they needed to care for people appropriately. The provider did not ensure people’s communication needs were always being met as information was not always in an accessible format.

Since the last inspection the provider had developed some quality audits to monitor the service however, these had been ineffective because they had not identified the issues we found during our inspection.

Staff were aware of their responsibilities in relation to the reporting of abuse within the safeguarding policy. Staff understood how to prevent the spread of infection by using protective clothing such as aprons and gloves.

Accidents and incidents had been recorded and analysed to ensure lessons were learnt to prevent reoccurrence, including the action taken following an incident.

New staff trained and worked alongside experienced members of staff till they were competent. People were happy with the care they received, and they felt staff had the appropriate training and support. Families commented positively about the care their relatives received.

People's needs were assessed prior to them moving into the home. This helped to ensure the provider had the necessary information to decide if they could meet people’s needs and to plan their care accordingly. People’s health was well managed and If people became unwell staff took appropriate action.

The home had a complaints procedure and there had been no complaints since the last inspection. The registered manager and the provider acted promptly to rectify areas identified as needing improvement during the inspection. The home conducted regular staff meetings and staff told us this was a good way to keep informed of the changes in the 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 requires improvement (published 16 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, need for consent, person centred care, staffing and good governance. Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

At our previous inspection on the 18 September 2017 we found a breach of the regulations in Good governance. This was because not all risks were being identified and appropriately mitigated by the registered person.

Following the last inspection, the provider had completed an action plan to improve the key questions of ‘is the service safe, responsive and well-led?’ to at least good. They told us measures would be in place by 8 January 2018. During this inspection we found the measures had been put in place and there was a good standard of risk assessment with guidance for staff that was detailed and thorough about minimising the risks.

Ealing Manor Nursing Home provides nursing care for up to 33 older people and younger adults with a physical disability. It 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. At the time of our inspection 32 people were living at the home.

There was an experienced 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.

During the last inspection we found that there were not sufficient activities for all people living in the home to enjoy. At this inspection we saw this had been addressed. There was evidence of varied activities and people who remained in bed had regular staff interaction throughout the day.

During this inspection we found that some records were not being kept in a robust manner for people’s ongoing safety. This was because there were not always weekly fire alarm check recordings that demonstrated the alarms had been tested and were in working order. In addition, deep cleaning of the premises were not recorded so their regularity and effectiveness could be evidenced during audits and checks.

There were some infection control and some medicines management issues that were identified during the inspection. These were addressed by the registered manager on the day of inspection.

There was a programme of redecoration and this had refreshed the look of the premises. However, some window restrictors and other implements had been removed during the redecoration work and had not been replaced. This was brought to the registered manager’s attention and they were replaced the same day.

People and their relatives described staff as caring and kind. We observed care was offered in a polite and respectful manner. People were supported to be as independent as possible by staff.

The registered manager and staff could recognise signs of abuse and reported concerns to the appropriate authorities. The registered manager held reflective meetings when errors had occurred to promote good practice and to help ensure mistakes did not reoccur.

Medicines were administered appropriately and although we identified a few minor errors the registered manager audited monthly and addressed any errors with the nursing staff.

Staffing levels were assessed by the registered manager who ensured there was a suitably skilled staff team. Staff absence was covered by known bank staff. Recruitment processes were safe as checks were undertaken to ensure staff were of good character before they were employed. Staff were provided with an induction and ongoing training to equip them to undertake their role.

The registered manager worked in line with the Mental Capacity Act 2005 and applied for authorisations to deprive people of their liberty appropriately when this was indicated and people lacked the capacity to decide about their care and treatment. Also in line with legislation and good practice, they assessed people’s care needs prior to offering them a service.

People told us they enjoyed the food served and had their choice of meals. Drinks were served on a regular basis.

People found the registered manager very visible and approachable. They felt they could raise concerns and that the registered manager would take appropriate action.

The registered manager kept their own knowledge updated and worked in partnership with health and social care professionals for the benefit of the people living at the service.

Ealing Manor Nursing Home provides nursing care for up to 33 older people and younger adults with a physical disability.

At the previous inspection in August 2015 they were rated ‘Good’. At this inspection we have rated the home ‘Requires improvement’. This is because we found that although people had individualised risk assessments to keep them safe, some risk assessments were not in place to fully ensure their safety. We brought this to the attention of the registered manager and provider and they ensured these were completed immediately.

In addition there was a lack of stimulating activities for people. We have made a recommendation for the provider to review the provision of person centred activities for both people who wished to attend planned activities and those remaining in their bedrooms.

The provider had quality assurance systems in place however these had not identified the concerns we found during our inspection. Therefore, we found a breach of the regulations with regard to good governance.

People and their relatives spoke very positively about the 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. The registered manager was visible and active in the home and everyone we spoke with including staff found them approachable. People and their relatives described staff as caring. We saw some sensitive and gentle interactions between staff and people.

People’s support needs were assessed prior to admission to ensure the home could meet their needs and to ensure there were enough staff to provide a quality service. The staff team was well established and were familiar to people. The staff recruitment procedure was robust to ensure the safety of people who use the service.

People’s care plans contained their views and stated how they wished to be supported. Staff reviewed care plans on a regular basis. People were appropriately supported when they reached the end of their lives because the provider had suitable arrangements in place for this purpose..

People told us they felt safe living at the home and the registered manager had reported safeguarding adult concerns appropriately. Staff had received safeguarding adults training so they knew what to do if they suspected people were at risk of abuse.

Nursing staff administered people’s medicines and medicine administration records were completed without errors or omissions.

Staff had received infection control training and were provided with disposable protective equipment to help prevent cross infection.

The registered manager and provider understood their responsibilities under the Mental Capacity Act 2005 and applied for Deprivation of Liberty Safeguards appropriately. People were supported to make choices by staff who gained people’s consent before offering care. The policies and systems in the service supported this practice.

Staff received a thorough induction and appropriate training and support to undertake their role.

Staff supported people to access the appropriate health services in a timely manner. There was close liaison between the service and the palliative care team.

People were supported to eat a nutritious and healthy diet and remain hydrated.

People and staff said they felt comfortable in raising concerns and knew how to complain. Auditing and checks took place to ensure the quality of the service.

The service worked in partnership with health professionals and asked for feedback to monitor and assess the quality of the service provided so they could make any identified improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The staff conveyed an in-depth knowledge of each person's needs and how they liked to be supported. We saw the people who use the service and the staff had developed positive relationships with each other and there was good communication and a relaxed atmosphere within the home.

People were involved in identifying their preferences and wants. This was reflected in the support plans that detailed how people liked to live their life and how they were supported with this.

People were supported to maintain a balanced diet and were provided with a variety of foods that reflected the needs of people who use the service.

People received support for their needs from the service and from external health and social care professionals. Within the home they were supported by sufficient levels of staff, which was flexible to meet people's individual needs.

Staff supported people in a professional and friendly way. People were offered choices about the food they ate at lunchtime and whether they took part in activities during the day. People also told us they were involved in making decisions. One person told us "I choose to stay in my room. I can go to the lounge if I want but I'd rather stay here. Staff are always popping in to check on me' Another person said "the food is always very good and there's always a choice."

We spoke with eight staff who were able to tell us about how they maintained people's dignity, respected their privacy and gave them choices. They told us there were always enough staff to care for people. Their comments included "I love working here. We work together to make sure people are looked after.' Another person said "we do all the training every year.' Staff we spoke with were aware of the risk of abuse and gave appropriate answers when we asked what they would do if they thought a person using the service was at risk.

The provider had arrangements in place to make sure people were cared for safely. Appropriate checks were carried out before new staff were appointed and complaints were responded to appropriately.