Manor Care Home - Middlewich

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider did not have consistent processes in place to assess people’s needs prior to admission. For example, we found a person living with epilepsy who lacked details in both their care plan and risk assessment to guide staff in providing appropriate support. Additionally, some records for people at risk of self-harm and with diabetes were insufficiently detailed. The registered manager took action to put these in place.

However, the provider used nationally recognised assessment tools to monitor and support people’s skin integrity and nutritional needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Some care records lacked sufficient detail to effectively guide care. For example, a care plan for a person with diet-controlled diabetes did not specify the dietary requirements needed to manage the condition. Additionally, records did not clearly document people’s involvement in their care planning. Food intake monitoring charts were often incomplete; several entries stated ‘soft’ without specifying what food had been consumed. This lack of detail hindered effective monitoring and nutritional intake for those at risk of weight loss.

Despite these gaps, the provider made appropriate referrals to dieticians to ensure individuals received specialist nutritional support. People were provided with enough food and drink and could request additional portions as needed. Staff prioritised supporting those who required assistance at mealtimes by serving their meal first. Staff reported having sufficient time to help people eat and drink and demonstrated knowledge of who was diabetic and who was on a modified diet.

The provider did not always work well across teams and services to support people.

Information and guidance received from professionals were not consistently acted upon. For example, one professional provided specific instructions regarding repositioning to support the healing of pressure sores; however, this information was not updated in the person’s care records or reflected on their repositioning charts. Staff were not consistently following instructions on the repositioning charts. This increased the risk of new pressure sores developing and delayed recovery of existing wounds.

However, other partner agencies reported active participation in multidisciplinary team meetings with the provider, describing their engagement as positive and collaborative especially around falls prevention.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

External professional confirmed they were contacted promptly when concerns arose, enabling early intervention.

The provider promoted self-management and independence. For example, one person independently managed their continence aids, while others self-propelled their wheelchairs to maintain mobility and autonomy.

Staff actively encouraged physical activity and supported people to move around the home and garden independently where safe to do so. On the day of our onsite visit, the provider hosted an annual ‘sports day’ event, promoting both physical well-being and social interaction.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

People had access to regular clinical input, including daily visits from district nurses and routine GP reviews, supporting ongoing health monitoring. However, instructions provided by healthcare professionals were not always recorded accurately or actioned in a timely manner, limiting their effectiveness. While monitoring tools were in place, these were not always completed thoroughly or lacked the necessary detail to inform care. For instance, several pressure mattress settings were incorrect, and there was no robust system to regularly check or adjust these. As a result, some people were at risk of inadequate pressure relief, potentially leading to discomfort or deterioration in pressure-related conditions.

Care records identified desired outcomes, but some lacked clear steps or measurable goals to demonstrate how those outcomes would be achieved. Although we noted examples of person-centred care that supported improved quality of life. For instance, one person who had previously remained in bed was supported with a structured plan involving gradual steps to prevent social isolation.

The provider made efforts to tailor activities to people’s interests. For example, after identifying several people enjoyed gardening, accessible planters and a wheelchair friendly greenhouse were introduced, allowing people to engage in individual activities even if they preferred not to participate in group sessions.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff consistently sought consent from people before delivering care or support, and we observed this practice in action. Staff described taking the time to ensure individuals were given the opportunity to make informed choices. They respected people’s decisions and preferences. One staff member explained, “If we ask [for consent] and they refuse, we try again later. Sometimes a different staff member may ask, and that helps.” People were not rushed or pressured into accepting support.

There were established systems in place to assess individual’s capacity to make decisions in line with the principles of the Mental Capacity Act 2005 (MCA). Where required, Deprivation of Liberty Safeguards (DoLS) were applied appropriately, involving family members and relevant professionals in best interest decisions. Staff had completed training in MCA and DoLS and were able to identify which individuals were subject to these safeguards. Where advanced decisions had been made, these were recorded and reflected the involvement of the person and, where appropriate, their relatives.