We carried out an unannounced comprehensive inspection on 30 October 2017 and 01 November 2017.The Manor Nursing and Residential Home is a care home with nursing. It also specialises in end of life care. The service is registered to provide accommodation for nursing and personal care for up to 22 older people. On the days of our inspection there were 19 people living at the care home.
There was 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 lived in a service with exceptional leadership. The providers caring values were embedded into the culture and staff practice. People, relatives, external professionals and staff spoke positively about the management of the service. The registered manager had a committed and passionate attitude about the service, the staff, but most of all the people. Staff spoke of their love for the people they cared for, and their passion for working at the service.
People were treated with kindness and endearing compassion by staff who truly respected and valued them. Staff offered exceptional and distinctive care and support to people. People’s emotional needs and support were compassionately recognised. Staff displayed the upmost empathic and compassionate behaviour. People were supported and given time to express their views so that those caring for them fully understood their wishes and preferences.
People lived in a service which was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.
The provider and registered manager were open, transparent and admitted when things had gone wrong. This demonstrated their understanding and recognition of the Duty of Candour. The Duty of Candour means that a service must act in an open and transparent way in relation to care and treatment provided when things go wrong. The provider notified the Commission of significant events which had occurred in line with their legal obligations. For example, regarding safeguarding concerns, deaths and serious injuries.
People’s family and friends were warmly welcomed. When people did not have a family, or anyone to act on their behalf, advocacy services were appointed. People’s comments and complaints were viewed positively and used to help improve the quality of the service.
People received personalised care. People’s individual equality and diversity was respected, enabling people to be supported in the way they wanted to be. People’s care plans were person-centred. They detailed how they wanted their needs to be met in line with their wishes and preferences, taking account of their social and medical history, as well as their cultural, religious and spiritual needs. People’s communication needs were effectively assessed and met and staff told us how they adapted their approach to help ensure people received individualised support.
People received an organised and co-ordinated approach to their health and social care needs. People had access to external healthcare professionals to ensure their ongoing health and wellbeing. People’s care records detailed a variety of professionals were involved in their care and people were actively involved in monitoring their own healthcare.
People were supported at the end of their life to have a comfortable, pain free and dignified death by staff who were loving, and had received accredited palliative care training. The service was accredited with the local hospice. The staff worked collaboratively with external professionals, ensuring people received and individualised palliative care and pain relief promptly.
People were protected from abuse and avoidable harm. Staff knew what action to take, if they suspected someone was being abused, mistreated or neglected. Staff, were recruited safely to ensure they were suitable to work with vulnerable people.
People were cared for by suitable numbers of staff, who supported them and met their needs. The provider made sure there were enough staff by talking and obtaining feedback from people and the staff team.
People, who had risks associated with their care, had them assessed, monitored and managed by staff to ensure their safety. People’s safety was paramount. When things went wrong, the provider learnt from mistakes and took action to make improvements. People received their medicines safely and were given them, in a caring and compassionate manner.
People lived in a service which had been designed and adapted to meet their needs. The provider had taken into consideration people’s diverse care and support needs when making changes to the environment, and listened to what people needed.
People lived in an environment which the provider had assessed to ensure it was safe. People were protected by the provider’s infection control procedures, which helped to maintain a clean and hygienic service.
Overall, people were cared for by staff who had received training to meet their individual needs. However, not everyone had completed the providers ‘mandatory training’ courses, but action was being taken to rectify this.
Overall, people and their families told us they liked the meals. People were supported to eat a nutritious diet and were encouraged to drink enough. Staff knew what people’s nutritional needs were so they could be supported correctly. People, who required assistance, were supported in a respectful and dignified manner.
People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought.
Overall people and their families told us there were opportunities for social engagement. However, some people expressed they would like more to do, and to go out more. The registered manager had already been made aware of people’s views, and had started to take action.
People were encouraged to be involved in the development of their service. People lived in a service which was continuously and positively adapting to changes in practice and legislation.
People benefited from a registered manager who worked with external agencies in an open and transparent way and there were positive relationships fostered. The registered manager kept their ongoing practice and learning up to date to help develop the team and drive improvement.