Spetisbury Manor

Spetisbury Manor is a residential care home providing personal care for up to 25 people older people. At the time of our inspection there were 16 people using the service.

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

People, relatives, staff and professionals spoke positively about the culture and atmosphere in Spetisbury Manor. All felt it was a pleasant place to live and work.

People felt safe living at the home and their relative’s expressed confidence in the quality of care their family member received.

People had personalised risk assessments to help reduce risks in their lives and general risk assessments were undertaken to help ensure the safety of people and visitors.

There were enough staff on shift to meet people’s needs in a timely way. People received their medicines on time and as prescribed from staff with the relevant training and ongoing competency checks.

People had personalised care plans which were regularly updated to help staff provide care that recognised people’s needs, abilities and preferences. People’s communication needs were known and met.

People and staff knew how to complain and felt they would be listened to. Complaints were managed in line with the home’s complaints policy.

People had the opportunity to take part in a range of group and one to one activities which recognised their abilities and interests. Relatives were encouraged to visit the home and told us they were always made to feel welcome and involved.

People, relatives, staff and professionals felt the home was well managed and spoke highly of the manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Staff told us they felt supported, appreciated and enjoyed working at the home. They were encouraged to develop new skills and obtain further qualifications.

The home had developed and maintained links with other organisations and the local community.

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 27 February 2020).

Why we inspected

We received concerns in relation to the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the well led section of this 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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

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

Follow up

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

Spetisbury Manor is a residential care home providing personal care to 14 older people at the time of the inspection. The service can support up to 25 people. Accommodation is over three floors and includes specialised bathing facilities, in house laundry and catering.

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

People were supported by staff who understood their role in recognising and reporting concerns about suspected abuse or poor practice. People had their risks assessed and staff understood the actions needed to minimise avoidable harm. Staff practices protected people from preventable infections. Medicines were administered safely as prescribed. Staffing levels met the needs of people. by Staff had been recruited safely, ensuring they were suitable to work with older people.

Staff received an induction, support and on-going training that enabled them to carry out their roles effectively. People had their eating and drinking needs understood and met. Working with other professionals such as district nurses, dentists, audiologists and physiotherapists supported people to live healthier lives and have good healthcare outcomes. The design of the building enabled people to have access to both private and social space and level access to a garden.

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 described staff as caring and told us they had their dignity, privacy and independence was respected. People felt involved in decisions about their care and day to day lives. Staff understood people’s individual communication needs and were knowledgeable about their life histories and the family and friends important to them.

Care plans gave clear guidance on people’s care needs and choices and were understood and followed by the care team. People were involved in end of life planning which reflected their cultural and spiritual needs. Activities were specific to people’s interests and included daily newspapers, quizzes, exercise classes, church visits and music. A complaints procedure was in place that people were aware of and felt, if they needed to use it, they would be listened to and actions taken.

The service was being managed by an acting manager whilst a registered manager was being recruited. Staff spoke positively about the management of the home describing an open culture that enabled them to share ideas and promote person centred care. Quality monitoring processes were effective in ensuring regulatory standards were being met and capturing and acting upon feedback from people, their families and the staff team.

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

Rating at last

The last rating for this service was good (published 29 March 2019)

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 time of this inspection there were 11 people accommodated at the home. The service had been without a registered manager for nine and a half months; however, a new manager had been appointed. They had just finished their 5 week induction and were in the process of registering to become 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.

This focused, unannounced inspection was carried out on 10 December 2018 by two inspectors. The inspection was carried out because concerns had been raised about the management of the home and the care people received. The concerns were not substantiated at this inspection, although some areas for improvement were identified. The management team took immediate action to address the issues we identified.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The management team had systems in place that ensured most aspects of safety were addressed to promote safety in the home. Some hazards were identified during the inspection and the management took immediate action to address these.

The delivery of people's care had also been risk assessed to make this as safe for people as possible.

Staff were recruited in line with robust policies and all the necessary checks had been carried out by close of the inspection.

Medicines were well-managed and people received their medicines as prescribed by their doctor.

Staff had received training in safeguarding and were aware of their responsibility to report concerns.

Records we asked to see during the inspection were up to date and readily available on request.

Since the last inspection, the registered manager had ceased working at the home and a new manager had been appointed. They were in the process of registering to become registered manager and had kept us informed of progress. The period when there was no registered manager in post had led to some lack of leadership and instability in the running of the home.

There were auditing and monitoring systems in place seeking overall improvement. These could be improved to ensure that all areas of safety were addressed and actioned.

Spetisbury Manor is registered to provide accommodation for up to 26 people who require personal care. At the time of our inspection there were 16 older people living at the service. The home provides single room accommodation over two floors with the facilities to provide shared accommodation when required. Rooms have en-suite facilities and there is also a specialist bathroom on each floor.

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.

People were at risk of not having their topical creams administered safely. Cream prescription labels were not always clear, medicine administration records did not always match the creams prescribed, had not always been completed by staff and information was not available on where or how to apply creams to people. Medicine audits had been completed and included all other areas of medicine administration but had not included checking the recording and administration of topical creams. Where improvements had been identified an action plan had beencompleted, discussed with staff and better outcomes had been achieved for people. The registered manager agreed this was an area that required improvement and told us they would review the topical cream process and medicine audit tool immediately.

People and their families felt the care was safe. Staff had been trained to recognise signs of abuse and knew how to raise concerns. People were involved in decisions about their assessed risks and staff understood their role in minimising identified risk whilst respecting people’s freedoms and choices.

People were supported by enough suitably trained staff to meet their assessed needs. The registered manager told us they would source a staff dependency tool to assist in calculating staffing levels based on the changing needs of people and new admissions. Staff had been recruited safely with checks made to ensure they were suitable to work with vulnerable people. Induction and on going training provided staff with the skills to carry out their roles effectively. Staff received support through supervisions and appraisals with opportunities for professional development.

People had been 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 and their families described the staff as kind, caring, friendly and willing to help. Staff had a good knowledge of people, their interests, likes and dislikes and family and friends important to them. This was reflected in positive interactions between staff and people. People were involved in decisions about their day and felt their dignity, privacy and independence was respected. People’s individual eating and drinking needs were met and the mealtime experience was relaxed and at the persons pace.

People had their care and support needs assessed and reviewed regularly. Staff understood their role in supporting people whilst respecting the persons wishes and promoting independence. People had access to healthcare when it was needed. A range of activities was available to people including events linked with the local community.

The service was well led. Staff had a good understanding of their roles and responsibilities. Interaction between staff and the management was professional and communication effective. Feedback from people, their families and staff was had been used to review and improve outcomes for people. A complaints process was in place that people were aware of and felt if they used they would be listened to. The registered manager was pro-active and responsive to ideas and continual development of the service.

There were sufficient staff and staff received appropriate training, supervision and appraisal.

There were effective systems in place to handle complaints.

We spoke with seven people who lived at Spetisbury Manor. They said that staff looked after them well and said that they were comfortable. We spoke with the registered manager, the deputy manager and two members of staff. We also spoke with two relatives of a person living at the home.

Spetisbury Manor has recently enrolled in the 'Gold Standards Framework' an approach to promote the best care for people nearing the end of life.

People's needs were assessed and care was delivered in line with their care plan. .

The support we observed was delivered with kindness and respect. People told us that they were happy living at the home and we saw good interactions between the staff and people who live there. One person told us, ''It's very nice here, I would not want to go anywhere else".

There was an effective complaints system. People who were able to tell us, said that they were sure that their comments and complaints would be listened to and acted on effectively.