Archived: Tenchley Manor Nursing Home

At the time of our inspection there were 32 people receiving care at the home. We spoke with 12 people using the service about their experiences of living there. We also spoke with seven relatives, seven staff, the provider and the manager.

We considered all the evidence we had gathered under the outcomes we inspected. We looked at care and welfare of people, safeguarding adults, medicines management, staffing and assessing the quality of the service and records. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

The service was not safe because the arrangements for the effective management of people's medicines was not adequate and put people at risk of not receiving their medicines as prescribed. People were at risk of not receiving their medicines safely and consistently and according to their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

There were domestic and kitchen staff to support the care staff. However there were not always enough staff with the right skills to meet people's needs. This meant people were not always receiving the support they needed in a timely way.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the staff were knowledgeable about what constituted abuse.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. The manager confirmed there was no one who was subject to a DoLS authorisation at the time of the inspection.

Is the service effective?

The service was effective because risk assessments were carried out and care plans developed to show how people's assessed needs would be met. The staff were knowledgeable about the people they cared for. People received appropriate support with food and fluids to meet their nutritional needs. Equipment was in place to support people's mobility and to maintain their independence.

Is the service caring?

We saw people were supported in a caring and compassionate way. Staff and people using the service had developed good relationships and people were treated with respect. People told us they were able to exercise their choices and staff listened to them. People were complimentary about the care and support they received. Comments included 'staff are very nice' and 'the staff do their best'.

Is the service responsive?

The service was mainly responsive because people told us they felt they were able to raise any concerns with the provider and would be listened to. We saw people were supported to access external healthcare facilities as needed. People told us the staff 'make sure a doctor is called out' if they needed one. However, the care plans did not always reflect changes in people's needs and how these would be met. Where risks had been identified, action plans were not robust and reviews of care plans were not undertaken to ensure they were always reflective of people's current needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care plans.

Is the service well-led?

There were no systems in place to regularly assess and monitor the quality of service provided. This meant the provider was not able to demonstrate effectively how shortfalls would be identified so action could be taken. There was no robust quality improvement system to evidence how improvements would be embedded in practice. The records of care were not accurate and some records were not available when we requested to see them.

The registered manager had left the service a short time prior to our inspection. The provider had recruited a manager who confirmed they were in the process of applying to register with the Commission.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing the quality of the service provision and monitoring the outcomes for people and records' management.

There was a complaints process in place to support people to raise their concerns and this information was available to people.

During our visit we spoke with nine people who lived at the home. The vast majority told us that they were happy living there and that staff were supportive. One said, 'The staff are friendly and helpful'. Another told us, 'All the nurses are really nice people'. People told us that they particularly enjoyed the gardens and that there was, 'Plenty going on'.

We spoke with four relatives. They were positive about the home and the care provided. One told us, 'We looked at various homes and felt that none of them came up to this standard'. Another said, 'I think the care here is excellent'.

We spoke with four members of staff and the manager. Staff told us that it was a good place to work. One said, 'As an employee I can't fault it. If it was a bad environment, I couldn't work here'. Another told us, 'Everyone works together to give good care, we have good communication between staff'.

We found that there were some concerns over call bells not working reliably and with staff response times. We saw that this had been identified by the home and that in most cases people were satisfied. During our visit we saw that staff were available and that they provided support to people in a caring and professional manner.