The Manor

The Manor provides nursing care and accommodation for up to 86 people. It is arranged over two floors and divided into three units. Hestercombe on the ground floor provides care to older people and the two units on the first floor, Victoria and Vivary provide care and to older people and working age people who have nursing care needs.

At the time of the inspection there were 49 people living at the service; this included six people who were staying for short term respite stays.

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

People were mostly positive about the care and support they received, however, we received mixed feedback about staffing levels, especially from people living on the Hestercombe unit. The registered manager accepted the feedback and staffing was increased by one member of care staff on Hestercombe by the second day of the inspection. We have recommended the provider continues to monitor the deployment of staff across the service to ensure people received safe, effective and prompt care.

People told us they felt safe. Comments included, “I feel safe most of the time. They have got some excellent carers” and “I wouldn’t change it for anything. The staff are excellent” Risks to people had been assessed and mitigated to help keep people safe. People received their medicines safely. Infection control processes protected people from the risk of infection.

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 staff who were suitably trained and had their competencies assessed. People were supported in a respectful and dignified way and their privacy was respected, and their independence was promoted. The service employed a physiotherapist assistant. Several people spoke highly of the physiotherapist assistant’s help and support.

People's care plans were individualised and reflected their needs and personal preferences. The service worked together with healthcare professionals to ensure people's health, care and wellbeing needs were met.

People were supported and encouraged to pursue activities and interests. An activities programmes was in place and people said they enjoyed a range of activities. The building design met people's needs and the building was fully accessible. The premises were bright and spacious with wide corridors and opportunities to connect with the outdoors.

Quality assurance processes were in place to monitor and improve the quality and safety of the care provided. The provider sought feedback to help drive service improvement. We received positive feedback about the registered manager and how the service was managed since their appointment. Comments included, “The manager will listen” and “You can talk to (the registered manager). I find her very nice”. Professionals told us, “Until (the registered manager’s) appointment the ship was somewhat rudderless… With the registered manager’s appointment, we have found a responsive and effective manager who is clearly getting to grips with any issues and concerns and we have already made great progress”.

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 January 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.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed to 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 The 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.

The Manor Nursing Home providing personal and nursing care for up to 86 people. At the time of the inspection 40 people were living at the home.

The home is laid out over two floors and offers nursing and residential care. The home also provides a respite service.

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

Systems in place to communicate with people and relatives were not always effective. The registered manager was addressing some routines within the service, which had restricted some people’s freedom of movement and choice due to the pandemic.

Staff commented positively about the leadership and management of the home. Staff told us they had concerns in regard to the planned changes to the management of the service.

People and their relatives told us they felt safe at The Manor. Safeguarding incidents were reported to the appropriate agencies. Staff felt confident to raise safeguarding concerns with the registered manager and were aware of external agencies where they could report concerns.

Risks to people were identified and guidance was in place for staff to reduce the level of risk to people. Checks were in place to ensure the environment and equipment was safe.

The service had ongoing monitoring arrangements to ensure all aspects of infection control followed best practice guidance. The provider ensured people were aware of social distancing rules in regards the pandemic. Visitors were able to see their loved one from specially adapted visitor suites.

Medicines were managed safely, and people received their medicines as prescribed from staff who had received training and had their competency assessed.

Some people at the service were living with an acquired brain injury. They had access to the in-house physiotherapist, but they did not have detailed plans to ensure each person reached their full potential.

Governance systems were in place to monitor the quality of service and the health, safety and welfare of people. There were enough staff available to support people safely and meet their needs. Staff were recruited safely.

We found improvements had been made at this inspection. The provider had addressed issues raised at the last inspection in their action plan.

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

Rating at last inspection

The last rating for this service was requires improvement (published 09 October 2019). Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when. At this inspection we found improvements had been made and the provider was no longer in breach of Regulations 12 (Safe care and treatment), Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

The inspection was prompted in part due to concerns received about risk to people’s safe care and treatment at the service. A decision was made for us to inspect and examine those risks. The provider has taken action to mitigate the risks and these had been effective. We found no evidence during this inspection that people were at risk of harm from this concern.

At this inspection we only reviewed the safe and well led key questions. This is because of our current methodology and risks related to COVID-19 meant we were not reviewing the key questions in effective, caring and responsive. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 is a Nursing Home which was providing personal and nursing care to 69 younger adults and people aged 65 and over at the time of the inspection. The service can support up to 86 people.

The service was registered to provide the regulated activity Diagnostic and screening procedures which they were not providing, and we asked the provider to assess whether this was still required.

Care Homes

The Manor operates in a building that is designed to deliver care over two floors in three units.

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

People told us they were not happy with aspects of the service. In particular, staffing, being listened to and the quality of the food. They told us the care was delivered by staff who were caring, but the high use of agency staff and changes in management had not ensured they felt the service was as good as it could be. Staff and families shared similar concerns.

We found the service not meeting the standards to be safe, effective, caring, responsive and well-led. People’s records did not meet requirements of the legislation and people were at higher risk of unsafe, inappropriate and inconsistent care and of not having their preferences and needs met.

People had not been fully protected from the risk of abuse as some important information had not been shared with the local authority and CQC as required. This meant the safeguarding authority had not had the opportunity to review and oversee concerns as they arose.

People were not always protected from the risk of falling, skin damage, cross infection and, ensuring medicines practice was now always safe. The service was not always evidencing how essential equipment needed to support people in an emergency was kept ready for use. The clinical governance and records needed to improve to aid communication amongst staff and people were not fully involved in assessing and reviewing their care. This would have the additional benefit of the records and people’s care being more personalised.

People were not supported to have maximum choice and control of their lives. Staff spoke of trying to support people in the least restrictive way possible and in their best interests; however, the systems in the service did not support this practice. Staffing numbers were not always at the assessed level. This left staff short and put pressure on delivering tasks rather than ensuring all care was personalised.

We have made a recommendation in respect of the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand.

The provider had recognised there were issues at the service through their quality assurance systems however, there had been multiple managers leading to inconsistency and people continued to be impacted.

A new management team had started in the last six weeks, and people, family and staff were optimistic for the future of the service. One staff member has said, “I feel changes are being made for the best on a daily basis.”

On the first day of the inspection, the manager showed us an action plan they had developed the day before which demonstrated many, but not all, of the areas we found on inspection had been identified. As areas were identified during the inspection, these were added to the action plan. For example, ensuring people had their chosen gender of carer and issues with food quality and timing of meals.

The regional director explained how the provider had placed two operation managers at the service and other senior staff in support roles to manage the service while the appropriate new manager was recruited.

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 11 April 2017).

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

Why we inspected

This was a responsive, comprehensive inspection and was completed due to a range of concerns received. A decision was made for us to inspect and examine those risks alongside the full range of topics covered on all comprehensive inspections.

The concerns included:

•People requiring percutaneous endoscopic gastrostomy (PEG) feeding (feeding through the stomach wall) were not being supported safely;

•People with a tracheotomy in place were not being cared for safely;

•Where people required suctioning this was not being carried out safely or hygienically. Also, the service was not ensuring the suction machines, and any other lifesaving equipment, were kept ready for use;

•The service was not ensuring good skin care;

•Medicines errors had occurred, and reports suggested peoples ‘as required’ (PRN) pain relief medicines were not being made available outside of the usual medication administration rounds;

•Reports staff were not ensuring people’s GPs and/or other medical support was available when needed;

•Reports people were being injured during personal care;

•Reports a person had been scalded when given a hot drink without a lid on as per their care plan;

•Reports of people experiencing a high rate of falls;

•Reports people were not receiving good continence care;

•Reports of poor mouth care;

•Reports of records kept of people’s care were not accurate or complete. For example, when people needed to be supported to move to prevent their skin breaking down;

•Poor staff and provider interactions with people and their family members;

•Reports of good levels of staffing not being maintained, with additional concerns about the number of nurses on duty at any one time;

•The appropriate and safe use of bed side rails;

•People who smoked were not being assessed and supported to do this safely;

•People’s right to consent was not being ensured to be in line with the Mental Capacity Act 2005 (MCA) and there was low recording of Deprivation of Liberty (DoLS)

•Activities were not available for all to participate in. Reports said meaningful occupation/support to be active in mind and body were not available for people living with dementia and other cognitive and physical limiting conditions.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report. The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to safe care, safeguarding people and staffing at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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 the time of the inspection there were 52 people living at the home.

At the last comprehensive inspection in February 2015 the service was rated good. Following concerns a focussed inspection was carried out in May 2015 and two requirement notices were issued. At the inspection in May 2015 we found that people were not always treated with respect and dignity because language used by staff was not always appropriate. We also found that no care plan was in place for a person with specific needs around their swearing. At this inspection we found these issues had been addressed. All staff interactions we heard on the day of inspection were polite and respectful. We also found that specific care plans were in place to meet people’s individual needs.

At this inspection we found the service remained Good.

Why the service is rated Good

People were safe at the home because there were adequate numbers of suitable staff to support them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely.

Staff had the skills and knowledge required to effectively meet people’s needs. People’s health was monitored by the staff and people had access to healthcare professionals according to their individual needs. 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.

Improvements had been made to ensure people were always treated with respect and dignity. People told us staff were always kind and polite. People or their representatives were involved in decisions about their care and support.

The service was responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to.

People benefitted from a service which was well led. The provider had systems in place which sought people’s views and continually audited practice. Staff felt well supported by the management team which helped to create a relaxed and happy atmosphere for people to live in.

We observed staff spoke with people in a kind and respectful manner. One person said 'The staff are all very friendly, they talk to you like an equal'. People received personal care in the privacy of their own room which promoted their dignity. One person said 'The staff are always gentle and respectful when they help you'.

People were happy with the care they received. Comments included; 'I feel well cared for' and 'We are all really well looked after'. A visiting relative of a person with complex care needs said 'X seems very happy and contented'.

All areas of the home we visited were clean and fresh. One person said 'The cleaning staff are excellent'. We found effective systems were in place to reduce the risk and spread of infection.

People's medicines were administered by qualified nurses. Records had a photograph of the individual and information about the assistance they required to take their medicines. This minimised the risks of medication being given to the wrong person and ensured people received adequate support.

Staff had the skills and qualifications to meet people's needs. Care staff said they were well supported by the manager, nurses, senior care staff and other colleagues.

People told us that they were asked for their consent and the provider acted in accordance with their wishes. People said, “Staff always ask me what I want to do and respect my decisions” and “Staff always talk to me about my care, I feel very involved”. Regular meetings were held with people and their families and best interest decisions were made on behalf of people who lacked the ability to understand their care or treatment.

The majority of people were happy with the care provided. People said, “I love living here, I love the mixture of people”, “I’m taken care of so excellently” and ”Staff are kind and caring they treat me so well”.

There was a programme of group and individual activities for people to participate in. People told us, “I love the activities and can choose to join in or not” and “I enjoy the range of activities”.

We found appropriate arrangements were in place in relation to obtaining, recording and disposal of people’s medicines.

People told us, “There are usually enough staff. If I ring my buzzer they come within a few minutes” and “Staff are very good and generally they come quickly”.

We found complaints were fully investigated and resolved where possible to people’s satisfaction.